No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Kritische Lebensereignisse im 2-Jahresverlauf der „Major Depression”Eine prospektive Studie mit stationär behandelten Patienten
Abstract
A number of studies has shown a significant relationship between life events/life conditions and depression. However, there is only a small number of studies investigating the effect of life events/life conditions in patients with severe depression from the endogenous subtype. The results are inconsistent. The present study examines the significance of the patients’ life events/life conditions for the two year outcome of the illness in a prospective study with assessments every three months. Patients are compared to healthy controls with regard to the period three months prior to the admission to the hospital at the index episode. The results confirm the importance of life events and life conditions for the long term outcome of depressed patients with endogenous subtype respectively severe major depression in-patients. Relapsers show considerably more undesirable life conditions than non-relapsers three to six months prior to their relapse. Depressed patients indicate significantly more undesirable life events and life conditions and fewer desirable life conditions in comparison to the control group for the time span three months prior to their hospitalisation. Clinical implications are discussed.
... (Hammen, 1991;Harkness et al., 1999). Individuen mit vorausgegangener depressiver Episode haben auch außerhalb von depressiven Episoden mehr stressbesetzte Lebensereignisse (Kendler & Karkowski-Shuman, 1997 (Wittchen & von Zerssen, 1988, S.302;auch Keller, 1997;Klauer & Filipp, 1995;Reck, 2000). ...
... Wie deutlich wurde, ist es schwierig, verschiedene Typen von Lebensereignissen und Stressoren (minore und majore, chronische und akute, abhängige und unabhängige) voneinander abzugrenzen, und die Annahme der Unabhängigkeit dieser Belastungstypen scheint kaum haltbar. Aus diesem Grund wird von verschiedenen Autoren betont (Keller, 1997;Klauer & Filipp, 1995;Reck, 2000;Wittchen & von Zerssen, 1988), dass diese einzelnen Typen von Stressoren nicht isoliert betrachtet werden sollten, da sie keine konkurrierenden Belastungstypen darstellen, sondern oft erst als Ganzes belastend wirken und Summationseffekte haben können. Eine Unterscheidung ist deshalb möglich, aber nicht unbedingt sinnvoll, da sie der "dynamischen Verflochtenheit" unterschiedlicher Formen von Erfahrungen keine Rechnung trägt (Filipp, 1995, S. 295 (Kessler, 1997;Paykel & Cooper, 1992;Paykel, 2001 ...
... Eine zentrale Annahme vieler klinischer Studien ist, dass eine Anhäufung stressbesetzter Ereignisse eine additive Risikowirkung auf die Entwicklung einer Depression haben kann (Brostedt & Pedersen, 2003;Geyer, 1999;Keller, 1997;Reck, 2000;Romanov et al., 2003;Surtees & Ingham, 1980 House & Cottington, 1986). ...
Viele Studien zeigen Zusammenhänge zwischen depressiven Störungen und distalen sowie proximalen belastenden Lebensereignissen. Bisher fehlen jedoch Untersuchungen, die a) die Wirkung belastender distaler und proximaler Ereignisse gleichzeitig analysieren, b) den Einfluss dieser Ereignisse auf unterschiedliche Verlaufsformen depressiver Störungen untersuchen und c) die Rolle positiver Faktoren berücksichtigen. Basierend auf Daten von 349 Personen (geb. 1950-52), die an den ersten beiden Messzeitpunkten der Interdisziplinären Längsschnittstudie des Erwachsenenalters (ILSE) teilnahmen (T1-T2: 4.1 Jahre), wird der Einfluss von distalen und proximalen Lebensereignissen auf den weiteren Verlauf von minorer und Major Depression analysiert sowie die Rolle positiver Faktoren untersucht. Ausgehend von ILSE-T2 stehen 227 psychisch immer gesunden Teilnehmern, 78 remittierte Depressive (dies sind Probanden, die bis zu T1 irgendwann im Laufe ihres Lebens eine depressive Episode erlitten hatten, aber nicht mehr in den vier Erhebungszwischenjahren), 23 Depressive mit einem Rückfall und 21 späte neuerkrankte Depressive gegenüber. Die psychiatrischen Diagnosen wurden mit dem Strukturierten klinischen Interview für DSM-III-R erhoben. Belastende Kindheitsereignisse (0 bis 16. Lebensjahr) wurden zu T1 im Rahmen eines halbstrukturierten Interviews, anhand offener Fragen zur Kindheit, Situation in der Familie etc. erhoben und anhand einer qualitativen Inhaltsanalyse 20 Kategorien aus den Bereichen Verlust- Trennungsereignisse, Psychopathologie eines Elternteils, Traumatisierung durch andere und weitere Widrigkeiten (disharmonische Familienverhältnisse, eigene chronische Erkrankung) zugeordnet. Die zeitnahen Ereignisse wurden zu T2 anhand eines halbstrukturierten Interviews (offene Fragen zu Veränderungen in den vorausgegangenen vier Jahren) erhoben und 34 Kategorien aus den Bereichen Beruf, Gesundheit, Wohnen, Finanzen, Justiz, Partnerschaft, soziales Umfeld, Tod zugeordnet. Basierend auf einer Hauptkomponentenanalyse wurden die folgenden fünf positiven Faktoren aufgebaut: 1) Ausgedehnter Lebensraum/stützendes familiäres Umfeld, 2) hohe Selbstwirksamkeit, 3) hohe Integration in Peergruppen, 4) hohes Selbstwertgefühl/positives Selbstbild in der Jugend und 5) hohe kognitive Befähigung. Es zeigen sich im Vergleich mit der gesunden Kontrollgruppe bei remittierten, wieder erkrankten und neu erkrankten Personen a) mehr kritische Lebensereignisse, b)differenzielle Einflüsse der Ereignisse auf Inzidenz und Verlauf einer Depression und c) protektive Effekte von persönlichen und sozialen Ressourcen auf spezifische Lebensereignisse. Although many studies show relations between adverse distal (in childhood) and proximal events and the onset of depressive disorders in early adulthood, a) the association between childhood adversities and the first onset and the further course of depressive disorders in middle adulthood, b) the role of short-term effects of proximal stressful events in the run-up to the onset of a depression, and c) the role of protective factors regarding a specific mental disorder such as depression remains unclear. With data from N = 349 individuals (born 1950-52) who participated at both measurement points (T1-T2: 4.1 years) of the Interdisciplinary Longitudinal Study of Adult Development the study analysed the influence of stressful distal and proximal events and protective factors on the course of minor and major depression. The sample consists of 227 mentally healthy participants, 78 participants with a lifetime history of mMD, who stayed remitted in the preceding four years of ILSE-T2, 23 participants with a relapse of a depressive episode and 21 participants with an incident depressive episode between T1 and T2. Depression was assessed using the German version of the Structured Clinical Interview for DSM III-R. Childhood adversities were retrospectively assessed in a semi-structured interview at T1 (0-16 years of age). Using qualitative content analysis the adverse childhood experiences were classified into 20 categories of four event types: loss events, parental psychopathology, traumatic events and other adversities such as discord in family or chronical illness in childhood/youth. At T2 participants were asked in a semi-structured interview about the life events and life changes in the preceding four years. Using content analysis, recent stressful life events were classified into 34 categories of nine life-domains (work, health, residence/housing, finances, legal problems, partnership, social network, death, and others). Based on a principal component analysis, five protective factors were extracted out of a pool of primary 20 variables: Extended and supportive parental environment, high self-efficacy, high peer-group integration in youth, positive self-esteem in youth, and high cognitive ability and high postive self-esteem as pupil. Compared to healthy controls, individuals with an incidence, relapse or remission of a depressive disorder show higher amounts of distal and proximal stressful events. Differential influences of these events on the incidence and course of depression were found. Proximal events may function as trigger (i.e. unemployment) or marker (i.e. marital problems) of a depressive disorder. Including protective factors (i.e. lebensraum, self-efficacy, social integration) the effects of specific adverse events diminished. Consequences for further research, diagnostics and prevention are discussed.
Depressive disorders are among the most common mental illnesses. The prevailing concepts of their frequency, classification, course, and treatment have changed markedly in the last two decades. Epidemiological studies have shown that depressive disorders are more common, and have a less favorable course, than previously assumed. Concepts of diagnosis have also changed in the same period. The entity of endogenous depression, a part of the systematic, triadic nosology of Kraepelin (1913), was abandoned in favor of depressive episodes, as in ICD-10 (WHO 1992a), and major depression, as in DSM-IV (APA 1994), which became the new major diagnostic categories for depressive disorders. Meanwhile, many related diagnostic categories were developed to provide a more detailed description of the entire psycho-pathological spectrum of depressive disorders.
Im Rahmen der Life-event Forschung zur Pathogenese und zum Verlauf depressiver Störungen haben sich einige psychosoziale Faktoren als relevante Moderatorvariablen erwiesen. Diese Faktoren können das Risiko, an einer Depression zu erkranken, vergrößern, indem sie zu einer erhöhten Vulnerabilität beitragen. Die Life-event-Forschung konnte belegen, daß depressive Erkrankungen häufig in der Folge eines kritischen Lebensereignisses, vor allem nach Verlusterfahrungen, auftreten, und daß vulnerable Menschen eher mit einer Depression auf ein kritisches Lebensereignis reagieren. Als Vulnerabilitätsfaktoren wurden beispielsweise negative Kindheitserlebnisse, geringes Selbstwertgefühl und schlechte Beziehungsqualität untersucht. Auch genetische Faktoren sind wesentlich.
Depressive Störungen zählen zu den häufigsten psychischen Erkrankungen. Die Auffassungen, wie häufig sie sind, wie sie klassifiziert werden, wie sie verlaufen und behandelt werden, haben sich in den letzten 2 Jahrzehnten stark verändert. Epidemiologische Studien konnten zeigen, daß depressive Störungen häufiger sind und einen ungünstigeren Verlauf haben als bis dahin angenommen. Auch die diagnostische Konzeption wandelte sich in dieser Zeit. Der Begriff der endogenen Depression als Teil dertriadischen nosologischen Systematik Kraepelins (1913) wurde aufgegeben zugunsten des Konzepts der depressiven Episode der ICD-10 (WHO 1992a) und der majoren Depression des DSM-IV (APA 1994) als den neuen dia- gnostischen Hauptkategorien depressiver Störungen. Daneben wurden zahlreiche verwandte diagnostische Kategorien entwickelt, um den psychopathologischen Gesamtbereich depressiver Störungen zu gliedern. Washington DC
Das Thema soll in drei Schritten bearbeitet werden: Im ersten Schritt werden die Konzepte von pathogenetischen Mechanismen der Depressionsentstehung geschildert, die die therapeutischen Ansätze der psychodynamischen Psychotherapie begründen. Dabei soll hauptsächlich auf neuere psychoanalytische Forschungsergebnisse, die sich aus den Befunden der Säuglings- und Bindungsforschung ableiten, eingegangen werden. In einem zweiten Abschnitt werden therapeutische Techniken dargestellt und im dritten Abschnitt Ergebnisse der Evaluation.
The extent to which personality characteristics predict the course of severe depression has been controversially discussed. In a sample of 50 depressed inpatients, the significance of personality characteristics for the prediction of relapse was studied prospectively over 2 years. More than half of the patients studied suffered relapses within this period. Well-known predictors such as the number of previous episodes were confirmed. The personality characteristics studied showed different predictive effects at 1- and 2-year follow-up. Neurosis proved predictive of the 1-year course and outcome but not the 2-year course. In the 2nd year of follow-up, a melancholic personality structure was associated with favourable outcome. This personality type therefore seems to be more appropriate as a predictor of long-term outcome. Comparison with predictive factors described earlier showed that in this study, personality traits influence outcome independently and were not confused by other predictors. Implications for relapse prevention and psychotherapeutic management are discussed.
The Camberwell Collaborative Depression Study is an investigation of a series of 130 patients (76 female; 54 male) attending the Maudsley Hospital Services with unipolar depression of recent onset (the probands), and of their first-degree relatives. This paper describes the first element of the study, the investigation of the index cases or probands, which was carried out by members of the MRC Social Psychiatry Unit over the period 1982-1985. A description of the methods of the study is followed by an analysis of life events in relation to the symptomatic pattern of the depressive state. An 'endogenous' group was defined as cases of depression falling within Catego classes D and R, and compared with a 'neurotic' group conforming to classes N and A. The hypothesis that the 'endogenous' group of disorders would be relatively independent of prior life stress was not confirmed. Depressed women were more likely to have experienced life events or difficulties than their male counterparts, and there was some evidence that sex, but not age or social class, influenced the relationship between adversity and the type of depression. Examination of the timing of life events was strongly suggestive of a causal effect, with a pronounced rise in the month before onset. This was not limited to the most severe events. Differences between the 'endogenous' and 'neurotic' groups in the temporal patterning of events before onset are discussed. The findings are interpreted in terms of the literature on the topic.
We present evidence indicating that life events checklists may provide information both on eventful stressors and on chronic life strains. By making minor modifications to the probe questions that are asked of respondents, one can obtain additional information to measure the length of stressful experiences so that eventful stress can be disaggregated from more enduring strains. This procedure allows one to estimate the effect of chronic strain on psychological distress separately from the effect of acute stressors. In addition, such modifications provide information on the timing of discrete stressors so that one can assess the effect of more recent stressors as opposed to those that occurred earlier. The implications of these findings are discussed in terms of the use of checklists to identify chronic strains and the possibility that there are other enduring strains beside those that are role-related.
A prospective study of 400 largely working-class women with children living at home has once again demonstrated the major importance of long-term severe threatening life events in provoking caseness of depression. However, it again shows that only about one out of five women experiencing such an event go on to develop depression at a case level. This paper demonstrates that more sensitive characterisation of severe events can greatly increase the size of this association. This is done both by improving the description of the event itself and by taking into account various ways in which the event can 'match' characteristics of the women present at the first interview, well before the occurrence of the event or any onset of depression.
Life stressors and social resources have been implicated as contributors to the development of psychiatric disorders, but their role in the course of such disorders after treatment is less clear. This article examines pre- to posttreatment changes in life stressors and social resources, and their association with treatment outcomes, in a 12-month follow-up of 424 adults with unipolar depression. As expected, patients reported significant, multidimensional improvements in their functioning at follow-up. There were modest increases in patients' social resources but, surprisingly, no overall decrease in stressors. Life stress and resource factors were significantly related to patients' functioning at follow-up, even after considering the severity of their dysfunction at treatment intake and their length of treatment. Gender differences in these results were small. The findings have implications for developing a general body of knowledge about the process of recovery and relapse in behavioral disorders.
Fifty-nine women admitted to hospital because of severe depression were studied prospectively during hospital admission and nine months following hospital discharge in order to identify psychosocial and illness factors associated with prognosis. Outcome was measured in terms of both depression scores and recovery at the time of follow-up. In keeping with the findings of other studies, the outcome was often poor, with only 54% having recovered nine months after discharge, poorer outcome being associated with more negative self-esteem measured when the women were depressed and with suicidal ideas. The findings indicate that in severely depressed women likely to be admitted to hospital, psychosocial factors may have less relevance to outcome, at least in the short term, than in less severely depressed patients studied in community or out-patient samples.
A group of 71 patients were interviewed seven months after they had been screened for a new episode of unipolar depressive illness and the relationship between symptom severity at this time and the life stresses experienced over this period investigated. On the basis of the follow-up assessment, patients were divided into a well and ill group. The mean number of life events experienced during the study period did distinguish patients ill from patients well at follow-up but with less success than has been claimed for onset. Further analysis took into account both the severity of life stress suffered and the time of its occurrence. This improved the discrimination. Both time of event occurrence and event severity were then included in a model of adversity in which it was postulated that event stress dissipates with time. Application of the model to the study data resulted in the statistical relationship between life stress and outcome being somewhat strengthened. The possible implications of this result for further research in life stress are discussed.
Although a large number of studies have addressed issues of etiology associated with stressful life events and diverse forms of disorder, little attention has been focused on the importance of such psychosocial parameters for the course and remission of symptoms once the disorder has begun. The authors review research on this latter topic, with special reference to the depressive disorders. A longitudinal study of 130 22–60 yr old unipolar depressive females receiving treatment was conducted. Results indicate that life events preceding entry into treatment significantly predicted certain forms of depressive symptomatology and of clinical outcome over a 6-mo follow-up period. In contrast, events occurring during the treatment and/or posttreatment period were not related to any of the depressive symptom outcome measures. Different subclassifications of events particularly may have relevance for the course and remission of symptoms in unipolar depressives under treatment. (51 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)