| Abstract | Depresija je ozbiljno zdravstveno stanje u kojem oboljele osobe doživljavaju trpnju, te nisu sposobne funkcionirati adekvatno u poslovnom, obrazovnom i obiteljskom okruženju. Istraživanja individualnih čimbenika otpornosti, socijalne podrške i strategija suočavanja sa stresom danas donose nova znanja o psihološkom, socijalnom i neurobiološkom funkcioniranju osoba u riziku. Cilj ovog istraživanja jest istražiti doprinos čimbenika individualne otpornosti, percipirane socijalne podrške i strategija suočavanja sa stresom (zaštiti čimbenici) i socijalne funkcionalnosti (ishod) oboljelih od depresije (rizik). U istraživanje je uključeno 310 sudionika kojima je dijagnoza depresije prva dijagnoza, te se liječe u Zavodu za afektivne poremećaje i Zavodu za psihoterapiju Klinike za psihijatriju Vrapče, u razdoblju između listopada 2019. i prosinca 2019. godine. Sudionici istraživanja liječili su se u hospitalnom, dnevnobolničkom i ambulantnom tretmanu. Za mjerenje rizika korišten je Beckov inventar depresije (BDI-II) i Upitnik nepovoljnih iskustava u djetinjstvu (ACE). Za mjerenje zaštitnih čimbenika korišteni su: Skala procjene čimbenika individualne otpornosti (CD-RISC-25), Multidimenzionalna skala percipirane socijalne podrške (MSPPS) i Upitnik strategija suočavanja sa stresom (COPE). Ishod oboljelih od depresije mjeren je Upitnikom za procjenu funkcionalnosti u depresiji (FAD).
U skladu s istraživačkim pitanjima važno je istanuti sljedeće:
1. Istražen je odnos između razina depresije i nepovoljnih iskustava u djetinjstvu. Rezultati su pokazali kako pojedinci koji su imali više nepovoljnih iskustava u djetinjstvu u kasnijem životu imaju višu razinu depresije. Razlike među grupama sudionika različite razine depresije su statistički značajne. Pojedinci s teškom depresijom naveli su da su tijekom djetinjstva prosječno doživjeli 3,50 nepovoljnih iskustava, dok su pojedinci s nižim razinama depresije naveli da su doživjeli između 2,09 i 2,50 nepovoljna iskustva u djetinjstvu.
2. Istražen je odnos između strategija suočavanja sa stresom, individualnih čimbenika otpornosti i percipirane socijalne podrške kod oboljelih od depresije. Rezultati ukazuju kako postoji povezanost između individualnih čimbenika otpornosti pojedinca i percipirane socijalne podrške. Povezanost različitih oblika socijalne podrške (podrška obitelji, podrška prijatelja, podrška značajnih drugih, te ukupna socijalna podrška) i razine individualnih čimbenika
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otpornosti je niska do umjerena. Pojedinci koji doživljavaju veću razinu svih oblika socijalne podrške ujedno izvještavaju i o više čimbenika otpornosti. Kao najbolji prediktori ističu se podrška značajnih drugih i podrška prijatelja, dok se podrška obitelji nije pokazala značajnom odrednicom otpornosti.
Nadalje, rezultati pokazuju kako postoji visoka povezanost između proaktivnih strategija suočavanja sa stresom i čimbenicima otpornosti. Pojedinci koji koriste proaktivne strategije suočavanja sa stresom, odnosno suočavanje usmjereno na problem (facet: pozitivna interpretacija i rast ličnosti, aktivno suočavanje, planiranje, prihvaćanje, obuzdavanje suočavanja, te potiskivanje kompeticijskih aktivnosti) ujedno imaju i višu razinu individualnih čimbenika otpornosti. Pojedinci s više individualnih čimbenika otpornosti ujedno koriste i proaktivnije strategije suočavanja sa stresom.
3. Istražena je povezanost razine depresije i nepovoljnih iskustava u djetinjstvu i socijalnog funkcioniranja oboljelih od depresije. Koeficijent korelacije smanjene kvalitete socijalnog funkcioniranja i razine depresije ukazuje kako sudionici istraživanja koji imaju lošiju kvalitetu socijalnog funkcioniranja ujedno imaju i višu razinu depresije, odnosno sudionici svrstani u kategorije više razine depresije imaju i više poteškoća u socijalnom funkcioniranju. Nadalje, sudionici koji imaju lošiju kvalitetu socijalnog funkcioniranja ujedno izvještavaju i o većem broju nepovoljnih iskustava u djetinjstvu.
4. Ispitano je kojim putevima individualni čimbenici otpornosti, percipirana socijalna podrška i strategije suočavanja sa stresom ostvaruju medijatorski efekt u odnosu između razine depresije/ intenziteta nepovoljnih iskustva iz djetinjstva i kvalitete funkcioniranja oboljelih od depresije. Provedena je hijerarhijska regresijska analiza, te je potvrđen djelomičan medijacijski utjecaj individualnih čimbenika otpornosti, socijalne podrške i proaktivnih strategija suočavanja sa stresom na odnos depresije i kvalitete funkcioniranja u depresiji. Djelomičan medijacijski utjecaj ostvaren jedino preko socijalne podrške jer z-vrijednost utvrđena za taj medijator nadilazi graničnu vrijednost od zgr = 1,96. Percipirana socijalna podrška je jedini značajan medijator preko kojeg se ostvaruje efekt depresivnosti na kvalitetu funkcioniranja u depresiji. Depresivnost djeluje izravno na kvalitetu funkcioniranja u depresiji, ali i posredno, preko socijalne podrške. Pojedinci s izraženijom depresijom imaju i sniženu kvalitetu funkcioniranja u depresiji. Sama depresivnost može biti direktno odgovorna za lošiju kvalitetu funkcioniranja u depresiji (izravan put), ali ipak se dio tog efekta ostvaruje se i kroz socijalnu podršku, na način da depresivnost umanjuje socijalnu podršku, koja potom dovodi i do
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smanjenja kvalitete funkcioniranja u depresiji (medijatorski efekt). Nadalje, nije potvrđen medijacijski utjecaj individualnih čimbenika otpornosti, socijalne podrške i proaktivnih strategija suočavanja sa stresom na odnos nepovoljnih iskustava u djetinjstvu i kvalitete funkcioniranja u depresiji. Efekt nepovoljnih iskustava u djetinjstvu i kvalitete funkcioniranja u depresiji je izravan te ne ovisi o utjecaju medijacijskih varijabli. Nepovoljna iskustava u djetinjstvu imaju izravan učinak na smanjenje kvalitete funkcioniranja u depresiji.
Predlažu se nova istraživanja koja bi detaljnije i longitudinalno provjeravala utjecaj individualnih čimbenika otpornosti, socijalne podrške i strategija suočavanja sa stresom na ishode hospitalnog, dnevnobolničkog i/ili ambulantnog tretmana. Rezultati takvih istraživanja dali bi nove spoznaje koje bi se mogle implementirati u razvoj intervencija/kliničkih praksi utemeljenih na dokazima kao i razvoj intervencija utemeljenih na dokazima u području prevencije depresije. |
| Abstract (english) | Depression is a serious condition in which patients experience suffering and are unable to function at work, in the educational environment or in a family. Research of individual resilience factors, social support and coping strategies provide us with new knowledge of psychological, social and neurobiological functioning of persons at risk. The objective of this research is to examine the contribution of the factors of individual resilience, perceived social support, stress coping strategies (protective factors) and social functionality (outcome) of the patients suffering from depression (risk). The research included 310 participants with depression as their primary diagnosis, who received treatment at the Department of Affective Disorders and the Department of Psychotherapy of Vrapče University Psychiatric Hospital, between October 2019 and December 2019. Research participants were treated as hospital patients, day hospital patients and outpatients. For the purpose of measuring risk, Beck’s Depression Inventory (BDI-II) was used, as well as an Adverse Childhood Experience (ACE) Questionnaire. For measuring protective factors, the following was used: Connor – Davidson Resilience Scale (CD-RISC-25), Multidimensional Scale of Perceived Social Support (MSPPS) and the Coping Orientation to Problems Experienced (COPE). The outcome of patients suffering from depression was measured using the Functional Assessment of Depression Questionnaire (FAD).
In line with the research questions, the following conclusions have been made:
1. The relation between depression levels and adverse childhood experiences was studied. The results have shown that individuals who had more adverse experience in their childhood experienced greater levels of depression later on in their lives. The differences between participant groups with different depression levels are statistically significant. Individuals suffering from severe depression reported 3.5 adverse experiences in their childhood on average, whereas those with lower level depressions experienced between 2.09 and 2.50 such experiences.
2. The relationship between stress coping strategies, individual resilience factors and perceived social support among patients suffering from depression was examined. The results point to a connection between individual’s resilience factors and the perceived social support. The connection between different types of social support (the support of the family, friends, significant others, and overall social support) and the level of individual resilience factors is
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low to moderate. Individuals experiencing greater level of all types of social support reported more resilience factors as well. The best predictors are the support received from significant others and friends, whereas family support did not prove to be a significant factor of resilience.
Furthermore, the results point to a great connection between proactive stress coping strategies and resilience factors. Individuals who use proactive stress coping strategies, that is, face the problem directly (facet: positive reinterpretation and personality growth, active coping, planning, acceptance, restraint and supressing competing activities) also had a greater level of individual resilience factors. Those individuals also used more proactive stress coping strategies.
3. The connection between depression levels, adverse childhood experience and social functioning of the patients suffering from depression was also examined. The correlation coefficient of lower quality of social functionality and depression level indicates that research participants with lower quality of social functionality demonstrated a higher depression level, and also had greater difficulty in social functionality. In addition, participants with lower quality of social functionality reported a greater number of adverse childhood experiences.
4. The paths of individual resilience factors, the perceived social support and stress coping strategies achieve a mediator effect in the relations between depression levels / intensity of adverse childhood experience and the quality of functioning of the patients suffering from the depression. A hierarchical regression analysis was carried out, and the partial mediation impact of individual resilience factors, social support and proactive stress copping strategies was confirmed in the relation between depression and the quality of functioning in the depression. A partial mediation impact was achieved only through social support, as the z-score determined for that mediator exceeds the limit value of zgr = 1.96. It can therefore be concluded that the perceived social support is the only significant mediator that achieves the effect of depression on the quality of functioning in depression. Depression has a direct impact on the quality of functioning, as well as an indirect one, through social support. Individuals with emphasised depression showed a lower quality of functioning in depression. The depression itself can be directly responsible for a poorer quality of functioning (direct path), but a part of the effect is also achieved through social support, in the way that depression reduces such support, which in turn leads to the reduced quality of functioning (mediator effect). Furthermore, the mediation effect of individual resilience factors, social support and proactive stress coping strategies on the relations between adverse childhood experience and the quality of functioning in depression has not been confirmed. The effects of adverse childhood experiences and the quality of functioning in depression is direct and does not depend on the impact of mediation variables.
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Adverse childhood experiences have a direct impact on the reduced quality of functioning in depression.
It is proposed to conduct a new research that would examine longitudinally and in more detail the impact of individual resilience factors, social support and stress coping strategies on the outcomes of hospital, day hospital and/or outpatient treatment. The results of research would provide new insights that could be implemented in the development of evidence-based interventions/clinical practice, as well as the development of interventions based on evidence in the area of depression prevention. |
