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Originalia

Subjektive Krankheitskonzepte bei depressiven Störungen

Längsschnittstudie einer rehabilitativen Maßnahme

Published Online:January 20, 2010https://doi.org/10.1026/0943-8149/a000006

Abstract

Zusammenfassung. Depressive Störungen sind ein weit verbreitetes und oft chronisches Gesundheitsproblem mit erheblichem Leiden des Individuums und hohen Gesundheitskosten. Die subjektiven Wahrnehmungen einer solchen Erkrankung korrelieren mit deren Bewältigung. Dies kann insbesondere für depressive Störungen angenommen werden, da bei Depressionen die dysfunktionalen kognitiven Bewertungsprozesse sowohl ätiologisch relevant sind als auch die Krankheitsbewältigung ungünstig beeinflussen. Diese Studie hat zum Ziel, Zusammenhänge zwischen Dimensionen der Krankheitskonzepte von Patientinnen und Patienten, der depressiven Symptomatik und positivem Affekt zu untersuchen. Dazu wurden 60 Patientinnen und Patienten einer stationären psychosomatischen Rehabilitationsmaßnahme sowohl im Quer- als auch im Längsschnitt bis zur dreimonatigen Katamnese nach Entlassung befragt. Die Studienteilnehmer wurden weiterhin randomisiert einer Expressiven Schreib- oder einer Kontrollbedingung zugeteilt, um die Effekte dieser Minimalintervention als adjunkte Maßnahme zu untersuchen. Die Ergebnisse zeigen, dass die Wahrnehmung des zeitlichen Verlaufs und des Schwergrads der Depression sowie die emotionalen Repräsentationen der eigenen Erkrankung mit vermehrten depressiven Symptomen assoziiert sind. Im Längsschnitt zeigt sich, dass die Ausprägung kontrollbezogener subjektiver Krankheitskonzepte mit unterschiedlichen Verläufen der depressiven Symptomatik und des Wohlbefindens über einen Zeitraum von 3 Monaten nach Beendigung des stationären Aufenthalts im Zusammenhang stehen. Die subjektiv erlebte Kohärenz des Krankheitskonzepts war nur mit dem Wohlbefinden, aber nicht mit Depression verbunden. Expressives Schreiben konnte in dieser kleinen Gruppe zusätzlich zum stationären Aufenthalt zwar keine signifikanten Verbesserungen erzielen, jedoch zeigt sich, dass Personen mit einer stark ausgeprägten Neigung zu emotionalen Repräsentationen tendenziell mehr vom Schreiben profitieren und dass sich dieser Effekt über die Zeit zu verstärken scheint.


Subjective illness representations in depressive disorder: A longitudinal study

Abstract. Depressive disorders are a wide spread and often chronic health problem leading to substantial impairment of the patient and elevated health-care costs. Illness representations are known to be correlated with the success in coping with the illness. This can be presumed particularly in the case of depression as here dysfunctional cognitive appraisal processes are not only linked to coping with the disease but also with its aetiology. This study aims at exploring associations between illness representation dimensions and depressive symptoms as well as positive affect reported by 60 inpatients of a psychosomatic rehabilitation-clinic cross-sectionally and in follow ups at discharge and 3 months after discharge. Furthermore, participants were randomly assigned to an expressive writing or control writing group in order to explore the effects of expressive writing as an adjunct therapy. Results show that the perceived time line, consequences, and emotional representations of the illness are associated with an increased number of depressive symptoms. Longitudinally, control-related beliefs at baseline were linked with the course of depression and positive affect at discharge and 3 months after. Coherence was only associated with positive affect and not with depressive symptoms. Even though expressive writing did not add significantly to the inpatient treatment in this small group, patients with elevated emotional representations tended to benefit from the expressive writing task, especially at the follow up points of measurement.

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