Rumination as a Mediator of Depression Prevention Effects among College Students

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Depression is a common mental health concern facing students across American colleges and universities (Roberts, Glod, Kim, & Hounchell, 2010). Students with depression symptoms are more likely to struggle with academics (Hysenbegasi, Hass, & Rowland, 2005), partake in unsafe drug and alcohol use (Dennhardt & Murphy, 2011), and complete suicide (Suicide Prevention Resource Center, 2004). While treatment for depression is typically available through college counseling centers, most students with depression do not receive services (Eisenberg & Chung, 2012). This indicates a need for alternative approaches to mental healthcare in this population.

Prevention is one such alternative that seeks to remediate problems leading to depression before a clinical diagnosis is reached. One such precursor for depression is rumination. Rumination is a negative, recyclic pattern of thinking in response to low mood (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Research shows that individuals who tend to ruminate are more likely to develop depression (Aldao, Nolen-Hoeksema, & Schweizer, 2010). Rumination also serves as a more proximal risk mechanism for depression through which other frequently noted risk factors exert their effects (Spasojevic & Alloy, 2001). Therefore, reducing or preventing rumination may be a highly effective means for preventing depression.

The current study examines data from a pilot prevention intervention conducted with undergraduate students at two U.S. universities. In order to obtain a sample of mentally healthy college students who had not yet experienced depression, participants reporting high levels of depression symptoms at baseline were excluded from the sample. Participants (N = 70) were assigned to either a coping skills group, a cognitive training condition, a combined condition, or a control group. The coping skills group consisted of six 1.5-hour weekly sessions where participants learned strategies for coping with stress. Participants in the cognitive training condition completed online “brain training” using Lumosity. Participants in the combined condition received both interventions and those in the control group received readings on stress management. Depression symptoms and rumination were assessed across three time points: pre-intervention, post-intervention, and 6-week follow up.

There is evidence to suggest that the skills targeted by the coping skills group will result in reductions in rumination, although they do not directly target rumination (for review see Topper, Emmelkamp, & Ehring, 2010). Likewise, there is evidence suggesting that brain training programs such as Lumosity may help to bolster executive functioning deficits thought to underlie rumination (e.g., Åkerlund, Esbjörnsson, Sunnerhagen, & Björkdahl, 2013). Thus these interventions may prevent increases in depression symptoms by preventing increases in rumination.

Planned analyses will examine the direct effects of the intervention on depression symptoms and rumination. Additionally, rumination will be examined as a mediator of intervention effects on depression, in order to further understand its role as a risk factor and prevention target. The successful prevention of depression by way of rumination would encourage the consolidation of prevention efforts that target other, less proximal risk factors.