According to the helplessness model of depression,(89) vulnerability to depression derives from a habitual style of explaining the causes of life events, known as attributional style. A large body of research found that individuals suffering from depression think more negatively than healthy individuals. Specifically, depressed patients have a tendency to make internal, stable, and global causal attributions for negative events, and to a lesser extent, the attribution of positive outcomes to external, specific, and unstable causes. In other words, depressed patients have a low self-esteem.(9 Thus, when thinking about the self, past, current, and future circumstances, depressed patients emphasize the negative, and this process is likely to contribute to the perpetuation of their depressed mood. However, the role of self-esteem in depression has not yet been well established. A controversy persists as to whether low self-esteem is a consequence of depression or a vulnerability factor of the disease. Lewinsohn et al.'(92) assume that low self-esteem neither precedes nor follows depressive episode. Several studies have yielded no evidence of risk of depression associated with pre-depressive cognitions. (9,,94) To the contrary, Beck(74) has emphasized the aetiological significance of low self-esteem in depression. According to Beck, the low self-esteem should increase vulnerability to depression by existing in a latent state, to be activated by relatively minor experiences of deprivation or rejection. Brown and collaborators(9 96 and 97) have developed a psychosocial model of depression, similar to the Beck's model, in which the importance of the occurrence of both a negative life events and low self-esteem is highlighted. A number of prospective studies using college student samples support the predictive effect of negative attributions on the later development of depression following negative life events. (98) However, Haaga et al.(99) has reviewed five studies, and none of them indicate that negative cognitions added significantly to the prediction of later symptoms. More recently, Staner et al/1.00 failed to support the predictive effects of self-esteem on later recurrence of depression in bipolar and unipolar patients. In summary, evidence supports the notion that depressed individuals have lower self-esteem, but less evidence is in favour of a causal role of negative thinking in the development of the disease.
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