The role of cognitive processing in the relationship of posttraumatic stress symptoms and depression among older Holocaust survivors: a moderated-mediation model

Background and Objectives: Trauma often affects cognitive processes; however, little is known about their role in the relationship between posttraumatic stress and depression among traumatized people. This study aimed to examine three cognitive processes (intrusive rumination, deliberate rumination, and looming cognitive style) and the moderated-mediation effect of these processes in the relationship between posttraumatic stress and depression. Design: The study design was multiple-group cross-sectional. Methods: Participants included 159 Holocaust survivors and 87 matched participants without Holocaust experience. Participants completed questionnaires that assessed levels of rumination, looming cognitive style, posttraumatic stress, and depression. Results: Holocaust survivors reported higher levels of intrusive and deliberate rumination and looming, as well as higher levels of posttraumatic stress and depression than the non-exposed participants. Structural equation modeling revealed a direct association between posttraumatic stress and depression among the non-exposed group. Among the Holocaust survivors, higher levels of posttraumatic stress were related to more depression through the mediators of looming and intrusive rumination, and lower levels of posttraumatic stress were related to lower levels of depression through deliberate rumination. Conclusion: Findings suggest that trauma influences unique cognitive processes that affect the relationship between posttraumatic stress and depression.