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Depressive Personality Disorder: Construct, measurement, clinical correlates, and treatment outcome

Maddux, Rachel LU (2012)
Abstract (Swedish)
Popular Abstract in Swedish

Depression är ett allvarligt och potentiellt förödande hälsoproblem som drabbar flera miljontals människor i världen. Trots framsteg inom depressionsforskningen återstår flera frågor kring varför vissa individer upplever depression, och andra inte, och varför vissa blir hjälpta av behandling, och andra inte. Den forskning som rapporteras här tar som utgångspunkt hypotesen att studier av personer med depressiva personlighetsdrag (depressive personality disorder, DPD) kan bidra till att ge svar på dessa frågor. DPD definieras som ett bestående mönster av depressiva tankar och beteenden som uppstår tidigt under barndomen, och som uppträder i ett flertal kontexter. Symtomen utmärks huvudsakligen av... (More)
Popular Abstract in Swedish

Depression är ett allvarligt och potentiellt förödande hälsoproblem som drabbar flera miljontals människor i världen. Trots framsteg inom depressionsforskningen återstår flera frågor kring varför vissa individer upplever depression, och andra inte, och varför vissa blir hjälpta av behandling, och andra inte. Den forskning som rapporteras här tar som utgångspunkt hypotesen att studier av personer med depressiva personlighetsdrag (depressive personality disorder, DPD) kan bidra till att ge svar på dessa frågor. DPD definieras som ett bestående mönster av depressiva tankar och beteenden som uppstår tidigt under barndomen, och som uppträder i ett flertal kontexter. Symtomen utmärks huvudsakligen av en glädjelös stämning, pessimism, känslor av skuld och ånger, övertygelse om den egna otillräckligheten, låg självuppskattning, en kritisk, klandrande och förringande självkänsla, och en negativistisk, kritisk och fördömande inställning till andra. Ett syfte med avhandlingsarbetet var att samla information kring denna typ av personlighetsmönster bland personer i allmänhet och bland personer som söker hjälp för psykiska problem. Avhandlingsarbetet syftar också till att undersöka i vilken utsträckning dessa depressiva drag ändras eller är stabila över tid. Slutligen syftar avhandlingsarbetet till att undersöka om personer med DPD svarar på behandling av psykiska problem, särskilt depression, på ett annat sätt än personer utan DPD. Arbetet genomfördes inom ramen för tre empiriska studier.



Studie 1 (Artikel I) syftade till att utveckla och utvärdera en svensk version av Depressive Personality Disorder Inventory med målet att kunna använda den för att insamla data kring DPD hos svensktalande personer. Bland de 255 undersökningsdeltagarna uppvisade ungefär en av 10 tydliga tecken på att lida av DPD. Jämfört med de övriga deltagarna uppvisade DPD-gruppen i högre utsträckning depression, ångest, bekymmer och grubblande och i mindre utsträckning positiv självuppskattning, optimism, hopp och positiv livskvalitet.



I studie 2 (Artikel II) undersöktes en grupp av 159 individer som fick psykologisk behandling vid en universitetsklinik. En stor procentandel av dem (44 %) uppvisade tecken på att lida av DPD vid början av behandlingen. Deras grad av depressiva personlighetsdrag minskade dock i signifikant utsträckning under behandlingen, och endast 11 % av dem visade tecken på DPD vid behandlingens slut. Förekomst av DPD hade inte någon negativ effekt på psykoterapins utkomst, utan tvärtom visade de med DPD större förbättringar vad gäller depressiva symtom och allvarlighetsgrad av symtom i allmänhet, jämfört med dem som inte hade DPD.



I studie 3 (Artikel III) undersöktes DPD i en stor grupp av psykiatriska öppenvårdspatienter (N = 680), diagnosticerade som kroniskt depressiva. Dessa erhöll enligt en randomiserad design antingen 12 veckors behandling med det antidepressiva medlet nefazodone (200-600 mg/day), eller Cognitive Behavioral-Analysis System of Psychotherapy (16-20 sessioner) eller en kombination av dessa båda. Trettiosex procent av patienterna uppvisade DPD före behandling, men detta hade ingen negativ påverkan på deras depressionsbehandling. Det är samtidigt oklart om behandlingen ledde till en minskning av depressiva personlighetsdrag då ingen bedömning gjordes av graden av DPD efter avslutad behandling.



Sedda i sin helhet talar resultaten i dessa tre studier för att individer med DPD upplever psykiskt lidande i betydande grad före behandling, och att många av dessa inte längre uppvisar DPD efter behandling. Ytterligare forskning behövs för att undersöka om behandlingen är en direkt orsak till sådana förändringar i depressiva drag, eller om DPD endast ökar under perioder av psykiskt lidande, och sedan återgår till sin normala nivå parallellt med symtomförbättringen. (Less)
Abstract
Depression is a serious and potentially devastating health problem, impacting millions of individuals worldwide. Although advances have been made in depression research, there remain a number of outstanding questions as to why certain individuals experience depression and why some respond to treatment and others do not. The present research takes a starting-point in the hypothesis that the existence of depressive personality traits (depressive personality disorder, DPD) may contribute in providing some answers to these questions. The purpose was to garner descriptive information about this type of maladaptive personality – DPD – in both non-clinical and clinical samples, and to examine DPD in terms of its clinical correlates, stability... (More)
Depression is a serious and potentially devastating health problem, impacting millions of individuals worldwide. Although advances have been made in depression research, there remain a number of outstanding questions as to why certain individuals experience depression and why some respond to treatment and others do not. The present research takes a starting-point in the hypothesis that the existence of depressive personality traits (depressive personality disorder, DPD) may contribute in providing some answers to these questions. The purpose was to garner descriptive information about this type of maladaptive personality – DPD – in both non-clinical and clinical samples, and to examine DPD in terms of its clinical correlates, stability over time, and potential influence on treatment response for individuals with psychopathology in general and depression in particular. These objectives were carried out in a series of three empirical studies.



Study 1 (Paper I) was designed to evaluate a translated Swedish version of the Depressive Personality Disorder Inventory, to determine its psychometric properties and suitability for use with Swedish samples. Among the 255 non-clinical volunteers who participated in the study, approximately 1 in 10 individuals qualified for DPD, and compared to those without, those with DPD reported statistically higher levels of depression, anxiety, worry, and rumination, and statistically lower levels of self-esteem, optimism, hope, and life quality.



Study 2 (Paper II) took the investigation to a clinical sample of 159 clients receiving psychological services at a University clinic. A large percentage of those entering treatment - 44% - qualified for DPD, and these individuals had a comparatively more severe clinical presentation than those without DPD. The presence of DPD did not adversely affect psychotherapy outcome; rather those with DPD showed greater improvements in depression and global symptom severity as compared to those without DPD. Only 11% of the sample endorsed DPD at treatment endpoint.



Study 3 (Paper III) examined a large group of psychiatric outpatients with chronic major depression (N=680), who were randomly assigned to 12 weeks of treatment with an antidepressant, nefazodone (200-600 mg/day), the Cognitive Behavioral-Analysis System of Psychotherapy (16-20 sessions), or their combination. Thirty six percent of this sample was diagnosed with DPD prior to treatment. Results indicated that DPD did not negatively impact depression outcome in any treatment modality; however, it remains unclear as to whether treatment was successful in the remediation of DPD since it was measured only at baseline.



Taken together, this collection of studies convincingly demonstrates that individuals with DPD experience significant psychological distress, but they appear to respond as well or better than individuals without DPD to various types of treatment. Thus, DPD should not be viewed as an impediment to successful outcomes. Further, DPD itself appears to resolve for many individuals over the course of treatment, although future experimental work is needed to determine whether treatment is causal in the amelioration of these traits. (Less)
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author
supervisor
opponent
  • Professor Hetta, Jerker, Karolinska Institutet
organization
publishing date
type
Thesis
publication status
published
subject
keywords
depression, personality disorder, treatment, DPD, Depressive Personality Disorder, psychometric
pages
144 pages
publisher
Printus
defense location
Edens hörsal, Paradisgatan 5H, Lund
defense date
2012-01-20 13:15
ISBN
978-91-7473-197-2
language
English
LU publication?
yes
id
b57fc78e-ab19-40a1-9986-f01e5a3de7d5 (old id 2270064)
date added to LUP
2011-12-27 16:26:14
date last changed
2016-11-29 15:30:55
@misc{b57fc78e-ab19-40a1-9986-f01e5a3de7d5,
  abstract     = {Depression is a serious and potentially devastating health problem, impacting millions of individuals worldwide. Although advances have been made in depression research, there remain a number of outstanding questions as to why certain individuals experience depression and why some respond to treatment and others do not. The present research takes a starting-point in the hypothesis that the existence of depressive personality traits (depressive personality disorder, DPD) may contribute in providing some answers to these questions. The purpose was to garner descriptive information about this type of maladaptive personality – DPD – in both non-clinical and clinical samples, and to examine DPD in terms of its clinical correlates, stability over time, and potential influence on treatment response for individuals with psychopathology in general and depression in particular. These objectives were carried out in a series of three empirical studies.<br/><br>
<br/><br>
Study 1 (Paper I) was designed to evaluate a translated Swedish version of the Depressive Personality Disorder Inventory, to determine its psychometric properties and suitability for use with Swedish samples. Among the 255 non-clinical volunteers who participated in the study, approximately 1 in 10 individuals qualified for DPD, and compared to those without, those with DPD reported statistically higher levels of depression, anxiety, worry, and rumination, and statistically lower levels of self-esteem, optimism, hope, and life quality. <br/><br>
<br/><br>
Study 2 (Paper II) took the investigation to a clinical sample of 159 clients receiving psychological services at a University clinic. A large percentage of those entering treatment - 44% - qualified for DPD, and these individuals had a comparatively more severe clinical presentation than those without DPD. The presence of DPD did not adversely affect psychotherapy outcome; rather those with DPD showed greater improvements in depression and global symptom severity as compared to those without DPD. Only 11% of the sample endorsed DPD at treatment endpoint.<br/><br>
 <br/><br>
Study 3 (Paper III) examined a large group of psychiatric outpatients with chronic major depression (N=680), who were randomly assigned to 12 weeks of treatment with an antidepressant, nefazodone (200-600 mg/day), the Cognitive Behavioral-Analysis System of Psychotherapy (16-20 sessions), or their combination. Thirty six percent of this sample was diagnosed with DPD prior to treatment. Results indicated that DPD did not negatively impact depression outcome in any treatment modality; however, it remains unclear as to whether treatment was successful in the remediation of DPD since it was measured only at baseline. <br/><br>
<br/><br>
Taken together, this collection of studies convincingly demonstrates that individuals with DPD experience significant psychological distress, but they appear to respond as well or better than individuals without DPD to various types of treatment. Thus, DPD should not be viewed as an impediment to successful outcomes. Further, DPD itself appears to resolve for many individuals over the course of treatment, although future experimental work is needed to determine whether treatment is causal in the amelioration of these traits.},
  author       = {Maddux, Rachel},
  isbn         = {978-91-7473-197-2},
  keyword      = {depression,personality disorder,treatment,DPD,Depressive Personality Disorder,psychometric},
  language     = {eng},
  pages        = {144},
  publisher    = {ARRAY(0x89da648)},
  title        = {Depressive Personality Disorder: Construct, measurement, clinical correlates, and treatment outcome},
  year         = {2012},
}