Ghatavi Kayhan, Nicolson Rob, MacDonald Cathy, Osher Sue, Levitt Anthony
Sunnybrook and Women's College Health Sciences Centre, Ontario, Toronto, Canada.
J Affect Disord. 2002 Apr;68(2-3):307-15. doi: 10.1016/s0165-0327(01)00335-4.
Although guilt is a widely accepted feature of depression, there is limited and inconsistent data defining the nature of this symptom. The purpose of the current study was to examine the specificity and nature of guilt in subjects with major depression as compared to patients with another chronic medical illness and healthy controls.
Outpatients with current major depressive episode (MDE; n=34), past-MDE (n=22), chronic cardiac illness (n=20) and healthy controls (n=59) were administered the following measures: The Guilt Inventory (GI), State Shame and Guilt Scale (SSGS), 17-item Hamilton Rating Scale for Depression (Ham-D) and the Structured Clinical Interview for DSM-IV.
Overall multivariate analysis of covariance comparing mean scores for the six guilt subscales [state-guilt, trait-guilt, moral standards (from the GI); state-guilt, -pride, and -shame (from the SSGS)] across the four groups was significant (F=9.1, df=6:121, p<0.0001). Post-hoc analysis revealed the following differences (each at least p<0.01): for state-guilt (GI), current-MDE>past-MDE>cardiac=healthy controls; for trait-guilt (GI), current-MDE=past-MDE>cardiac=healthy controls; for state-shame, -guilt and -pride (SSGS), current-MDE>past-MDE, past-MDE=cardiac, past-MDE>healthy, cardiac=healthy controls. Among depressed patients, there was significant correlation between Ham-D score and all guilt sub-scales (p<0.01), except moral standards.
The cardiac group may have less illness burden than currently depressed.
State expression of guilt, shame and low pride distinguish acutely depressed from all other groups, and are highly influenced by severity of depression. Trait-guilt does not differentiate acute from past depressed. Data suggests guilt may represent both an enduring and fluctuating feature of depressive illness over its longitudinal course.
尽管内疚是抑郁症广泛认可的一个特征，但界定该症状本质的数据有限且不一致。本研究的目的是，将重度抑郁症患者的内疚特异性及本质，与患有其他慢性疾病的患者及健康对照者进行比较。
对当前患有重度抑郁发作（MDE；n = 34）、既往有MDE（n = 22）、患有慢性心脏病（n = 20）以及健康对照者（n = 59）的门诊患者进行以下测量：内疚量表（GI）、状态羞耻与内疚量表（SSGS）、17项汉密尔顿抑郁评定量表（Ham-D）以及《精神疾病诊断与统计手册》第四版（DSM-IV）结构化临床访谈。
对四组患者六个内疚分量表（状态内疚、特质内疚、道德标准（来自GI）；状态内疚、自豪和羞耻（来自SSGS））的平均得分进行总体多变量协方差分析，结果具有显著性（F = 9.1，自由度= 6:121，p < 0.0001）。事后分析显示了以下差异（每项至少p < 0.01）：对于状态内疚（GI），当前MDE组>既往MDE组>心脏病组=健康对照组；对于特质内疚（GI），当前MDE组=既往MDE组>心脏病组=健康对照组；对于状态羞耻、内疚和自豪（SSGS），当前MDE组>既往MDE组，既往MDE组=心脏病组，既往MDE组>健康对照组，心脏病组=健康对照组。在抑郁症患者中，除道德标准外，Ham-D得分与所有内疚分量表之间均存在显著相关性（p < 0.01）。
心脏病组的疾病负担可能低于当前抑郁症患者。
内疚、羞耻和低自尊的状态表达将急性抑郁症患者与所有其他组区分开来，并且受抑郁症严重程度的高度影响。特质内疚无法区分急性抑郁症患者与既往抑郁症患者。数据表明，内疚可能代表了抑郁疾病在其病程中的一个持久且波动的特征。
