Uğur ÇAKIR, NERMİN GÜNDÜZ, Hatice TURAN, Emrah GÜLEŞ, Tamer AKER

Kadın majör depresif bozukluk hastalarında cinsel travmaya bağlı travma sonrası stres bozukluğu ve ilişkili bilişler

Amaç: Bu çalışmada cinsel travma sonrası travma sonrası stres bozukluğu (TSSB) eşlik ettiği majör depresif bozukluklu (MDB) kadın hastaların bilişsel şemalarının değerlendirilmesi ve TSSB eşlik etmeyen MDB'li kadınların şemalarıyla karşılaştırılması amaçlanmıştır. Yöntem: DSM-IV-TR'ye göre MDB ve cinsel TSSB olan 32 kadın ve cinsel travma öyküsü olmayan 30 MDB'li kadın çalışmaya alınmış, bilişlerin değerlendirilmesinde Otomatik Düşünceler Ölçeği, Fonksiyonel Olmayan Tutumlar Ölçeği ve Young Şema Ölçeği kullanılmıştır. Bulgular: MDB ve TSSB tanısı olan kadınların otomatik olumsuz düşünce toplam puanları sadece MDB'li kadınlara göre istatistiksel olarak anlamlı düzeyde daha yüksek bulunmuştur. MDB ve TSSB'li kadınların başarısızlık, dayanıksızlık ve boyun eğicilik şema puanları sadece MDB'li kadınlara göre anlamlı düzeyde daha olumsuzdur. MDB ve TSSB'li hastaların kendine zarar verme ve özkıyım riski sadece MDB'li hastalara göre daha fazladır. Sonuç: Cinsel şiddet öyküsü olan TSSB ve MDB'li kadınlar sadece MDB'li kadınlara göre daha olumsuz bilişsel şemalara ve daha fazla kendine zarar verme ve özkıyım riskine sahiptir. Klinisyenlerin tedavi planlamalarında ve olgu formulasyonlarında bu durumu değerlendirmeleri önemli gözükmektedir.

Cognitive schemas of women those have major depressive disorder comorbid with sexual trauma related PTSD

Objective: In this study, it has been aimed to evaluate the cognitive schemas of women those have major depressive disorder (MDD) comorbid sexual trauma related posttraumatic stress disorder (PTSD) and than to compare schemas of women those have MDD comorbid PTSD with schemas of women those have MDD without comorbid PTSD. Methods: Thirty-two women those met DSM IV-TR ciriterias for MDD comorbid with PTSD, and 30 women have MDD without comorbid PTSD participated the study. Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale and Young Schema Questionnaire were used to assesment of the beliefs, attitudes and schemas of two groups. Results: Women those have MDD comorbid with PTSD had the significantly higher scores of authomatic thoughts and three early maladaptive schemas which were failure, vulnerability and subjugation as compared with women those have no PTSD comorbidity. Women with PTSD comorbidity have also higher rates of suicidal and self harm behaviors. Conclusion: Women those have MDD comorbid with sexual violence related PTSD had more negative beliefs, schemas and higher risk of suicidal and self harm behaviors in comparision with women those have MDD without PTSD. Clinicians should consider these results while they establish their treatment plans and case formulations

PDF

___

Jewkes R, Sen P, García-Moreno C. Sexual vio- lence. Krug et al. (Eds.), World Report on Vio- lence and Health, Geneva: World Health Organi- zation, 2002, p.149.
WHO. WHO Multi-Country Study on Women's Health and Domestic Violence Against Women: Summary Report of Initial Results on Prevalence, Health Outcomes and Women's Responses. Geneva: World Health Organization, 2005.
Finkelhor D. The international epidemiology of child rape. Child Abuse & Neglect 1994; 18:409- 417.
Kohsin Wang S, Rowley E. Rape: How Women, the Community and the Health Sector Respond. World Health Organisation/Sexual Violence Re- search Initiative, 2007.
Campbell R, Dworkin E, Cabral G. An ecological model of the impact of sexual assault on women's mental health. Trauma Violence Abuse 2009; 10:225-246.
Stevens L. Screening for sexual violence: Gaps in research and recommendations for change. Harrisburg, PA: Vawnet, a project of the national resource centre on domestic violence/ Pennsyl- vania Coalition Against Domestic Violence, 2007.
Nixon RD, Resick PA, Nishith P. An exploration of comorbid depression among female victims of intimate partner violence with posttraumatic stress disorder. J Affect Disord 2004; 82:315-320.
Wise LA, Zierler S, Krieger N, Harlow BL. Adult onset of major depressive disorder in relation to early life violent victimisation: a case-control study. Lancet 2001; 358:881-887.
Green BL, Krupnick JL, Chung J, Siddique J, Krause ED, Revicki D, et al. Impact of PTSD comorbidity on one-year outcomes in a depres- sion trial. J Clin Psychol 2006; 62:815-835.
Taft CT, Resick PA, Watkins LE, Panuzio J. An investigation of posttraumatic stress disorder and depressive symptomatology among female vic- tims of interpersonal trauma. J Fam Violence 2009; 24:407-415.
Campbell DG, Felker BL, Kirchner JE, Chan D, Rubenstein LV. Prevalence of depression-PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions. J Gen Intern Med 2007; 22:711-718.
Çorapçıoğlu A, Aydemir Ö, Yıldız M, Danacı AE, Köroğlu E. DSM-IV Eksen-I Bozuklukları için Yapılandırılmış Klinik Görüşme. Ankara: HYB, 1999.
Hollon SD, Kendal PC. Cognitive self-statements in depression: Development of an automatic thoughts questionnaire. Cogn Ther Res 1980; 4:383-395.
Aydın G, Aydın O. Otomatik düşünceler ölçeğinin geçerlik ve güvenirliği. Psikoloji Dergisi 1990; 7:51-57.
Weissman A. The Dysfunctional Attitudes Scale: A Validation Study. Unpublished Doctoral Disser- tation, Philadelphia, University of Pennsylvania, 1979.
Şahin NH, Şahin N. How dysfucntional are the dysfuctional attitudes in another culture? Br J Med Psychol 1192; 65:17-26.
Waller G, Meyer C, Ohanian V. Psychometric properties of the long and short versions of the Young Schema Questionnaire: Core beliefs among bulimic and comparison women. Cogn Ther Res 2001; 25:137-147.
Karaosmanoğlu A, Soygüt G, Tuncer E. The dance of schemas relations between parenting, schema, overcompensation and avoidance. Şema Terapi Sempozyumu, Selanik, 2005.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed., Text Revision (DSM-IV-TR), Washington, DC: APA, 2000.
Winfield I, George LK, Swartz M, Blazer DG. Sexual assault and psychiatric disorders among a community sample of women. Am J Psychiatry 1990; 147:335-341.
Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the national comorbidity survey. Arch Gen Psychiatry 1999; 56:617-626.
Breslau N, Davis CG, Peterson LE, Schultz LR. A second look at comorbidity in victims of trauma: the posttraumatic stress disorder-major depres- sion connection. Biol Psychiatry 2000; 48:902- 909.
Oquendo M, Brent DA, Birmaher B, Greenhill L, Kolko D, Stanley B, et al. Posttraumatic stress disorder comorbid with major depression: factors mediating the association with suicidal behavior. Am J Psychiatry 2005; 162:560-566.
Bernal M, Haro JM, Bernert S, et al., ESEMeD/MHEDEA Investigators. Risk factors for suicidality in Europe: results from the ESEMeD study. J Affect Disord 2007; 101:27-34.
Zlotnick C, Mattia JI, Zimmerman M. Clinical correlates of self mutilation in a sample of general psychiatric patients. J Nerv Ment Dis 1999; 187:296-301.
Harned MS, Lisa MN, Roger DW. Self harm and suicidal behavior in women with comorbid PTSD and substance dependence. Am J Addict 2006; 15:392-395.
Yargıç İ, Ersoy E, Oflaz SB. The relation of childhood trauma with suicide attempt and self- mutilation. Anatolian Journal of Psychiatry 2012; 13:277-284.
Hegel MT, Unützer J, Tang L, Areán PA, Katon W, Noël PH, et al. Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in pri- mary care. Am J Geriatr Psychiatry 2005; 13:48- 58.
Holtzheimer PE, Russo J, Zatzick D, Bundy C, Roy-Byrne PP. The impact of comorbid post- traumatic stress disorder on short-term outcome in hospitalized patients with depression. Am J Psychiatry 2005; 162:970-976.
Nishith P, Nixon RDV, Resick PA. Resolution of trauma-related guilt following treatment of PTSD in female rape victims: a result of cognitive pro- cessing therapy targeting comorbid depression. J Affect Disord 2005; 86:259-265.