Faktori rizika za nastanak depresije u adolesceniciji iz ugla transakcionog stres modela kognitivne vulnerabilnosti

Abstract

Glavni cilj ove doktorske disertacije je da se ispitaju i utvrde uloge i povezanosti faktora rizika (kognitivne vulnerabilnosti, psihosocijalnih faktora rizika, socio- demografskih faktora) i klini č ke i subklini č ke depresije u okviru Transakcionog stres modela kognitivne vulnerabilnosti za depresiju. Proverili smo i statisti č ki dokazali pretpostavljenu povezanost ovih faktora sa depresijom u adolescenciji. Finalni uzorak istra ž ivanja č ine 412 adolescenta (61.7% ž enskog i 38.3% mu š kog pola) na uzrastu od 13-17 godina (M=15.70,SD = 1.22). Procedura uzorkovanja odvijala se u dve faze. Prva faza (pilot istra ž ivanje) , za potrebe provere pouzdanosti instrumenata sprovedena je na neklini č kom uzorku 282 adolescenta na uzrastu od 13-17 godina, u š kolama u Skoplju. Instrumenti su pokazali dobre psihometrijske karakteristike. U drugoj fazi, u dvogodi š njem periodu, glavno istra ž ivanje je sprovedeno u klinikama i š kolama u tri glavna centra socio-demografskih regiona u Makedoniji ( Š tip, Isto č ni region; Skoplje, Centralni region; Bitolj, Zapadni region). Formirane su tri grupe: klini č ka grupa, subklini č ka grupa i kontrolna grupa. Finalni uzorak č ine: klini č ka grupa, 139 (33.7%) ispitanika; subklini č ka grupa, 133 (32.3 %) ispitanika i 140 (34.0%) ispitanika u kontrolnoj grupi. Kriterijum za uklju č ivanje u klini č ki uzorak je ispunjavanje dijagnosti č kih kriterijuma DSM -IV- TR/DSM -V (APA, 2000; 2013) za unipolarne depresije bez psihoti č nih karakteristika (Velika depresija, Major Depression, MDD). Ispitanici iz subklini č kog uzorka imaju cut off skor za subklini č ku depresiju na BDI II, iznad 16 i ne ispunjavaju kriterijume prema M.I.N.I. kid intervjuu za veliku depresiju. Od preostalih adolescenata koji imaju niske skorove na BDI II, ispod cut–off skora za subklini č ku depresiju, i pomo ć u skrining M.I.N.I. kid intervjua, a na bazi dobijenih podataka iz liste osnovnih podataka, formirali smo kontrolni uzorak adolescenata. Ekskluzivni kriterijumi su bili: prisustvo organskih i psihoti č nih poreme ć aja; somatske bolesti; i IQ ispod 75. Svi ispitanici su popunili isti komplet instrumenata koji smo koristili za ovo istra ž ivanje. Faktori kognitivne vulnerabilnosti za depresiju (disfunkcionalni stavovi, negativan inferencijalni stil, ruminativni stil reagovanja), psihosocijalni faktori rizika, (negativni ž ivotni doga đ aji i percipirana socijalna podr š ka) i socio-demografski faktori (pol, uzrast i š kolski prosek) mereni su pomo ć u seta instrumenata. Primenili smo: Listu podataka za sve ispitanike; M.I.N.I. intervju (M.I.N.I. kid Screen / DSM-IV - TR/ Sheehan & Lecrubier, 2001/2006); Skalu disfunkcionalnih stavova (Dysfunctional Attitude Scale, DAS; Weissman & Beck, 1978); Upitnik kognitivnog stila adolescenata (Adolescent's Cognitive Style Questionnaire, ASCQ; Hankin & Abramson, 2002); Upitnik ruminativnog stila reagovanja (Ruminative Response Style Questionnaire, RSQ; Nolen-Hoeksema & Morrow,1993); Upitnik ž ivotnih doga đ aja adolescenata (Adolescent Life Events Questionnaire, ALEQ; Hankin & Abramson, 2002); Multidimenzionalnu skalu percipirane socijalne podr š ke (Multidimensional Scale of Perceived Social Support, M PS S ; Zimet, Dahlem, Zimet & Farley,1988) i Bekovu Skalu depresije (Beck Depression Inventory II, BDI-II; Beck, Steer , & Brown,1996). Statisti č ke analize su ra đ ene za svaku grupu posebno. Rezultati istra ž ivanja potvr đ uju da, u okviru Transakcionog stres modela kognitivne vulnerabilnosti depresije u adolescenciji, postoji zna č ajna povezanost izme đ u faktora rizika depresije s jedne strane, i nivoa simptoma depresije sa druge. Svi uklju č eni faktori rizika u modelu su jako me đ usobno povezani i imaju visoku interkorelaciju. Najve ć u korelaciju (negativna povezanost) sa nivoom simptoma depresije ima percipirana socijalna podr š ka , a najni ž u korelaciju (pozitivna povezanost) sa nivoom simptoma depresije imaju negativni ž ivotni doga đ aji u domenu romanti č ne veze. Jedino pol i uzrast nisu statisti č ki zna č ajno povezani sa nivoom simptoma depresije. Potvrdili smo i pretpostavljena o č ekivanja da su faktori rizika koji su bili predmet na š eg interesa zna č ajni prediktori nivoa simptoma depresije. Analiza tri prediktivna modela, za sve unesene faktore rizika i za svaku grupu posebno, pokazala je da najve ć u prediktivnu mo ć ima model klini č ke grupe (90.4%), zatim model subkl in i č ke grupe (89.5%) i model kontrolne grupe (86.8%). U klini č koj grupi kao najja č i prediktor iz grupe unesenih faktora rizika se pokazala niska precipirana socijalna podr š ka koja predvi đ a vi š i nivo simptoma depresije, a sa veoma nisk im negativnim vrednostima bete je prediktor uzrast. Analiza u subklini č koj grupi je pokazala da, isto kao i u klini č koj grupi, od grupe faktora rizika, percipirana socijaln a podr š ka je najja č i prediktor, a najslabiji je nizak š kolski prosek . Za kontrolnu grupu najja č i prediktor je negativan inferencijalni stil...

The main objective of this PhD thesis is to investigate and determine the role and relationship of risk factors (cognitive vulnerability, psychosocial risk factors, socio- demographic factors) and clinical and subclinical depression within the Cognitive vulnerability-Transactional stress model of depression. We checked and statistically proven the assumed association of these factors with depression in adolescen ce. The final survey sample consists of 412 adolescents (61.7% female and 38.3% male) aged 13-17 years (M = 15.70, SD = 1.22). The sampling procedure was carried out in two phases. The first phase (pilot study) , for the purpose of checking the reliability of the instruments, was conducted on a non-clinical sample of 282 adolescent s, between the ages of 13-17 in schools in Skopje. The instruments showed good psychometric properties . In the second phase , in a two- year period , the main research was conducted in clinics and schools in the three main centers of socio-demographic regions in Macedonia (Stip, Eastern Region, Skopje, Central Region; Bitola, Western Region). Three groups were formed: a clinical group, a subclinical group and a control group. The final sample consisted of: the clinical group 139 (33.7%) respondents; the subclinical group, 133 (32.3%) respondents and 140 (34.0%) respondents in the control group. The criterion for inclusion in the clinical sample was the fulfillment of the diagnostic criteria of DSM-IV-TR / DSM-V (APA, 2000; 2013) for unipolar depression without psychotic features (Major Depression, MDD). The respondents from subclinical sample have the cut off score for subclinical depression on the BDI II, over 16 and do not fulfill the criteria of the MINI kid interview for Major Depression. Of the remaining adolescents who have low scores on BDI II, below the cut-off score for subclinical depression, and by screening with MINI kid interviews, based on the data obtained from the list of basic data, we formed a control sample of adolescents. The exclusive criteria were: the presence of organic and psychotic disorders; somatic diseases; and IQ below 75. All respondents completed the same set of instruments that we used for this study. Cognitive vulnerability factors for depression (dysfunctional attitudes, negative inferential style, ruminative response style), psychosocial risk factors (negative life events and perceived social support) and socio-demographic factors (gender, age and school average success) were measured by a set of instruments. We applied: Data sheet for all respondents; M.I.N.I. Interview (MINI kid Screen / DSM-IV - TR / Sheehan & Lecrubier, 2001/2006); Dysfunctional Attitude Scale (DAS, Weis sman & Beck, 1978); Adolescent's Cognitive Style Questionnaire (ASCQ, Hankin & Abramson, 2002); Ruminative Response Style Questionnaire (RSQ, Nolen-Hoeksema & Morrow, 1993); Adolescent Life Events Questionnaire (ALEQ, Hankin & Abramson,2002); Multidimensional Scale of Perceived Social Support (M PS S, Zimet, Dahlem, Zimet & Farley, 1988) and Beck Depression Inventory II ( BD-II, Beck, 1996). Statistical analyses were performed for each group separately. The survey results confirm that within the Cognitive vulnerability-Transactional stress model of depression in adolescence, there is a significant association between risk factors of depression on the one hand, and the level of symptoms of depression, on the other. All risk factors included in the model are strongly connected to each other and have a high inter- correlation. The perceived social support has the highest correlation (negative correlation) with the level of symptoms of depression, and negative life events in the domain of romantic relationships have the lowest correlation (positive correlation) with the level of symptoms of depression. Only gender and age were not significantly associated with the level of symptoms of depression. We have also confirmed the presumed expectations that the risk factors that have been the subject of our interest are significant predictors of levels of depression symptoms. The analysis of the three predictive models for all input risk factors and for each group separately showed that the model of the clinical group (90.4%) has the highest predictive power, followed by the model of the subclinical group (89.5%) and the model of the control group (86.8%). In the clinical group the strongest predictor in the group of input risk factors is the low perceived social support which anticipates a higher level of depression symptoms, and the predictor age is with a very low negative values of beta. The analysis of the subclinical group has shown that, the same as in the clinical group, in the group of risk factors, the perceived social support is the strongest predictor, and the lowest is the low academic average . For the control group , the strongest predictor is the negative inferential style ...