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The experience of “depression” in hospitalized medically Ill patients: an ethnographic analysis
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Poster abstracts / Journal of Psychosomatic Research 55 (2003) 147–178
The experience of ‘‘depression’’ in hospitalized medically Ill patients: an ethnographic analysis Clarke DM, Cook KE, Coleman J, Smith GC Objective: To describe, using qualitative methodology, the experience of ‘‘being depressed’’, separating out what is unique to depression from experiences common to being ill or in hospital. Method: Unstructured interviews were conducted on 49 patients — 19 depressed and 30 nondepressed according to self-report screening. From the transcripts, a folk or native taxonomy was constructed using an ethnographic approach of frame elicitation (identifying important concepts), componential analysis (defining the attributes of each domain), contrast analysis (contrasting experiences of depressed and nondepressed patients), and finally theoretical analysis (comparing the results with contemporary categories and classifications of depression). Results: Experiences common to all patients (depressed and nondepressed) were being in hospital, being ill or in pain, not being able to do things, and having time to think and regret. Unique to depressed patients were the experiences of having to think about things (a forceful intrusive thinking), as a consequence not being able to sleep, having to rely on others, being a burden to others (with associated shame), guilt, and feeling that they were not getting better. Theoretical analysis suggests this experience of depression fits well the concept of demoralization described by Jerome Frank — feeling unable to cope and increasingly helpless, hopeless, and despairing, with a concomitant sense of subjective incompetence, diminished personal esteem, and a perception of meaningless and pointlessness to life.
An empirically derived taxonomy of common distress syndromes in the medically III Clarke DM, Smith GC, Mckenzie DP, Mackinnon AJ, Dowe DL Background: Contemporary psychiatric classifications have not proven useful in the understanding and care of people with physical illness. We sought, therefore, to develop a numeric taxonomy of common distress syndromes. Method: Three hundred and twelve medical patients were interviewed using a structured psychiatric interview to elicit the presence of mood, anxiety, and somatoform symptoms. Data were subjected first to latent trait analysis to reveal symptom dimensions and then to cluster analysis. Results: Five dimensions of symptoms were found: demoralization, anhedonia, grief, somatoform symptoms, and autonomic anxiety. There
was moderate correlation between demoralization, anxiety, and somatoform symptoms. Patients were given symptom scores on each dimension and on this basis subjected to cluster analysis. Five taxonomic classes were derived characterized as demoralization (high demoralization, anxiety, and somatoform symptoms), demoralized grief (high demoralization, anxiety, somatoform symptoms, and grief), uncomplicated grief (high grief), moderate distress (moderate scores generally), and anhedonic depression (high anhedonia). Demoralization and demoralized grief were associated with younger age, somatoform illness, past psychiatric history, and lower 12-month GAF scores. Anhedonic depression had greatest social dysfunction. Conclusion: A taxonomy involving the concepts of demoralization, anhedonia, and grief has validity. It may also have utility in guiding specific interventions.
Blood pressure reactivity: interactive effects of the endothelin-1 gene Lys198Asn polymorphism with SES and obesity Treiber FA, Barbeau P, Harshfield G, Kang H, Pollock D, Pollock J, Snieder H The Lys198Asn polymorphism of the endothelin-1 (ET-l) gene has been associated with increased blood pressure (BP) levels in several epidemiologic studies. We examined the potential moderating influence of ethnicity, obesity, and socioeconomic status (SES) upon associations between the ET-l/Lys198Asn polymorphism and hemodynamic function at rest and during two laboratory stressors. One hundred and sixty-one African American and 213 European American normotensive young adults (mean age = 18.5 F 2.7 years) participated in the study. The ET-1/Lys198Asn polymorphism was detected by a polymerase chain reaction followed by direct sequence analysis. Hemodynamic measurements were conducted prior to and following 1-min forehead cold stimulation and a 10-min video game challenge. Carrier status of the T allele was not associated with resting BP or total peripheral resistance index. However, carriers of the T allele showed greater diastolic BP increases to the video game ( P < .04), particularly among those who were obese ( P < .02). Carrier status also interacted with SES such that T allele carriers who came from lower SES backgrounds exhibited the greatest increases in systolic BP to the video game challenge ( P < .05). The findings point out the importance of examining the impact of genetic polymorphisms upon BP control phenotypes within the context of potentiating environmental factors.
Poster abstracts / Journal of Psychosomatic Research 55 (2003) 147–178
The experience of ‘‘depression’’ in hospitalized medically Ill patients: an ethnographic analysis Clarke DM, Cook KE, Coleman J, Smith GC Objective: To describe, using qualitative methodology, the experience of ‘‘being depressed’’, separating out what is unique to depression from experiences common to being ill or in hospital. Method: Unstructured interviews were conducted on 49 patients — 19 depressed and 30 nondepressed according to self-report screening. From the transcripts, a folk or native taxonomy was constructed using an ethnographic approach of frame elicitation (identifying important concepts), componential analysis (defining the attributes of each domain), contrast analysis (contrasting experiences of depressed and nondepressed patients), and finally theoretical analysis (comparing the results with contemporary categories and classifications of depression). Results: Experiences common to all patients (depressed and nondepressed) were being in hospital, being ill or in pain, not being able to do things, and having time to think and regret. Unique to depressed patients were the experiences of having to think about things (a forceful intrusive thinking), as a consequence not being able to sleep, having to rely on others, being a burden to others (with associated shame), guilt, and feeling that they were not getting better. Theoretical analysis suggests this experience of depression fits well the concept of demoralization described by Jerome Frank — feeling unable to cope and increasingly helpless, hopeless, and despairing, with a concomitant sense of subjective incompetence, diminished personal esteem, and a perception of meaningless and pointlessness to life.
An empirically derived taxonomy of common distress syndromes in the medically III Clarke DM, Smith GC, Mckenzie DP, Mackinnon AJ, Dowe DL Background: Contemporary psychiatric classifications have not proven useful in the understanding and care of people with physical illness. We sought, therefore, to develop a numeric taxonomy of common distress syndromes. Method: Three hundred and twelve medical patients were interviewed using a structured psychiatric interview to elicit the presence of mood, anxiety, and somatoform symptoms. Data were subjected first to latent trait analysis to reveal symptom dimensions and then to cluster analysis. Results: Five dimensions of symptoms were found: demoralization, anhedonia, grief, somatoform symptoms, and autonomic anxiety. There
was moderate correlation between demoralization, anxiety, and somatoform symptoms. Patients were given symptom scores on each dimension and on this basis subjected to cluster analysis. Five taxonomic classes were derived characterized as demoralization (high demoralization, anxiety, and somatoform symptoms), demoralized grief (high demoralization, anxiety, somatoform symptoms, and grief), uncomplicated grief (high grief), moderate distress (moderate scores generally), and anhedonic depression (high anhedonia). Demoralization and demoralized grief were associated with younger age, somatoform illness, past psychiatric history, and lower 12-month GAF scores. Anhedonic depression had greatest social dysfunction. Conclusion: A taxonomy involving the concepts of demoralization, anhedonia, and grief has validity. It may also have utility in guiding specific interventions.
Blood pressure reactivity: interactive effects of the endothelin-1 gene Lys198Asn polymorphism with SES and obesity Treiber FA, Barbeau P, Harshfield G, Kang H, Pollock D, Pollock J, Snieder H The Lys198Asn polymorphism of the endothelin-1 (ET-l) gene has been associated with increased blood pressure (BP) levels in several epidemiologic studies. We examined the potential moderating influence of ethnicity, obesity, and socioeconomic status (SES) upon associations between the ET-l/Lys198Asn polymorphism and hemodynamic function at rest and during two laboratory stressors. One hundred and sixty-one African American and 213 European American normotensive young adults (mean age = 18.5 F 2.7 years) participated in the study. The ET-1/Lys198Asn polymorphism was detected by a polymerase chain reaction followed by direct sequence analysis. Hemodynamic measurements were conducted prior to and following 1-min forehead cold stimulation and a 10-min video game challenge. Carrier status of the T allele was not associated with resting BP or total peripheral resistance index. However, carriers of the T allele showed greater diastolic BP increases to the video game ( P < .04), particularly among those who were obese ( P < .02). Carrier status also interacted with SES such that T allele carriers who came from lower SES backgrounds exhibited the greatest increases in systolic BP to the video game challenge ( P < .05). The findings point out the importance of examining the impact of genetic polymorphisms upon BP control phenotypes within the context of potentiating environmental factors.