Psychosocial factors and depression in torticollis.

Sixty-seven patients suffering from spasmodic torticollis, a neurological disorder in which involuntary contractions of the head produce an abnormal head posture, completed a booklet of questionnaires aiming to assess psychosocial adjustment. Twenty-four per cent of the patients were moderately to severely depressed. Overall, as a sample the patients were not acceptant of or adjusted to their illness. Cognitive and emotion-focused strategies were slightly more widely used than instrumental ways of coping. Both adaptive and maladaptive coping strategies were more frequently used by female than male sufferers. The number of individuals who were potential sources of social support was not high (mean = 2.7, SD = 1.2). The patients were, however, generally satisfied with the available support. Self-depreciation, lack of control over head position/movement and the resulting disability in activities of daily living, lack of satisfaction with available social support, and the use of maladaptive coping strategies accounted for 75% of the variance of depression in torticollis. Self-depreciation, which was the most salient predictor of depression in torticollis, accounting for 59% of its variance, was itself shown to arise from the patient's negative body concept relating to the postural abnormality of the head. As the severity of illness and resulting disability contributed to depression, successful symptomatic treatment of torticollis would be expected to ameliorate mood. However, as the currently available medical treatments are not effective for all treated cases, and as the self-depreciation resulting from a negative body concept formed the core of depression in torticollis, cognitive-behavioural therapy could improve the quality of life of the depressed torticollis patient.