How Rejection Leads to Depression, and Vice Versa

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Think back to a time when you were ostracized by a group of classmates or coworkers, or rejected by a person you loved. Then, answer the following questions:

Did you experience feelings of worthlessness and depression? Did this experience affect how you expected to be treated by others? And did this expectation affect your mood?

It is plausible that expectations of social rejection would result in depression. But the reverse is also plausible. In other words, individuals with a history of depression may be more likely to expect social rejection.

So, both hypotheses appear rational. But what does the research say? Let us examine a recent study by Kirchner and colleagues, published in the June issue of Psychology and Psychotherapy.

An Investigation of Depression and Social Rejection Expectations

Sample: 347 participants; 80 percent female; 95 percent Caucasian; average age of 32 years old; 48 percent with a college degree; 32 percent living alone; 48 percent in a romantic relationship; mostly students (50 percent) or working (37 percent); 72 percent with least one episode of depression and 20 percent with at least one “persistent depressive episode.”

Participants completed the baseline assessment (T1) and follow-up assessment (T2) that took place two months later.

Measures (German translations were used):

• Social rejection expectations: The Rejection Sensitivity Questionnaire for adults; and the social rejection subscale of the Depressive Expectations Scale.
• Depressive symptoms: The nine-item Public Health Questionnaire module for depression (PHQ-9)
• Anamnestic depression: There were only two questions; “How often in your life have you felt depressed, disinterested, or joyless, and lacking drive for at least two weeks almost all day long?” and “If you ever felt this way, did this condition ever last two years or more?”
• Social anxiety: The six-item version of the Social Anxiety Scale
• Social phobia: The six-item version of the Social Phobia Scale
• Perceived social support: The six-item Perceived Social Support Questionnaire
• Interpersonal competencies: The 15-item version of the Interpersonal Competence Questionnaire

Results

1. Social rejection expectations were predictive of symptoms of depression (two months later).
2. Depressive symptoms were predictive of social rejection expectations, again at the two-month follow-up.

Perceived social support did not mediate these effects, nor did interpersonal competencies.

The Bidirectional Relationship Between Depression and Rejection Expectations

Thus, Kirchner and coauthors found correlational support for both hypotheses. Let's now discuss the possible mechanisms of this bidirectional relationship, beginning with the first hypothesis: Why might expectations of being socially rejected increase the risk of developing depression?

Interpersonal risk models of depression suggest depressive symptoms are related to certain risk factors (e.g., social skills deficits, constant reassurance-seeking) that make rejection more likely and thus interfere with the satisfaction of the need to belong.

Similarly, the expectation of being rejected may elevate the likelihood of developing depression by increasing the probability of perceiving social rejection and thus responding negatively (e.g., expressing hostile feelings and behaving aggressively).

These types of negative social interactions have been predictive of depression in previous studies.

Let us consider the second hypothesis: Why might depression increase the risk of social rejection expectations?

According to the scar model of depression, people with a history of depression acquire a “scar,” which makes future depressive episodes more likely.

Specifically, people with a history of depression are prone to perceiving and remembering past rejections. Why?

It's likely due to attentional and memory biases. One example is misinterpreting neutral expressions as sad. In addition, because of poor social functioning (e.g., smiling less, maintaining less eye contact), they tend to experience more social rejection than the average person.

Together, these two mechanisms (i.e., depression-related biases and poor social functioning) increase the likelihood of depressed individuals developing social rejection expectations in future interactions.

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Takeaway

Depression can increase the probability of expecting rejection in social situations. The opposite is also true, meaning that expecting social rejection can heighten the probability of developing depression.

So, to understand the development and maintenance of depression, we need to pay greater attention to patients’ thoughts and beliefs, especially those about the future and social interactions (e.g., expectations of being rejected by coworkers or classmates). Challenging these negative beliefs may have to become a key part of cognitive-behavioral therapy (CBT) for depression.

Also helpful could be behavioral experiments and exposure exercises, which allow patients with depression to test assumptions empirically—i.e., to test whether or how often the feared outcome, meaning rejection, occurs in a particular social situation.

These exercises can provide patients with evidence that contradicts their negative expectations, and over time, modify their dysfunctional assumptions.

In short, we may be able to prevent the development of depression if social rejection expectations are detected and treated early.

And the treatment of these expectations in people already diagnosed with depression may help stop the vicious cycle of depression and social rejection expectations, and thus make it possible to treat depression more effectively.

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