Najeeb Bahjat, Malik Muhammad Faisal Amir, Nizami Asad T, Yasir Sadia
Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, PAK.
Cureus. 2023 Mar 13;15(3):e36102. doi: 10.7759/cureus.36102. eCollection 2023 Mar.
Psychosocial and cultural factors play an important, but often neglected, role in depression in young individuals. In this article, we present two cases of young, educated males with major depressive disorder and prominent themes of guilt and spiritual distress. We explore the relationship between moral incongruence, spiritual distress, and feelings of guilt with major depressive episodes by presenting two cases of depression in young individuals who were high-achieving students. Both cases presented with low mood, psychomotor slowing, and selective mutism. Upon detailed history, spiritual distress and feelings of guilt due to internet pornographic use (IPU) and the resulting self-perceived addiction and moral incongruence were linked to the initiation and progression of major depressive episodes. The severity of the depressive episode was measured using the Hamilton Depression Scale (HAM-D). Themes of guilt and shame were measured using the State of Guilt and Shame Scale (SSGS). High expectations from the family were also a source of stress. Hence, it is important to keep these factors in mind while managing mental health problems in young individuals. Late adolescence and early adulthood are periods of high stress and vulnerabe to mental illness. Psychosocial determinants of depression in this age group generally go unexplored and unaddressed leading to suboptimal treatment, particularly in developing countries. Further research is needed to assess the importance of these factors and to determine ways to mitigate them.
社会心理和文化因素在年轻人的抑郁症中起着重要但常常被忽视的作用。在本文中，我们呈现了两例患有重度抑郁症的年轻高学历男性病例，其中内疚和精神痛苦的主题较为突出。通过介绍两例成绩优异的年轻抑郁症患者病例，我们探讨了道德不一致、精神痛苦以及内疚感与重度抑郁发作之间的关系。两例患者均表现出情绪低落、精神运动迟缓以及选择性缄默症。经详细问诊，因使用网络色情内容（IPU）导致的精神痛苦和内疚感，以及由此产生的自我认知成瘾和道德不一致，与重度抑郁发作的起始和进展相关。使用汉密尔顿抑郁量表（HAM-D）来衡量抑郁发作的严重程度。使用内疚与羞耻状态量表（SSGS）来衡量内疚和羞耻的主题。来自家庭的高期望也是压力的一个来源。因此，在处理年轻人的心理健康问题时牢记这些因素很重要。青春期后期和成年早期是压力较大且易患精神疾病的时期。这个年龄组中抑郁症的社会心理决定因素通常未被探索和解决，导致治疗效果不佳，尤其是在发展中国家。需要进一步研究以评估这些因素的重要性并确定减轻它们的方法。
