Do depressive symptoms differ between medically ill and non-medically ill patients referred for psychological therapy? Comparing negative thoughts about the self in cancer and non-cancer patients

Negative thoughts about the self are a core component of Beck's cognitive triad of depression, and are seen by some as the central cognitive symptom of the disorder. The role of negative thoughts about the self in secondary depression associated with medical illness is less clear: thoughts relating to hopelessness and helplessness rather than guilt, self blame and failure may be more prominent. This study tested the hypothesis that the cognitive symptoms of depression in cancer patients would be less negatively self-referent than a psychiatric control group. Forty patients with cancer referred to a psychological medicine department were matched for age, sex and BDI score with 40 patients referred to a psychological therapies department for CBT. The cognitive-affective section of the BDI (items 1-14) was divided into a negative self-referent cognitions subscale (items 3, 5, 7, 8) and a mood-motivation subscale. These two subscales were then compared with the somatic-performance subscale (items 15-21). As a percentage of the total matched BDI score, the cancer patients had more somatic symptoms (42.7 v 34.8%), equivalent mood/motivation symptoms (44.5 v 45.6%) and less negative self-referent symptoms (12.8 v 19.5%). This difference may apply more to mild symptoms than moderate-severe symptoms. Some preliminary support for the hypothesis is therefore available.