From Social Struggles to Internal Battles: Understanding Depression Through Interpersonal Problems and Rumination
,
Abstract
Objective: Depression represents a significant global health burden, with interpersonal problems and rumination emerging as crucial correlates. However, the precise nature of the associations linking these elements remains unclear. This study investigated the statistical mediation pattern of rumination in the relationship between interpersonal problems and depressive symptoms in the Iranian population.
Method: A cross-sectional study was conducted with 564 participants (38.5% male, 61.5% female; mean age = 21.50, SD = 3.47) recruited through social media networks in Zanjan, Iran. Participants completed the Inventory of Interpersonal Problems (IIP-32), Rumination Response Scale (RRS), and Beck Depression Inventory-II (BDI-II). Structural equation modeling was employed to test the hypothesized mediation model.
Results: The structural model demonstrated an excellent fit (χ²/df = 2.904, RMSEA = 0.055, CFI = 0.979). Interpersonal problems were significantly associated with both rumination (β = 0.637, P < 0.001) and depressive symptoms (β = 0.253, P < 0.001). Rumination showed a significant indirect association (β = 0.373, P < 0.001) in the relationship between interpersonal problems and depression symptoms. The total association of interpersonal problems with depressive symptoms was substantial (β = 0.627, P < 0.001).
Conclusion: The findings confirm that interpersonal problems are both directly and indirectly associated with depressive symptoms, with the indirect statistical pathway operating via rumination. This suggests that the interplay between interpersonal difficulties and ruminative thinking patterns may be a relevant consideration for future clinical research aiming to improve depression outcomes.
1. Kim BJ, Kihl T. Suicidal ideation associated with depression and social support: a survey-based analysis of older adults in South Korea. BMC Psychiatry. 2021;21(1):409.
2. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-38.
3. Thomas L, Kessler D, Campbell J, Morrison J, Peters TJ, Williams C, et al. Prevalence of treatment-resistant depression in primary care: cross-sectional data. Br J Gen Pract. 2013;63(617):e852-8.
4. Cano-Lopez JB, Garcia-Sancho E, Fernandez-Castilla B, Salguero JM. Empirical evidence of the metacognitive model of rumination and depression in clinical and nonclinical samples: A systematic review and meta-analysis. Cognit Ther Res. 2022;46(2):367-92.
5. Horowitz LM, Rosenberg SE, Bartholomew K. Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy. J Consult Clin Psychol. 1993;61(4):549-60.
6. Horowitz LM, Vitkus J. The interpersonal basis of psychiatric symptoms. Clinical Psychology Review. 1986;6(5):443-69.
7. Barrett MS, Barber JP. Interpersonal profiles in major depressive disorder. J Clin Psychol. 2007;63(3):247-66.
8. Nezlek JB, Hampton CP, Shean GD. Clinical depression and day-to-day social interaction in a community sample. J Abnorm Psychol. 2000;109(1):11-9.
9. Dinger U, Zilcha-Mano S, McCarthy KS, Barrett MS, Barber JP. Interpersonal problems as predictors of alliance, symptomatic improvement and premature termination in treatment of depression. J Affect Disord. 2013;151(2):800-3.
10. McEvoy PM, Burgess MM, Page AC, Nathan P, Fursland A. Interpersonal problems across anxiety, depression, and eating disorders: a transdiagnostic examination. Br J Clin Psychol. 2013;52(2):129-47.
11. Talebi Joybari M. Depression and interpersonal problems in adolescents: their relationship with alexithymia and coping styles. Iran J Psychiatry Behav Sci. 2014;8(4):38-45.
12. Besharat MA, Jafari F, Gholam Ali Lavasani M. Predicting symptoms of anxiety and depression based on interpersonal problems. Rooyesh-e-Ravanshenasi Journal (RRJ). 2021;10(2):35-44.
13. Peters J, Aan Het Rot M. Interpersonal problems across anxiety and depressive disorders. Compr Psychiatry. 2026;149:152726.
14. Fonseca A, de Matos MG, Gois C. Can Interpersonal Problems Predict Female Depression? Mediterranean Journal of Clinical Psychology. 2023;11(1).
15. Triscoli C, Croy I, Sailer U. Depression predicts interpersonal problems partially through the attitude towards social touch. J Affect Disord. 2019;246:234-40.
16. Alavinikoo S, Pirmoradi M, Zahedi Tajrishi K, Arezoomandan R. Structural equation modeling of problematic internet use based on executive function, interpersonal needs, fear of missing out and depression. J Clin Exp Neuropsychol. 2025;47(3):185-204.
17. Iovoli F, Rubel JA, Steinbrenner T, Lauterbach R. Interpersonal Problems and Their Mental Health Correlates: A Meta-Analytic Review. J Clin Psychol. 2025;81(11):1046-56.
18. McEvoy PM, Burgess MM, Nathan P. The relationship between interpersonal problems, negative cognitions, and outcomes from cognitive behavioral group therapy for depression. J Affect Disord. 2013;150(2):266-75.
19. Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB. Specificity of rumination in anxiety and depression: A multimodal meta‐analysis. Clinical Psychology: Science and Practice. 2013;20(3):225.
20. McLaughlin KA, Aldao A, Wisco BE, Hilt LM. Rumination as a transdiagnostic factor underlying transitions between internalizing symptoms and aggressive behavior in early adolescents. J Abnorm Psychol. 2014;123(1):13-23.
21. Luttenbacher I, Breukel JS, Adamson MM. The mediating role of rumination in the relationship between loneliness and depression in university students during the COVID-19 pandemic. COVID. 2021;1(2):447-57.
22. Rasouli A, Tirgari SH, Saed O. Factor structure and psychometric properties of the Iranian version of Relational Rumination Questionnaire (RelRQ). 2025.
23. Tao S, Xiong Y, Guo M, Mao G, Wu D. Meta-Analysis of the Correlation Between Rumination and Depression Among Adolescents. J Psychosoc Nurs Ment Health Serv. 2026;64(7):11-7.
24. Weinstock LM, Whisman MA. Rumination and Excessive Reassurance-Seeking in Depression: A Cognitive–Interpersonal Integration: Weinstock and Whisman. Cognitive Therapy and Research. 2007;31(3):333-42.
25. Hu Y, Jiang X, Zhang Q, Zhang A. Investigating the mediating roles of executive functioning and rumination in the relations between dispositional mindfulness and depression among high school students. Current Psychology. 2024;43(21):19468-80.
26. Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991;100(4):569-82.
27. Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000;109(3):504-11.
28. Brinker JK, Dozois DJ. Ruminative thought style and depressed mood. J Clin Psychol. 2009;65(1):1-19.
29. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking Rumination. Perspect Psychol Sci. 2008;3(5):400-24.
30. Silveira Éde M, Jr., Kauer-Sant'Anna M. Rumination in bipolar disorder: a systematic review. Braz J Psychiatry. 2015;37(3):256-63.
31. Ghorbani N, Watson PJ, Hargis MB. Integrative Self-Knowledge Scale: correlations and incremental validity of a cross-cultural measure developed in Iran and the United States. J Psychol. 2008;142(4):395-412.
32. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76-84.
33. Dejman M, Forouzan AS, Assari S, Rasoulian M, Jazayery A, Malekafzali H, et al. How Iranian lay people in three ethnic groups conceptualize a case of a depressed woman: an explanatory model. Ethn Health. 2010;15(5):475-93.
34. Westland JC. Lower bounds on sample size in structural equation modeling. Electron Commer Res Appl. 2010;9(6):476-87.
35. Barkham M, Hardy GE, Startup M. The IIP-32: a short version of the Inventory of Interpersonal Problems. Br J Clin Psychol. 1996;35(1):21-35.
36. Horowitz LM, Rosenberg SE, Baer BA, Ureño G, Villaseñor VS. Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol. 1988;56(6):885-92.
37. Fath N, AZADFALLAH P, RASOOLZADEH TK, Rahimi C. Validity and reliability of the inventory of interpersonal problems (IIP-32). 2013.
38. Beck AT, Steer RA, Brown G. Beck depression inventory–II. Psychological assessment. 1996.
39. Han X, Yang H-f. Chinese version of Nolen-Hoeksema ruminative responses scale (RRS) used in 912 college students: reliability and validity. Chinese Journal of Clinical Psychology. 2009.
40. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: A psychometric analysis. Cognit Ther Res. 2003;27(3):247-59.
41. Hooper D, Coughlan J, Mullen M. Structural Equation Modeling: Guidelines for Determining Model Fit. The Electronic Journal of Business Research Methods. 2007;6.
42. Vrshek-Schallhorn S, Stroud CB, Mineka S, Hammen C, Zinbarg RE, Wolitzky-Taylor K, et al. Chronic and episodic interpersonal stress as statistically unique predictors of depression in two samples of emerging adults. J Abnorm Psychol. 2015;124(4):918-32.
43. Hammen C. Self-cognitions, stressful events, and the prediction of depression in children of depressed mothers. J Abnorm Child Psychol. 1988;16(3):347-60.
44. Joiner TE, Jr., Metalsky GI. Excessive reassurance seeking: delineating a risk factor involved in the development of depressive symptoms. Psychol Sci. 2001;12(5):371-8.
45. Boone T, Reilly AJ, Sashkin M. SOCIAL LEARNING THEORY albert bandura englewood cliffs, NJ: Prentice-hall, 1977. 247 pp., paperbound. Group & Organization Studies. 1977;2(3):384-5.
46. Lewinsohn PM, Hoberman H, Teri L, Hautzinger M. An integrative theory of depression. Theoretical issues in behavior therapy. 1985;331359.
47. Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol Bull. 1991;110(3):406-25.
48. Carver CS, Scheier MF. On the self-regulation of behavior: cambridge university press; 2001.
49. Takano K, Sakamoto S, Tanno Y. Ruminative and reflective forms of self-focus: Their relationships with interpersonal skills and emotional reactivity under interpersonal stress. Pers Individ Dif. 2011;51(4):515-20.
50. 50. Saffrey C, Ehrenberg M. When thinking hurts: Attachment, rumination, and postrelationship adjustment. Personal relationships. 2007;14(3):351-68.
51. Saffari Nia M, Dehestani M, Fetri A. The mediating effect of empathy, rumination, and anger on the relationship between narcissism and lack of interpersonal forgiveness. Social Cognition. 2018;6(2):143-54.
52. Namdarpour F, Fatehizade M, Bahrami F, Mohammadi Fesharaki R. How rumination affects marital conflict in Iranian women: A qualitative study. Journal of Divorce & Remarriage. 2019;60(3):171-82.
53. Watkins E, Moulds M. Distinct modes of ruminative self-focus: impact of abstract versus concrete rumination on problem solving in depression. Emotion. 2005;5(3):319.
54. Papageorgiou C, Wells A. Nature, functions, and beliefs about depressive rumination. Depressive rumination: Nature, theory and treatment. 2003:1–20.
55. Bagherinezhad M, Salehi FJ, Tabatabaee S. Relationship between rumination and depression in a sample ofiranian students. 2010.
56. Flynn M, Kecmanovic J, Alloy LB. An Examination of Integrated Cognitive-Interpersonal Vulnerability to Depression: The Role of Rumination, Perceived Social Support, and Interpersonal Stress Generation. Cognit Ther Res. 2010;34(5):456-66.
57. Flynn M, Rudolph KD. Stress generation and adolescent depression: contribution of interpersonal stress responses. J Abnorm Child Psychol. 2011;39(8):1187-98.
58. Heissel A, Pietrek A, Kangas M, Van der Kaap-Deeder J, Rapp MA. The Mediating Role of Rumination in the Relation between Basic Psychological Need Frustration and Depressive Symptoms. J Clin Med. 2023;12(2).
59. Rajyaguru P, Lewis G, Stringaris A, Banaschewski T, Bokde A, Desrivieres S, et al. The associations between rumination and depression in late adolescence: a longitudinal study using the IMAGEN adolescent cohort. 2026.
60. Clark DA, Beck AT. Cognitive therapy of anxiety disorders: Science and practice: Guilford press; 2011.
61. Kuster F, Orth U, Meier LL. Rumination mediates the prospective effect of low self-esteem on depression: a five-wave longitudinal study. Pers Soc Psychol Bull. 2012;38(6):747-59.
62. Ingram RE, Luxton DD. Vulnerability-stress models. Development of psychopathology: A vulnerability-stress perspective. 2005;46(2):32-46.
63. Lyubomirsky S, Nolen-Hoeksema S. Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Pers Soc Psychol. 1995;69(1):176-90.
64. Morrow J, Nolen-Hoeksema S. Effects of responses to depression on the remediation of depressive affect. J Pers Soc Psychol. 1990;58(3):519-27.
65. Nolen-Hoeksema S, Davis CG. "Thanks for sharing that": ruminators and their social support networks. J Pers Soc Psychol. 1999;77(4):801-14.
66. Rasouli A, Soumee ZN-E, Seraji HT, Saed O. Co-rumination in depression: the protective role of perceived social support. Current Psychology. 2026;45(5):468.
67. Saris IMJ, Aghajani M, van der Werff SJA, van der Wee NJA, Penninx B. Social functioning in patients with depressive and anxiety disorders. Acta Psychiatr Scand. 2017;136(4):352-61.
2. Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-38.
3. Thomas L, Kessler D, Campbell J, Morrison J, Peters TJ, Williams C, et al. Prevalence of treatment-resistant depression in primary care: cross-sectional data. Br J Gen Pract. 2013;63(617):e852-8.
4. Cano-Lopez JB, Garcia-Sancho E, Fernandez-Castilla B, Salguero JM. Empirical evidence of the metacognitive model of rumination and depression in clinical and nonclinical samples: A systematic review and meta-analysis. Cognit Ther Res. 2022;46(2):367-92.
5. Horowitz LM, Rosenberg SE, Bartholomew K. Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy. J Consult Clin Psychol. 1993;61(4):549-60.
6. Horowitz LM, Vitkus J. The interpersonal basis of psychiatric symptoms. Clinical Psychology Review. 1986;6(5):443-69.
7. Barrett MS, Barber JP. Interpersonal profiles in major depressive disorder. J Clin Psychol. 2007;63(3):247-66.
8. Nezlek JB, Hampton CP, Shean GD. Clinical depression and day-to-day social interaction in a community sample. J Abnorm Psychol. 2000;109(1):11-9.
9. Dinger U, Zilcha-Mano S, McCarthy KS, Barrett MS, Barber JP. Interpersonal problems as predictors of alliance, symptomatic improvement and premature termination in treatment of depression. J Affect Disord. 2013;151(2):800-3.
10. McEvoy PM, Burgess MM, Page AC, Nathan P, Fursland A. Interpersonal problems across anxiety, depression, and eating disorders: a transdiagnostic examination. Br J Clin Psychol. 2013;52(2):129-47.
11. Talebi Joybari M. Depression and interpersonal problems in adolescents: their relationship with alexithymia and coping styles. Iran J Psychiatry Behav Sci. 2014;8(4):38-45.
12. Besharat MA, Jafari F, Gholam Ali Lavasani M. Predicting symptoms of anxiety and depression based on interpersonal problems. Rooyesh-e-Ravanshenasi Journal (RRJ). 2021;10(2):35-44.
13. Peters J, Aan Het Rot M. Interpersonal problems across anxiety and depressive disorders. Compr Psychiatry. 2026;149:152726.
14. Fonseca A, de Matos MG, Gois C. Can Interpersonal Problems Predict Female Depression? Mediterranean Journal of Clinical Psychology. 2023;11(1).
15. Triscoli C, Croy I, Sailer U. Depression predicts interpersonal problems partially through the attitude towards social touch. J Affect Disord. 2019;246:234-40.
16. Alavinikoo S, Pirmoradi M, Zahedi Tajrishi K, Arezoomandan R. Structural equation modeling of problematic internet use based on executive function, interpersonal needs, fear of missing out and depression. J Clin Exp Neuropsychol. 2025;47(3):185-204.
17. Iovoli F, Rubel JA, Steinbrenner T, Lauterbach R. Interpersonal Problems and Their Mental Health Correlates: A Meta-Analytic Review. J Clin Psychol. 2025;81(11):1046-56.
18. McEvoy PM, Burgess MM, Nathan P. The relationship between interpersonal problems, negative cognitions, and outcomes from cognitive behavioral group therapy for depression. J Affect Disord. 2013;150(2):266-75.
19. Olatunji BO, Naragon-Gainey K, Wolitzky-Taylor KB. Specificity of rumination in anxiety and depression: A multimodal meta‐analysis. Clinical Psychology: Science and Practice. 2013;20(3):225.
20. McLaughlin KA, Aldao A, Wisco BE, Hilt LM. Rumination as a transdiagnostic factor underlying transitions between internalizing symptoms and aggressive behavior in early adolescents. J Abnorm Psychol. 2014;123(1):13-23.
21. Luttenbacher I, Breukel JS, Adamson MM. The mediating role of rumination in the relationship between loneliness and depression in university students during the COVID-19 pandemic. COVID. 2021;1(2):447-57.
22. Rasouli A, Tirgari SH, Saed O. Factor structure and psychometric properties of the Iranian version of Relational Rumination Questionnaire (RelRQ). 2025.
23. Tao S, Xiong Y, Guo M, Mao G, Wu D. Meta-Analysis of the Correlation Between Rumination and Depression Among Adolescents. J Psychosoc Nurs Ment Health Serv. 2026;64(7):11-7.
24. Weinstock LM, Whisman MA. Rumination and Excessive Reassurance-Seeking in Depression: A Cognitive–Interpersonal Integration: Weinstock and Whisman. Cognitive Therapy and Research. 2007;31(3):333-42.
25. Hu Y, Jiang X, Zhang Q, Zhang A. Investigating the mediating roles of executive functioning and rumination in the relations between dispositional mindfulness and depression among high school students. Current Psychology. 2024;43(21):19468-80.
26. Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes. J Abnorm Psychol. 1991;100(4):569-82.
27. Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol. 2000;109(3):504-11.
28. Brinker JK, Dozois DJ. Ruminative thought style and depressed mood. J Clin Psychol. 2009;65(1):1-19.
29. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking Rumination. Perspect Psychol Sci. 2008;3(5):400-24.
30. Silveira Éde M, Jr., Kauer-Sant'Anna M. Rumination in bipolar disorder: a systematic review. Braz J Psychiatry. 2015;37(3):256-63.
31. Ghorbani N, Watson PJ, Hargis MB. Integrative Self-Knowledge Scale: correlations and incremental validity of a cross-cultural measure developed in Iran and the United States. J Psychol. 2008;142(4):395-412.
32. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76-84.
33. Dejman M, Forouzan AS, Assari S, Rasoulian M, Jazayery A, Malekafzali H, et al. How Iranian lay people in three ethnic groups conceptualize a case of a depressed woman: an explanatory model. Ethn Health. 2010;15(5):475-93.
34. Westland JC. Lower bounds on sample size in structural equation modeling. Electron Commer Res Appl. 2010;9(6):476-87.
35. Barkham M, Hardy GE, Startup M. The IIP-32: a short version of the Inventory of Interpersonal Problems. Br J Clin Psychol. 1996;35(1):21-35.
36. Horowitz LM, Rosenberg SE, Baer BA, Ureño G, Villaseñor VS. Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol. 1988;56(6):885-92.
37. Fath N, AZADFALLAH P, RASOOLZADEH TK, Rahimi C. Validity and reliability of the inventory of interpersonal problems (IIP-32). 2013.
38. Beck AT, Steer RA, Brown G. Beck depression inventory–II. Psychological assessment. 1996.
39. Han X, Yang H-f. Chinese version of Nolen-Hoeksema ruminative responses scale (RRS) used in 912 college students: reliability and validity. Chinese Journal of Clinical Psychology. 2009.
40. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: A psychometric analysis. Cognit Ther Res. 2003;27(3):247-59.
41. Hooper D, Coughlan J, Mullen M. Structural Equation Modeling: Guidelines for Determining Model Fit. The Electronic Journal of Business Research Methods. 2007;6.
42. Vrshek-Schallhorn S, Stroud CB, Mineka S, Hammen C, Zinbarg RE, Wolitzky-Taylor K, et al. Chronic and episodic interpersonal stress as statistically unique predictors of depression in two samples of emerging adults. J Abnorm Psychol. 2015;124(4):918-32.
43. Hammen C. Self-cognitions, stressful events, and the prediction of depression in children of depressed mothers. J Abnorm Child Psychol. 1988;16(3):347-60.
44. Joiner TE, Jr., Metalsky GI. Excessive reassurance seeking: delineating a risk factor involved in the development of depressive symptoms. Psychol Sci. 2001;12(5):371-8.
45. Boone T, Reilly AJ, Sashkin M. SOCIAL LEARNING THEORY albert bandura englewood cliffs, NJ: Prentice-hall, 1977. 247 pp., paperbound. Group & Organization Studies. 1977;2(3):384-5.
46. Lewinsohn PM, Hoberman H, Teri L, Hautzinger M. An integrative theory of depression. Theoretical issues in behavior therapy. 1985;331359.
47. Monroe SM, Simons AD. Diathesis-stress theories in the context of life stress research: implications for the depressive disorders. Psychol Bull. 1991;110(3):406-25.
48. Carver CS, Scheier MF. On the self-regulation of behavior: cambridge university press; 2001.
49. Takano K, Sakamoto S, Tanno Y. Ruminative and reflective forms of self-focus: Their relationships with interpersonal skills and emotional reactivity under interpersonal stress. Pers Individ Dif. 2011;51(4):515-20.
50. 50. Saffrey C, Ehrenberg M. When thinking hurts: Attachment, rumination, and postrelationship adjustment. Personal relationships. 2007;14(3):351-68.
51. Saffari Nia M, Dehestani M, Fetri A. The mediating effect of empathy, rumination, and anger on the relationship between narcissism and lack of interpersonal forgiveness. Social Cognition. 2018;6(2):143-54.
52. Namdarpour F, Fatehizade M, Bahrami F, Mohammadi Fesharaki R. How rumination affects marital conflict in Iranian women: A qualitative study. Journal of Divorce & Remarriage. 2019;60(3):171-82.
53. Watkins E, Moulds M. Distinct modes of ruminative self-focus: impact of abstract versus concrete rumination on problem solving in depression. Emotion. 2005;5(3):319.
54. Papageorgiou C, Wells A. Nature, functions, and beliefs about depressive rumination. Depressive rumination: Nature, theory and treatment. 2003:1–20.
55. Bagherinezhad M, Salehi FJ, Tabatabaee S. Relationship between rumination and depression in a sample ofiranian students. 2010.
56. Flynn M, Kecmanovic J, Alloy LB. An Examination of Integrated Cognitive-Interpersonal Vulnerability to Depression: The Role of Rumination, Perceived Social Support, and Interpersonal Stress Generation. Cognit Ther Res. 2010;34(5):456-66.
57. Flynn M, Rudolph KD. Stress generation and adolescent depression: contribution of interpersonal stress responses. J Abnorm Child Psychol. 2011;39(8):1187-98.
58. Heissel A, Pietrek A, Kangas M, Van der Kaap-Deeder J, Rapp MA. The Mediating Role of Rumination in the Relation between Basic Psychological Need Frustration and Depressive Symptoms. J Clin Med. 2023;12(2).
59. Rajyaguru P, Lewis G, Stringaris A, Banaschewski T, Bokde A, Desrivieres S, et al. The associations between rumination and depression in late adolescence: a longitudinal study using the IMAGEN adolescent cohort. 2026.
60. Clark DA, Beck AT. Cognitive therapy of anxiety disorders: Science and practice: Guilford press; 2011.
61. Kuster F, Orth U, Meier LL. Rumination mediates the prospective effect of low self-esteem on depression: a five-wave longitudinal study. Pers Soc Psychol Bull. 2012;38(6):747-59.
62. Ingram RE, Luxton DD. Vulnerability-stress models. Development of psychopathology: A vulnerability-stress perspective. 2005;46(2):32-46.
63. Lyubomirsky S, Nolen-Hoeksema S. Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Pers Soc Psychol. 1995;69(1):176-90.
64. Morrow J, Nolen-Hoeksema S. Effects of responses to depression on the remediation of depressive affect. J Pers Soc Psychol. 1990;58(3):519-27.
65. Nolen-Hoeksema S, Davis CG. "Thanks for sharing that": ruminators and their social support networks. J Pers Soc Psychol. 1999;77(4):801-14.
66. Rasouli A, Soumee ZN-E, Seraji HT, Saed O. Co-rumination in depression: the protective role of perceived social support. Current Psychology. 2026;45(5):468.
67. Saris IMJ, Aghajani M, van der Werff SJA, van der Wee NJA, Penninx B. Social functioning in patients with depressive and anxiety disorders. Acta Psychiatr Scand. 2017;136(4):352-61.
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How to Cite
1.
Tirgari Seraji H, Rasouli A, Saed O, Bayazidi S. From Social Struggles to Internal Battles: Understanding Depression Through Interpersonal Problems and Rumination. Iran J Psychiatry. 2026;:1-12.
