The association among neuropsychological functioning, response styles, cognitive content, and the severity of depression in people diagnosed with end -stage liver disease evaluated for a liver transplant: A structural equation model

Significance. The presence of a clinically significant depressed mood in people diagnosed with end-stage liver disease (ESLD) is a factor contributing to premature mortality. To date, investigations concerning potent and modifiable predictors of depression among people diagnosed with ESLD awaiting a liver transplant are scant. Investigations in non-medically ill people suggest that ruminative and problem-solving coping styles predict the onset and maintenance of depression over time (Response Styles Theory; Nolen-Hoeksema, 1991). In light of these findings, the current study evaluates the fit of a structural equation model (SEM) that incorporates neuropsychological functioning, response styles, and dysfunctional attitudes as correlates of the severity of depression. Method. Two independent samples comprised of 119 people diagnosed with ESLD evaluated for a liver transplant and 45 people diagnosed with Multiple Sclerosis (MS) were drawn from the University of Nebraska Medical Center. Results. Fit indices for the ESLD and MS samples suggest that the overall fit of the models were good. Conclusions. Results from the SEM suggest that decrements in neuropsychological functioning are associated with higher levels of ruminative coping and lower levels of problem-solving coping. In turn, higher levels of ruminative coping are associated with higher endorsement of dysfunctional attitudes and increased severity of depression, while lower levels of problem-solving coping are associated with increased severity of depression. These findings shed light on neuropsychological impairments that restrict a person's ability to engage in adaptive coping and disengage from adaptive coping, and provide a theoretical framework to understand the role of neuropsychological functioning in mood disturbance among people diagnosed with serious medical illnesses who are susceptible to neuropsychological compromise. This research goes beyond theoretical implications and into the applied realm of neuropsychological remediation and psychotherapy geared toward increasing neuropsychological functioning, and modifying cognitive content and coping styles respectively.