PDF(Pubmed)
Abstract：
Major depressive disorder (MDD) is a common, seriously impairing, and often recurrent mental disorder. Based on the predictions of the Circumplex Model of Marital and Family Systems and the Common-Sense Self-Regulation Model, the aim of the present prospective study is to examine the predictive value of clinical outcomes of a process model in which associations between perceived family functioning and patient\'s clinical outcomes (i.e., symptom severity and suicide risk) are mediated by illness representations and coping strategies. A total of 113 patients with a clinical diagnosis of MDD (16.8% males and 83.2% females) aged 47.25 ± 13.98 years and recruited from the outpatient department and the mobile mental health unit of the Psychiatric Clinic of the University Hospital of Heraklion in Crete, Greece, and from a Greek online depression peer-support group participated in the study. Family functioning was assessed in terms of cohesion and flexibility (Family Adaptability and Cohesion Evaluation Scales IV) at baseline. Illness representations (Illness Perception Questionnaire-Mental Health) and coping strategies (Brief Cope Orientation to Problems Experienced) were measured about five months later (5.04 ± 1.16 months). Symptom severity (Beck Depression Inventory) and suicidality (Risk Assessment Suicidality Scale) were measured about 10 months after the baseline assessment (9.56 ± 2.52 months). The results indicated that representations about MDD impact and symptom severity serially mediated the association between family cohesion and suicide risk in MDD. Furthermore, family cohesion was found to be linked with maladaptive coping through MDD impact representations. Family-based psychotherapeutic interventions specifically designed to target unhealthy family functioning, along with negative illness perceptions and dysfunctional coping, could be further developed and explored as adjunctive therapy to standard treatment in MDD.
摘要：
重度抑郁症（MDD）是一种常见的，严重损害，经常反复发作的精神障碍。基于婚姻和家庭系统的环绕模型和常识自我调节模型的预测，本前瞻性研究的目的是检查过程模型对临床结果的预测价值，在该过程模型中，感知的家庭功能与患者的临床结果之间存在关联(即，症状严重程度和自杀风险)是由疾病表征和应对策略介导的。共有113名临床诊断为MDD的患者（男性16.8％，女性83.2％），年龄为47.25±13.98岁，从克里特岛伊拉克利翁大学医院精神病诊所的门诊部和流动精神卫生部门招募，希腊,来自希腊的在线抑郁症同伴支持小组参与了这项研究。在基线时，根据凝聚力和灵活性（家庭适应性和凝聚力评估量表IV）评估家庭功能。大约五个月后（5.04±1.16个月）测量了疾病表征（疾病感知问卷-心理健康）和应对策略（对所经历问题的简要应对方向）。在基线评估后约10个月（9.56±2.52个月）测量症状严重程度（贝克抑郁量表）和自杀程度（风险评估自杀程度量表）。结果表明，有关MDD影响和症状严重程度的表述连续介导了MDD中家庭凝聚力与自杀风险之间的关联。此外，通过MDD影响表征，发现家庭凝聚力与适应不良应对有关。以家庭为基础的心理治疗干预措施，专门针对不健康的家庭功能，伴随着负面的疾病认知和功能失调的应对，可以进一步开发和探索作为MDD标准治疗的辅助治疗。
