Rumination in major depressive and bipolar disorder – a meta-analysis

Background: rumination, defined as repetitive thoughts about emotionally relevant experiences, has been linked extensively with mood disorders, especially major depressive disorder (MDD). However, there is a growing body of evidence suggesting the importance of rumination in bipolar disorder (BD) as well.

Methods: we searched for studies that investigated rumination in both BD and MDD in four databases. Our systematic search identified 12 studies with an overall sample size of 2071 clinical patients. 

Results: results demonstrated no significant difference in the ruminative tendencies of the two patient groups when all rumination measures were included. We tested for the effect of rumination subtype, BD subgroups, and the current mood state of BD and MDD patients. There were no significant differences in terms of depressive rumination, however, BD patients reported more rumination on positive affect. This difference remained significant when examining in BD-I and BD-II patient groups, with similar effect sizes. 

Limitations: due to the lack of sufficient data in the literature, only a few self-report studies qualified to be included in our analysis. Thus additional moderating factors, such as the current mood state of the two patient groups could not be analyzed. 

Conclusions: this review demonstrates that rumination is a significant process in both MDD and BD, highlighting the importance of interventions to reduce rumination in mood disorders. The two patient groups share several commonalities in terms of rumination, however, rumination subtype was found to be an important moderating variable underlining a difference in rumination on positive affect.