Empowerment und Stigma als Mediatorvariablen zwischen Krankheitsschwere und Lebensqualität bei Patienten mit einer affektiven Erkrankung

Zusammenfassung

Ziel Die Analyse der Effekte von Empowerment und Stigma auf den Zusammenhang von Depressivität und subjektiver Lebensqualität bei Patienten mit affektiven Erkrankungen.

Methodik Messung von Depressivität (BDI-II), internalisiertem und wahrgenommenem Stigma (ISMI; PDDQ), Empowerment (EPAS) und subjektiver Lebensqualität (WHOQOL-BREF) bei 37 Patienten mit affektiver Erkrankung.

Ergebnisse Empowerment und in geringem Maße Stigmatisierung erwiesen sich als vermittelnde Variablen zwischen Depressivität und Lebensqualität.

Schlussfolgerung Empowerment hat einen bedeutenden Einfluss als Mediator zwischen Depressivität und Lebensqualität.

Abstract

Objective The investigation of mediating effects of empowerment and stigmatization on the association between depressive symptoms and subjective quality of life in patients with affective disorders.

Method Depressive Symptoms (BDI-II), internalized and perceived stigmatization (ISMI; PDDQ), empowerment (EPAS) and subjective quality of life (WHOQOL-BREF) were assessed in 37 patients with affective disorders (F31 – F33; ICD-10), age 18+ in inpatient, day hospital or outpatient psychiatric treatment. Data analyses were conducted by means of path-analysis.

Results Empowerment and in low proportion internalized and perceived stigma turned out to be mediating variables between the severity of depression and subjective quality of life. 57 % of the variance of the subjective quality of life could be explained by the path model.

Conclusion Empowerment has meaningful influence mediating between depression and subjective quality of life. In order to improve the quality of life of patients with an affective disorder, strategies for increasing empowerment are to be integrated into treatment.

Schlüsselwörter

Depression - Empowerment - Lebensqualität - Stigma

Keywords

depression - empowerment - quality of life - stigma

• Literatur

• 1 Berlim MT, McGirr A, Fleck MP. Can sociodemographic and clinical variables predict the quality of life of outpatients with major depression?. Psychiatry Res 2008; 160: 364-371
• 2 Zikić O, Tosić-Golubović S, Slavković V. Quality of life of patients with unipolar depression. Med Pregl 2010; 63: 113-116
• 3 Angermeyer MC, Holzinger A, Matschinger H. et al. Depression and quality of life: Results of a follow-up study. International Journal of Social Psychiatry 2002; 48: 189-199
• 4 Brieger P, Röttig S, Marneros A. Quality of Life in Unipolar Depressive and Bipolar Affective Patients. Psychiat Prax 2004; 31: 304-309
• 5 Cramer V, Torgersen S, Kringlen E. Mood disorders and quality of life. A community study. Nordic Journal of Psychiatry 2010; 64: 58-62
• 6 Hsiung P, Pan A, Liu S. et al. Mastery and stigma in predicting the subjective quality of life of patients with schizophrenia in Taiwan. Journal of Nervous and Mental Disease 2010; 198: 494-500
• 7 Yen C, Chen C, Lee Y. et al. Self-Stigma and Its Correlates Among Outpatients With Depressive Disorders. PS 2005; 56: 599-601
• 8 Rose T, Joe S, Lindsey M. Perceived Stigma and Depression among Black Adolescents in Outpatient Treatment. Child Youth Serv Rev 2011; 33: 161-166
• 9 Pyne JM, Kuc EJ, Schroeder PJ. et al. Relationship between perceived stigma and depression severity. Journal of Nervous and Mental Disease 2004; 192: 278-283
• 10 Schomerus G, Schwahn C, Holzinger A. et al. Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica 2012; 125: 440-452
• 11 Angermeyer MC, Matschinger H, Schomerus G. 50 Jahre psychiatrische Einstellungsforschung in Deutschland. Psychiat Prax 2017; 44: 377-392
• 12 Pescosolido BA. The public stigma of mental illness: What do we think; what do we know; what can we prove?. Journal of Health and Social behavior 2013; 54: 1-21
• 13 Brohan E, Gauci D, Sartorius N. et al. Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: The GAMIAN–Europe study. J Affect Disord 2011; 129: 56-63
• 14 Krajewski C, Burazeri G, Brand H. Self-stigma, perceived discrimination and empowerment among people with a mental illness in six countries: Pan European stigma study. Psychiatry Research 2013; 210: 1136-1146
• 15 Livingston J. Self-Stigma and Quality of Life among people with mental illness who receive compulsory community treatment services. Journal of Community Psychology 2012; 40: 699-714
• 16 Earnshaw VA, Quinn DM, Park CL. Anticipated stigma and quality of life among people living with chronic illnesses. Chronic Illness 2012; 8: 79-88
• 17 Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer; 1984
• 18 Kilian R, Lindenbach I, Löbig U. et al. Indicators of empowerment and disempowerment in the subjective evaluation of the psychiatric treatment process by persons with severe and persistent mental illness: a qualitative and quantitative analysis. Social Science & Medicine 2003; 57: 1127-1142
• 19 Eklund M, Bäckström M. The role of perceived control for the perception of health by patients with persistent mental illness. Scand J Occup Ther 2006; 13: 249-256
• 20 Bejerholm U, Björkman T. Empowerment in supported employment research and practice: Is it relevant?. International Journal of Social Psychiatry 2011; 57: 588-595
• 21 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V. (DGPPN). S3-Leitlinie Psychosoziale Therapien bei schweren psychischen Erkrankungen. Im Internet: https://www.dgppn.de/leitlinien-publikationen/leitlinien.html Stand: 08.11.2018
• 22 Kosciulek JF, Merz M. Structural analysis of the consumer-directed theory of empowerment. Rehabilitation Counseling Bulletin 2001; 44: 209-216
• 23 Lundberg B, Hansson L, Wentz E. et al. Stigma, discrimination, empowerment and social networks: a preliminary investigation of their influence on subjective quality of life in a Swedish sample. Int J Soc Psychiatry 2008; 54: 47-55
• 24 Corrigan PW, Morris S, Larson J. et al. Self-stigma and coming out about one's mental illness. Journal of Community Psychology 2010; 38: 259-275
• 25 Vauth R, Kleim B, Wirtz M. et al. Self-efficacy and empowerment as outcomes of self-stigmatizing and coping in schizophrenia. Psychiatry Res 2007; 150: 71-80
• 26 Sibitz I, Amering M, Unger A. et al. The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. European Psychiatry 2011; 26: 28-33
• 27 Lanfredi M, Zoppei S, Ferrari C. et al. Self-stigma as a mediator between social capital and empowerment among people with major depressive disorder in Europe: The ASPEN study. Eur Psychiatry 2015; 30: 58-64
• 28 Graubner B. Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. 10.. Aufl. Köln: Deutscher Ärzte-Verlag; 2014
• 29 Hautzinger M, Keller F, Kühner C. et al. Beck Depressions-Inventar. BDI II. Frankfurt am Main: Pearson Assessment; 2009
• 30 Kühner C, Bürger C, Keller F. et al. Reliabilität und Validität des revidierten Beck-Depressionsinventars (BDI-II). Befunde aus deutschsprachigen Stichproben. Nervenarzt 2007; 78: 651-656
• 31 Kilian R, Becker T, Schleuning G. et al. Die Entwicklung eines standardisierten Verfahrens zur Messung von Empowerment im Prozess der psychiatrischen Behandlung von Patienten mit schweren psychischen Erkrankungen. Ulm: Abschlussbericht Förderkennz. 101GX0743 2012
• 32 Matschinger H, Angermeyer MC, Link BG. Variation der Antwortstrukturen in Abhängigkeit vom Grad der persönlichen Betroffenheit. Eine Methodenstudie am Beispiel der „Discrimination-Devaluation-Scale“. Psychotherapie, Psychosomatik, Medizinische Psychologie 1991; 41: 278-283
• 33 Boyd Ritsher J, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003; 121: 31-49
• 34 Angermeyer MC, Kilian R, Matschinger H. WHOQOL-100 und WHOQOL-BREF: Handbuch für die deutschsprachige Version der WHO-Instrumente zur Erfassung von Lebensqualität. Göttingen: Hogrefe & Huber; 2000
• 35 Angermeyer MC, Kilian R, Matschinger H. World Health Organization Quality of Life Assessment Instrument – deutsche Fassung. 2000. Im Internet: http://search-1ebscohost-1com-10012f2dl006b.emedia1.bsb-muenchen.de/login.aspx?direct=true&db=pdx&AN=PT9003714&site=ehost-live Stand: 20.12.2018
• 36 Kline RB. Principles and practice of structural equation modeling. New York: The Guilford Press; 2016
• 37 Abela JRZ, Seligman M. The Hopelessness Theory of Depression: A Test of the Diathesis-Stress Component in the Interpersonal and Achievement Domains. Cognitive Therapy and Research 2000; 24: 361-378
• 38 Chan CHY, Chan THY, Chan CLW. Translating Daoist concepts into integrative social work practice: An empowerment program for persons with depressive symptoms. Journal of Religion & Spirituality in Social Work: Social Thought 2014; 33: 61-72
• 39 Zoun MHH, Koekkoek B, Sinnema H. et al. Effectiveness of a self-management training for patients with chronic and treatment resistant anxiety or depressive disorders on quality of life, symptoms and empowerment: Results of a randomized controlled trial. BMC Psychiatry 2019; 19: 46
• 40 Crisp D, Griffiths K, Nackinnon A. et al. An online intervention for reducing depressive symptoms: Secondary benefits for self-esteem, empowerment and quality of life. Psychiatry Research 2014; 216: 60-66
• 41 Houle J, Gauvin G, Collard B. et al. Empowering adults in recovery from depression: A community-based self-management group program. Canadian Journal of Community Mental Health 2016; 35: 55-68
• 42 Bejerholm U, Roe D. Personal recovery within positive psychiatry. Nordic Journal of Psychiatry 2018; 72: 420-430
• 43 Timulak L, Elliott R. Empowerment Events in Process-Experiential Psychotherapy of Depression: An Exploratory Qualitative Analysis. Psychotherapy Research 2003; 13: 443-460
• 44 Hoe SL. Issues and Procedures in adopting structural equation modeling technique. Journal of applied quantitative methods 2008; 3: 76-83
• 45 Ioannidis JP. Why most discovered true associations are inflated. Epidemiology 2008; 19: 640-648
• 46 Hancock GR, Freeman MJ. Power and Sample Size for the Root Mean Square Error of Approximation Test of not Close Fit in Structural Equation Modeling. Educational and Psychological Measurement 2001; 61: 741-758