Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States.
J Affect Disord. 2020 Feb 15;263:472-479. doi: 10.1016/j.jad.2019.11.144. Epub 2019 Nov 30.
This study examined whether patients with hopelessness and those without may significantly differ regarding their main presentations and clinical course in a large Italian population.
The recruited sample included 583 currently euthymic outpatients with major affective disorders. The Beck Hopelessness Scale (BHS) assessed hopelessness using a cutoff score of 9 or higher. Participants were categorized based on the presence/absence of hopelessness. A binary logistic regression analysis -accounting for age and gender and considering history of psychotherapy, emotional/physical abuse, depressive symptoms, Toronto Alexithymia Scale (TAS) total score, difficulties identifying and communicating feelings as potential predictors- was carried out in order to detect the variables associated with hopelessness.
Individuals with hopelessness, compared to those without, were more likely to be older (p=0.005), females (p=0.01), to have a unipolar depressive disorder (p≤0.05), be prescribed antidepressants and psychotherapy in the past (p=0.001 and p≤0.05). Moreover, individuals with hopelessness scored higher on the Montgomery-Asberg Depression Rating Scale (p≤0.05) and on the emotional (p=<0.001), physical abuse (p≤0.01) and physical neglect (p≤0.05) subscales of the Childhood Trauma Questionnaire - Short form, and reported more difficulties identifying (p≤0.001) and communicating feelings (p≤0.001) than those without hopelessness. The multivariate analysis showed that having difficulties identifying feelings is independently associated with hopelessness.
These findings indicate that individuals with difficulties identifying feelings are at higher risk of hopelessness and of negative outcomes. Further studies need to explore the impact of alexithymia on hopelessness and clinical outcomes in the lifetime illness course.
本研究旨在探讨在意大利的大样本人群中，有无绝望感的患者在主要表现和临床病程方面是否存在显著差异。
本研究招募了 583 名目前处于轻躁期的重性情感障碍门诊患者。采用贝克绝望量表（BHS）评估患者的绝望感，得分≥9 分者被归为有绝望感组，<9 分者被归为无绝望感组。采用二元逻辑回归分析（校正年龄和性别，考虑心理治疗史、情感/躯体虐待史、抑郁症状、多伦多述情障碍量表（TAS）总分、识别和表达情感困难情况作为潜在预测因素），以确定与绝望感相关的变量。
与无绝望感者相比，有绝望感者更可能为女性（p=0.01）、年龄较大（p=0.005）、患有单相抑郁障碍（p≤0.05）、既往接受过抗抑郁药治疗和心理治疗（p=0.001 和 p≤0.05）。此外，有绝望感者的蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评分更高（p≤0.05），且童年创伤问卷-短式量表的情感虐待（p<0.001）、躯体虐待（p≤0.01）和躯体忽视（p≤0.05）分量表评分更高，识别（p≤0.001）和表达情感（p≤0.001）的困难也更多。多变量分析显示，识别情感困难与绝望感独立相关。
这些发现表明，识别情感困难的个体有更高的绝望感和负面结局风险。进一步的研究需要探讨述情障碍对绝望感和全病程临床结局的影响。
