The association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions: a systematic review
Open accessAbstract
Objective Depression is common in people with long term conditions, and is associated with worse medical outcomes. Previous research shows perseverative negative thinking (e.g. worry, rumination) predicts subsequent depression and worse medical outcomes, suggesting interventions targeting perseverative negative thinking could improve depression and medical outcomes. Previous studies recruited healthy individuals, however. This review aimed to determine the temporal relationship and strength of prospective association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions.Method Four electronic databases were searched for studies including standardised measures of perseverative negative thinking and depression, anxiety or emotional distress, and which presented prospective associations. Findings were narratively synthesized.Results Thirty studies were identified in a range of long term conditions. Perseverative negative thinking and subsequent depression, anxiety or emotional distress were significantly correlated in the majority of studies (bivariate r=0.23 to r=0.73). 25 studies controlled for confounders, and in 15 perseverative negative thinking predicted subsequent depression, anxiety or emotional distress. Results varied according to condition and study quality. Six of 7 studies found bivariate associations between depression, anxiety or emotional distress and subsequent perseverative negative thinking, though 2 studies controlling for key covariates found no association. Few studies assessed the impact of perseverative negative thinking on medical outcomes.Conclusion Strongest evidence supported perseverative negative thinking predicting subsequent depression, anxiety and emotional distress in people with long term conditions. Further prospective research is warranted to clarify the association of perseverative negative thinking with subsequent poor medical outcomes.
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Brooding rumination predicts subsequent depression in people with recent ACS.
“Consistent with previous studies (e.g.Denton, Rieckmann, Davidson & Chaplin, 2012), our findings indicate that brooding rumination (the tendency for individuals to passively and abstractly make negative comparisons when feeling sad or down) predicts subsequent depression in people with recent ACS (Trick et al., 2016).”
From Perseverative negative thinking predicts depression in people with acute coronary syndrome (2019) · cites this paper as Trick et al., 2016
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“48 – 51 Although feelings of distress tend to correlate with and reinforce unhelpful thoughts regarding symptoms, 48,52 there might be a bene fi t to addressing them separately in the care of individual patients.”
Tommel, J., Evers, A. W. M., van Hamersvelt, H. W., Jordens, R., van Dijk, S., Hilbrands, L. B., & van Middendorp, H. (2020) · Patient Education and Counseling · doi:10.1016/j.pec.2020.11.019 · Cited by 21 · see citing works
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Félix Cova, S., García, F. E., Oyanadel, C., Villagrán, L., Páez, D., & Inostroza, C. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01943 · Cited by 20 · see citing works
Surgery-Related Coping in Surgery Patients with Intracranial Tumors
Goebel, S., Mederer, D., & Mehdorn, H. M. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.05.091 · Cited by 18 · see citing works
Temple, J., Fisher, P., Davies, C., Millar, C., & Cherry, M. G. (2023) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2023.109522 · Cited by 17 · see citing works
“Exploring psychological factors which have been shown to predict both anxiety and depression in other physical health populations, such as worry and rumination, seems most appropriate [120 – 122].”
BackgroundBirk, J. L., Cornelius, T., Edmondson, D., & Schwartz, J. (2019) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000727 · Cited by 15 · see citing works
“It has been suggested that rumination may serve as a maladaptive pattern that contributes to the continuation of chronic illnesses (31,32).”
BackgroundWorking U.S. Adults without Paid Sick Leave Report more Worries about Finances
DeRigne, L., Stoddard-Dare, P. A., Collins, C. C., Quinn, L., & Fuller, K. A. (2018) · Journal of Social Service Research · doi:10.1080/01488376.2018.1481176 · Cited by 15 · see citing works
“This is troubling considering the known relationship between worry and health, mental health, and employee productivity (Kim & Garman, 2003; Trick et al., 2016; Tully, Cosh, & Baune, 2013).”
BackgroundKarnick, A. T., Fergerson, A. K., Caulfield, N. M., Buerke, M. L., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.07.050 · Cited by 14 · see citing works
Brinkman, N., Rajagopalan, D., Ring, D., Vagner, G. A., Reichel, L. M., Crijns, T. J., & Groupa, T. S. O. V. (2022) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000002496 · Cited by 12 · see citing works
“On the other hand, unhelpful thinking and feelings of distress tend to correlate with each other [1, 33].”
BackgroundPerseverative negative thinking predicts depression in people with acute coronary syndrome
Trick, L., Watkins, E. R., Henley, W., Gandhi, M. M., & Dickens, C. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.06.012 · Cited by 11 · see citing works
Mediating effects of depression on anxiety and leisure constraints in patients with breast cancer
Huang, H.-M., Lai, J.-H., & Huang, T.-W. (2019) · BMC Women's Health · doi:10.1186/s12905-019-0838-7 · Cited by 11 · see citing works
“The illness might have bright down their spirit to interpret self and the world in a negative way which is common across populations [38].”
BackgroundThe impact of rumination on fibromyalgia pain after physical activity: an experimental study
das Neves, J. F., Kornacka, M., Serra, E., Rollin, N., Kosinski, T., Maréchal, V., Jehel, L., & Rusinek, S. (2023) · Scientific Reports · doi:10.1038/s41598-023-47414-z · Cited by 11 · see citing works
“Although the link between pain and rumination was already shown in several qualitative (e.g., 19 ), correlational (for a review see: 20 ) or experimental (e.g., 21 ) studies, the impact of rumination on pain was not experimentally tested in the context of physical activity.”
BackgroundNeural representations of aversive value encoding in pain catastrophizers
Brown, C. A., Almarzouki, A. F., Brown, R. J., & Jones, A. K. P. (2018) · NeuroImage · doi:10.1016/j.neuroimage.2018.09.052 · Cited by 9 · see citing works
Li, J., Fong, D., Lok, K. Y. W., Wong, J. Y. H., Ho, M. M., Choi, E. P. H., Pandian, V., Davidson, P. M., Duan, W., Tarrant, M., et al. (2023) · Journal of Global Health · doi:10.7189/jogh.13.04125 · Cited by 8 · see citing works
Gaston, E., Ullén, F., Wesseldijk, L. W., & Mosing, M. A. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02855-6 · Cited by 10 · see citing works
“Indeed, feeling accomplished and masterful (as autotelic individuals often do; [75]) might create a generalized optimism that prevents depressive states [76, 77].”
BackgroundNeshat, Z., Bijari, A. F., & Dehshiri, G. (2023) · Cognitive Processing · doi:10.1007/s10339-023-01163-z · Cited by 8 · see citing works
“Characteristics of repetitive negative thinking are related to emotional distress (Trick et al. 2016).”
Butler, P., Nguyen, T. L., Giummarra, M. J., O’Leary, S. P., & Sterling, M. M. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1988732 · Cited by 8 · see citing works
Beblo, T., Haehnel, K., Michalak, J., Iffland, B., & Drießen, M. (2024) · Nordic Psychology · doi:10.1080/19012276.2024.2303432 · Cited by 7 · see citing works
“It is generally known that rumination is related to an increase of psychopathological symptoms (e.g. depression, anxiety, and stress) (Nolen-Hoeksema et al., 2008; Trick et al., 2016) and a decrease of health and well-being (McCarrick et al., 2021).”
Luisetto, M., Mashori, G. R., Nili-Ahmadabadi, B., Khan, F. A., & Khan, K. R. (2018) · Insights on the Depression and Anxiety · doi:10.29328/journal.ida.1001008 · Cited by 6 · see citing works
“Further prospective research is warranted to clarify the association of perseverative negative thinking with subsequent poor medical outcomes” [12].”
BackgroundBallesio, A., Cerolini, S., Vacca, M., Lucidi, F., & Lombardo, C. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01837 · Cited by 6 · see citing works
Yang, M., Meng, Z., Qi, H., Duan, X., & Zhang, L. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.857878 · Cited by 6 · see citing works
“Numerous interventions and treatments that target negative perceptions have been found to be effective in alleviating emotional and behavioral problems in children and adolescents (Trick et al., 2016).”
BackgroundMahgoub, Y. O., Pathare, A., Hamlin, D., Gomaa, H., Nutting, S., Mormando, C. B., & Francis, A. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1372136 · Cited by 6 · see citing works
Neurophysiology of stress: From historical to modern approach
Stanojlović, O. P., Šutulović, N., Mladenović, D. R., Zubelić, A., Hrnčić, D., Rašić-Marković, A., & Vesković, M. N. (2022) · Medicinska istrazivanja · doi:10.5937/medi55-37829 · Cited by 5 · see citing works
“Negative stress causes anxiety or withdrawal (depression and anxiety), and is accompanied by unpleasant feelings, reduced work ability leading to mental and physical illnesses (32).”
BackgroundNeppl, T. K., Diggs, O. N., Neppl, A. K., & Denburg, N. L. (2023) · Development and Psychopathology · doi:10.1017/s0954579423000081 · Cited by 5 · see citing works
Miethe, S., Muehlhan, M., & Trautmann, S. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114478 · Cited by 4 · see citing works
Cui, Y., Guo, Z., Yang, T., Liu, Q., Liu, N., Yang, H., Zhang, L., Mu, H., Zhang, L., & Zhang, Y. (2023) · Current Psychology · doi:10.1007/s12144-023-05111-0 · Cited by 4 · see citing works
“When the negative emotion of irritation accumulates to a certain extent, patients are prone to feel powerless and indulge themselves, exhibiting poor self-management behavior (Trick et al., 2016).”
Beiranvand, M., Moghadam, M. K., Sabounchi, R., Asadpour, G., Jahani, N., & Ghafuori, A. (2019) · Journal of Sports Science · doi:10.17265/2332-7839/2019.03.003 · Cited by 3 · see citing works
“) are conditions that cannot be cured at the moment, but can be managed with a proper treatment [5].”
BackgroundExploration of coping styles in male patients with head and neck cancer: a prospective cohort study.
Sato, N., Kimura, H., Adachi, Y., Nishio, N., Ando, M., Tokura, T., Nagashima, W., Kishi, S., Yamauchi, A., Yoshida, K., et al. (2019) · Europe PMC (PubMed Central) · doi:10.18999/nagjms.81.2.249 · Cited by 3 · see citing works
“In a recent systematic review, psychological distress has great effect on depression and anxiety.(16) The prevalence of depression is estimated to be 46% in HNC patients,(17) and the suicide rate is higher than that in patients with other types of cancer.”
BackgroundTesting the cognitive catalyst model of rumination with explicit and implicit cognitive content
Sova, C. C., & Roberts, J. E. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.01.002 · Cited by 3 · see citing works
Adrian Wells, A. (2018) · Journal of Cardiology and Cardiovascular Sciences · doi:10.29245/2578-3025/2018/3.1131 · Cited by 3 · see citing works
Vincenzo, F. D., Bernini, D., Contardi, A., Bungaro, N., Currado, D., Navarini, L., Marino, A., Alessio, C., & Iani, L. (2025) · Journal of Health Psychology · doi:10.1177/13591053251400827 · Cited by 2 · see citing works
“…relevant considering that rumination, pain, and BMI are well-documented predictors of anxiety and depression (Fonseca-Rodrigues et al., 2022; Malmir et al., 2019; Trick et al., 2016), and it is consistent with the potential protective role of compassion from others against psychological distress.”
White Noise—Is Anxiety in Late-Life Associated With White Matter Hyperintensity Burden?
Gerlach, A., Karim, H. T., Lee, S., Kolobaric, A., Tudorascu, D., Butters, M. A., & Andreescu, C. (2023) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2023.08.014 · Cited by 2 · see citing works
Resource-rational psychopathology.
Bari, B. A., & Gershman, S. J. (2024) · Behavioral Neuroscience · doi:10.1037/bne0000600 · Cited by 2 · see citing works
Sex differences in the association between repetitive negative thinking and neurofilament light
Lau, Y., Bansal, A., Palix, C., Demnitz‐King, H., Wirth, M., Klimecki, O., Chételat, G., Poisnel, G., Marchant, N. L., Chocat, A., et al. (2024) · npj Mental Health Research · doi:10.1038/s44184-024-00093-8 · Cited by 2 · see citing works
“Although RNT levels are elevated in clinical populations (e.g., depression and anxiety 5 ), non-clinical populations also engage in RNT, albeit to a lesser degree 6 .”
Borgmann, S., Chernyak, N., Haastert, B., Linnenkamp, U., Andrich, S., Schlenker, R., Razum, O., & Icks, A. (2021) · BMC Public Health · doi:10.1186/s12889-021-10231-y · Cited by 3 · see citing works
Apostol, M.-A., Trifu, S. C., Zanfir, A.-G., & Trifu, A.-D. (2026) · Diseases · doi:10.3390/diseases14050171 · Cited by 1 · see citing works
“A meta‑analysis of 30 prospective stud‑ ies confirmed strong associations between rumination and emotional distress across di‑ verse chronic conditions, and baseline rumination predicted later worsening of affective https://doi.org/10.3390/diseases14050171 symptoms [32].”
InfluentialLuisetto, M. (2018) · Journal of pharmacology & clinical research · doi:10.19080/jpcr.2018.05.555680 · Cited by 1 · see citing works
Couple‐Based Interventions for the Treatment of Depressive and Anxiety Disorders
Wittenborn, A. K., Baucom, B., Leifker, F. R., & Lachmar, E. M. (2020) · The Handbook of Systemic Family Therapy · doi:10.1002/9781119790945.ch9 · Cited by 1 · see citing works
Couple‐Based Interventions for the Treatment of Depressive and Anxiety Disorders
Wittenborn, A. K., Baucom, B., Leifker, F. R., & Lachmar, E. M. (2020) · The Handbook of Systemic Family Therapy · doi:10.1002/9781119438519.ch68 · Cited by 1 · see citing works
Neppl, A. K., Diggs, O. N., Neppl, T. K., & Denburg, N. L. (2020) · Iowa Research Online (The University of Iowa)
Manchaiah, V. K. C., Brazelton, A., Rodrigo, H., Beukes, E. W., Fagelson, M. A., Andersson, G., & Trivedi, M. V. (2021) · American Journal of Audiology · doi:10.1044/2021_aja-21-00062
Examining Working Memory Performance in Adult Psychosomatic Inpatients
Held, J., Ramadani, L., Vîslă, A., Köllner, V., Hilpert, P., & Flückiger, C. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.589809
“Moreover, integrating cognitive training programs focusing on compensating and improving WM functioning within the psychosomatic rehabilitation context could be beneficial (Wagner et al., 2008).”
BackgroundGedanken an Gesundheit bei Diabetes: Ergebnisse der DiaDec-Studie
Borgmann, S. O., Chernyak, N., Haastert, B., Linnenkamp, U., Andrich, S., Razum, O., & Icks, A. (2022) · Public Health Forum · doi:10.1515/pubhef-2022-0055
“Bei Menschen mit chronischen Erkrankungen sind häufige negative Gedanken mit Depressionen, Angst und emotionalem Stress assoziiert [4].”
BackgroundClayton, M., Young, E., Zhu, S., Renna, M. E., & Mennin, D. S. (2024) · Personality and Individual Differences · doi:10.1016/j.paid.2024.112579
EXPLORATORY ROLE OF COGNITIVE BEHAVIORAL FACTORS ON PSYCHOLOGICAL EMPOWERMENT AMONG YOUTH
Rathore, S., Limaye, T., & Bhair, K. (2024) · International Education and Research Journal · doi:10.21276/ierj24338506932052
Marchant, N. L., Lau, Y., Bansal, A., Palix, C., Demnitz‐King, H., Wirth, M., Klimecki, O., Chételat, G., Poisnel, G., & Medit‐Ageing Research Group (2024) · Research Square · doi:10.21203/rs.3.rs-4246401/v1
التنمر الإلكتروني وعلاقته بالتفكير السلبي لدى طالبات جامعة حائل
الرشيدي, أ. ف., & الرشيدي, ب. ب. ب. ا. (2025) · مجلة العلوم التربوية و النفسية · doi:10.26389/ajsrp.e101224
Borgmann, S. O., Chernyak, N., Haastert, B., Linnenkamp, U., Andrich, S., Schlenker, R., Razum, O., & Icks, A. (2021) · Figshare · doi:10.6084/m9.figshare.13646941
Schlosser, M., Demnitz‐King, H., Whitfield, T. J., Wirth, M., & Marchant, N. L. (2020) · Figshare · doi:10.6084/m9.figshare.13076684
Abichi, M. C., Davis, A., Proudfoot, H., Norton, S., Moss-Morris, R. E., & Hudson, J. L. (2026) · BJPsych Open · doi:10.1192/bjo.2025.10957
The effect of self-compassion on depression via rumination: A two wave longitudinal study
Lee, T., Ko, H., Hong, S. E., Han, X.-H., & Lee, S.-M. (2026) · Current Psychology · doi:10.1007/s12144-025-08575-4
“…linked to increased depressive symptoms (Connolly & Alloy, 2018 ; Huffziger et al., 2009; Nolen-Hoeksema et al., 2008; Nolen-Hoeksema, 2000; Trick et al., 2016), while self-compassion has been associated with lower rumination (Imtiaz & Kamal, 2016; Johnson & O’Brien, 2013; Krieger et al.,…”
Marchant, N. L., Jones, R., Demnitz‐King, H., & Schlosser, M. (2020) · OSF Preprints (OSF Preprints)
Akyıl, Y., Akçıl, S., Çağlar, A., & Erdinç, B. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70317
- Authors
- Trick, L., Watkins, E., Windeatt, S., & Dickens, C.
- Affiliations
- University of Exeter (GB)
- Corresponding author
- Trick, Leanne
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2016-12
- Volume
- 91
- Pages
- 89-101
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2551696677
- Cited by
- 70
- References
- 86
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 9 · 2023: 7 · 2022: 8 · 2021: 6 · 2020: 16 · 2019: 7 · 2018: 10 · 2017: 1
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion)
- Durham Research Online (Durham University) (submittedVersion, cc-by)
- Funders
- National Institute for Health Research
- Royal Devon and Exeter NHS Foundation Trust
- University of Exeter Medical School PhD Studentship awarded
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- rumination, worry, depression, anxiety, emotional distress, chronic disease, medical outcomes, prospective associations
- MeSH terms
- Pessimism, Adult, Anxiety, Chronic Disease, Depression, Female, Humans, Male, Stereotyped Behavior, Stress, Psychological, Young Adult
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