Faktori rizika za nastanak depresije u adolesceniciji iz ugla transakcionog stres modela kognitivne vulnerabilnosti
Risk factors of depression occurrence in adolescence from the perspective of the Cognitive vulnerability - transactional stress model
Doktorand
Miloševa, Lenče Z.Mentor
Vukosavljević-Gvozden, TatjanaČlanovi komisije
Mitić, MarijaBaucal, Aleksander
Opačić, Goran
Metapodaci
Prikaz svih podataka o disertacijiSažetak
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 sproved...eno
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 wa...s 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
...