背景:根据疾病表征的常识模型,疾病信念,比如因果归因,可以影响人们评估和应对疾病的方式,反之亦然。迄今为止,抑郁症状患者的因果归因主要是横断面研究,定量和独立。这项研究的目的是研究抑郁症状患者随时间的稳定性的因果归因,依赖治疗经验,和因果概念的区分。
方法:在基于人群的前瞻性样本中,至少有轻度抑郁症状(PHQ-9评分≥5分)的患者在T0和12个月后(T1)接受了电话访谈.使用简短的疾病感知问卷评估因果归因。在使用演绎归纳法对开放反应进行定性分析后,通过比较两个时间点之间的答案,评估了因果归因和概念随时间的稳定性.随后使用卡方检验进行探索性定量分析,t检验,和逻辑回归分析。
结果:共有471名个体(年龄M=53.9,53.6%为女性),PHQ-9平均得分为8.4分。与参与者社会环境相关的因果归因,workplace,过去是最稳定的。然而,有和没有时间稳定的因果概念的个体在社会人口统计学特征方面没有差异,抑郁症状的严重程度,合并症的风险,和治疗经验。总的来说,抑郁症状患者的因果概念似乎非常不同。与没有治疗经验的人相比,有治疗经验的人(M=2.21,SD=0.80)的因果归因明显更多(M=1.98,SD=0.81,t(471)=-3.060,p<0.01)。此外,逻辑回归分析显示,有治疗经验的受访者更有可能归因于“童年/青年/父母家庭”和“易感性”。
结论:我们的研究表明,有治疗经验的人倾向于报告治疗一致的因果归因,比如童年和家庭环境,以及易感性,更频繁。了解因果归因和概念是如何形成和变化的,有助于解决治疗中的因果归因。未来的研究应考虑采用定性调查方法探索因果归因的好处。
BACKGROUND: According to the Common-Sense Model of Illness Representations, illness beliefs, such as causal attributions, can influence the way people assess and cope with their illness and vice versa. To date, causal attributions in people with depressive symptoms have been studied mainly cross-sectionally, quantitatively and independently. The purpose of this study is to examine the causal attributions of people with depressive symptoms in terms of their stability over time, dependence on treatment experience, and differentiation of causal concepts.
METHODS: In a population-based prospective sample, people with at least mild depressive symptoms (PHQ-9 Score ≥ 5) were interviewed via telephone at T0 and twelve months later (T1). Causal attributions were assessed using the Brief Illness Perception Questionnaire. After the open responses were qualitatively analysed using a deductive-inductive approach, stability over time was assessed for causal attributions and concepts by comparing answers between the two time points. Subsequent exploratory quantitative analyses were conducted using chi-square tests, t-tests, and logistic regression analyses.
RESULTS: A total of 471 individuals (age M = 53.9, 53.6% female) with a mean PHQ-9 Score of 8.4 were included in the analyses. Causal attributions related to participants\' social environment, workplace, and past are the most stable over time. However, individuals with and without a time-stable causal concept showed no differences in terms of sociodemographic characteristics, severity of depressive symptoms, risk of comorbidity, and treatment experiences. Overall, the causal concepts of people with depressive symptoms appear to be very diverse. Those with treatment experience (M = 2.21, SD = 0.80) named significantly more causal attributions compared to people without treatment experience (M = 1.98, SD = 0.81, t(471) = -3.060, p < 0.01). In addition, logistic regression analyses revealed that treatment-experienced respondents were more likely to attribute \"childhood/youth/parental home\" and \"predisposition\".
CONCLUSIONS: Our study reveals that people with treatment experience tend to report treatment-congruent causal attributions, such as childhood and family environment, as well as predisposition, more frequently. Understanding how causal attributions and concepts are formed and change can be helpful for addressing causal attributions in treatment. Future studies should take into account the benefits of employing qualitative survey methods for exploring causal attributions.