Personality features, dissociation, self-stigma, hope, and the complex treatment of depressive disorder

Abstract

ObjectiveIdentifying the predictors of response to psychiatric and psychotherapeutic treatments may be useful for increasing treatment efficacy in pharmacoresistant depressive patients. The goal of this study was to examine the influence of dissociation, hope, personality trait, and selected demographic factors in treatment response of this group of patients.MethodsPharmacoresistant depressive inpatients were enrolled in the study. All patients completed Clinical Global Impression – both objective and subjective form (CGI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) at baseline and after 6 weeks of combined pharmacotherapy and psychotherapy (group cognitive-behavioral or group psychodynamic) treatment as an outcome measures. The Internalized Stigma of Mental Illness Scale (ISMI), Dissociative Experience Scale (DES), Adult Dispositional Hope Scale (ADHS), and Temperament and Character Inventory (TCI-R) were completed at the start of the treatment with the intention to find the predictors of treatment efficacy.ResultsThe study included 72 patients who were hospitalized for the pharmacoresistant major depression; 63 of them completed the study. The mean scores of BDI-II, BAI, subjCGI, and objCGI significantly decreased during the treatment. BDI-II relative change statistically significantly correlated with the total ISMI score, Discrimination Experience (ISMI subscale), and Harm Avoidance (TCI-R personality trait). According to stepwise regression, the strongest factors connected to BDI-II relative change were the duration of the disorder and Discrimination Experience (domain of ISMI). ObjCGI relative change significantly correlated with the level of dissociation (DES), the total ISMI score, hope in ADHS total score, and Self-Directedness (TCI-R). According to stepwise regression, the strongest factor connected to objCGI relative change was Discrimination Experience (domain of ISMI). The existence of comorbid personality disorder did not influence the treatment response.ConclusionAccording to the results of the present study, patients with pharmacoresistant depressive disorders, who have had more experience with discrimination because of their mental struggles, showed a poorer response to treatment.

Comparison of self-stigma and quality of life in patients with depressive disorders and schizophrenia spectrum disorders – a cross-sectional study

“…This seems to be in agreement with common sense – those who have experienced more hospitalizations are more likely to have met discrimination from others and to have suffered more attacks of the disorder. The finding is in agreement with the results of previous studies for both schizophrenia and depression 40,41…”

Confirmatory Factor Analysis of Persian Version of Depression, Anxiety and Stress (DASS-42): Non-Clinical Sample

“…The recommended interpretive guidelines score from 0 to 29 (23). Psychometric studies on second edition of the questionnaire show this edition has appropriate reliability and validity.…”

Estigma internalizado em pacientes com transtorno de humor e fatores associados

“…A ausência de tratamento adequado faz com que os sintomas psiquiátricos fiquem mais evidentes, o que pode resultar em comportamentos não aceitos socialmente e acentuação do estigma prejudicando, ainda mais, a qualidade de vida e autoestima do estigmatizado (HANAFIAH; BORTEL, 2015). Além disso, o polo de humor depressivo interfere diretamente na não adesão ao tratamento devido ao alto nível de desesperança e baixo poder de autoeficácia que ele gera (KAMARADOVA et al, 2016;PRASKO et al, 2016).…”

“…BUSBY;SAJATOVIC, 2010;CRUZ et al, 2011;MIASSO et al, 2011;ZAGO et al, 2015). O descrédito de que o tratamento pode fornecer apoio e ajuda é um dos fatores que leva o indivíduo com estigma internalizado à não aderência ao tratamento (KAMARADOVA et al, 2016;PRASKO et al, 2016).…”

“…A esperança motiva e sustenta as crenças e perspectivas sociais e ocupacionais que o indivíduo tem dele próprio, assim, a desesperança age como precursora de sentimentos de fracasso e, posteriormente, a desistência de atividades (BERRY; GREENWOLD, 2017). Ter esperança está relacionado a ter melhor humor, melhor saúde e melhor capacidade para lidar com as adversidades do ciclo saúde-doença(PRASKO et al, 2016).…”