Background. It is postulated that individuals who score high on neuroticism would ruminate when faced with stress. A ruminative response style to depression is associated with faulty attribution and higher dysfunctional beliefs, which in turn is associated with a higher level of depression and hopelessness. Distraction is associated with less severe depression. Evidence supporting these hypotheses mainly comes from a non-clinical population. Hence it is not clear if these theories apply to clinical depression.

Method. One hundred and nine out-patients suffering from unipolar major depressive disorder were recruited to test these theories, using model-fitting analysis technique.

Results. Certain rumination responses to depression were associated with higher levels of depression and hopelessness, faulty attribution and dysfunctional attitudes when gender and the level of depression were controlled. Principal component analysis of the Rumination Scale yielded four factors: ‘symptom-based rumination’, ‘isolation/introspection’, ‘self-blame’ and ‘analyse to understand’. Unlike the other factors, ‘analyse to understand’ did not correlate with the level of depression. Model fitting analysis, though not reflecting entirely the true model, captures most of the hypothesized relationships between important variables. Neuroticism was associated with stress. Rumination was associated with an increased level of dysfunctional beliefs and faulty attribution, which in turn was associated with increased severity of depression. Distraction, in contrast, was associated with lower levels of negative mood.

Conclusion. The results of our study support the importance of teaching depressed patients to manage their depressive symptoms by avoiding rumination about their symptoms and engaging in distracting and pleasurable activities.