NAZLI BURCU ÖZBARAN, Müge TAMAR, ZEKİ YÜNCÜ, Tezan BİLDİK, Nagehan DEMİRAL, Serpil ERERMİŞ

Majör depresif bozukluğu olan gençlerden oluşan bir klinik örneklemde anne baba tutumlarının değerlendirilmesi

Amaç: Majör depresif bozukluk (MDB) ergenlik döneminde biyolojik, kalıtımsal, çevresel ve psikolojik birçok etiyolojik etkenle ilişkilidir. Bu etkenlerden biri de anne-baba-çocuk ilişkisidir. Bu çalışmada, depresyonu olan ergenlerin bulunduğu bir klinik örneklemde anne baba tutumlarının değerlendirilmesi ve sağlıklı kontrollerle karşılaştırılması amaçlanmıştır. Yöntem: Çalışmada DSM-IV tanı ölçütlerine göre depresyonu olan 60 genç (30 kız, 30 erkek; yaş ortalaması 16.52±1.13; yaş aralığı: 14-18) ve çalışma grubu ile yaş, cinsiyet, aile durumu ve gelir düzeyi bakımından eşleştirilmiş 60 ruhsal yönden sağlıklı genç (30 kız, 30 erkek; yaş ortalaması 16.50±1.13; yaş aralığı: 14-18) ile anne-babaları değerlendirilmiştir. Değerlendirmeler, Çocuklar için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi (Kiddie Schedule for Affective Disorders and Schizophrenia) kullanılarak yapılmış, gençlere Beck Depresyon Ölçeği, anne-babalara da Aile Hayatı ve Çocuk Yetiştirme Tutumu Ölçeği (Parental Attitude Research Instrument) uygulanmıştır. Bulgular: Aşırı annelik, eşler arası geçimsizlik ve otoriter tutumlar depresyonu olan gençlerin anne babalarında kontrol grubunun anne-babalarına göre daha yüksek oranlarda bulunmuştur. Anne-baba tutumlarında, reddedici tutum ve otoriter tutumun fazla olduğu gençlerde özkıyım girişimlerinin fazla olduğu belirlenmiştir. Sonuç: Bulgular aşırı annelik, eşler arası geçimsizlik ve otoriter tutumlar gibi; aşırı kontrolün, aşırı isteklerin ve cezalandırmanın bulunduğu anne-baba tutumlarının gençlerdeki depresyon ile ilişkili olduğunu düşündürtmektedir. Bu tür aile tutumlarının aile içi ilişkilerde çatışmaların bir göstergesi olduğu düşünülebilir.

Evaluation of parental attitudes in a clinical sample of adolescents with major depressive disorder

Objective: Depression in adolescence is associated with a number of ethological factors such as genetic, biologic, environmental, and psychological. Recently, parent-child interaction models are considered as important contributors to depression in adolescents. The aim of this study was to investigate the characteristics of parental attitudes in depressed adolescents compared to healthy controls. Methods: One hundred and twenty adolescents participated: 60 major depression participants, and 60 healthy control participants without a history of any psychiatric disorder. Sixty adolescent outpatients (30 females, 30 males; mean age: 16.52±1.13 years; range: 14-18 years) fulfilling the DSM-IV criteria for MDD and 60 matched psychiatrically healthy adolescents (30 females, 30 males; mean age: 16.50±1.13 years; range: 14-18 years) were included in the study. Evaluations of adolescents were made using the Schedule for Affective Disorders and Schizophrenia for Kiddie and Young Adult, Beck Depression Inventory, and the parents have filled the Parental Attitude Research Instrument. Results: Our findings revealed that over parenting, marital discordancy and authoritarian attitudes scores were higher in depressed adolescents’ parents than the control group. As another important result of this study, hostile, rejecting, and authoritarian attitudes were found to be related with suicidal behavior of depressed adolescents. Conclusion: These results suggest that certain aspects of parenting such as over parenting, marital discordancy and authoritarian attitudes contribute to the pathogenesis of major depression in Turkish adolescents. High levels of marital discordancy, over-parenting, and authoritarian attitudes in the study group may be associated with conflicts in family relations.

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1. Mufson L, Aidala A, Warner V. Social dysfunction and psychiatric disorder in mothers and their children. J Am Acad Child Adolesc Psychiatry 1994; 33:1256-1264.
2. Parker G, Roy K. Adolescent depression: a review. Aust N Z J Psychiatry 2001; 35:572.
3. Goddard N, Subotsky F, Fombonne E. Ethnicity and adolescent deliberate self-harm. J Adolesc 1996; 19:513-521.
4. Ackard DM, Neumark-Sztainer D, Story M, Perry C. Parent-child connectedness and behavioral and emotional health among adolescents. Am J Prev Med 2006; 30:59-66.
5. Gil-Rivas V, Greenberger E, Chen C, Montero y Lopez-Lena M. Understanding depressed mood in the context of a family oriented culture. Adolescence 2003; 38:93-109.
6. Montemayer R. Parents and adolescents in conflict. All families some of the time and some families most of the time. J Early Adolesc 1983; 3:83-103.
7. Robin AL, Koepke T, Moye A. Multi-dimensional assessment of parent-adolescent relations. Psychol Assess 1990; 4:451-459.
8. Sagrestano LM, Paikoff RL, Holmbeck GN, Fendrich M. A longitudinal examination of familial risk factors for depression among inner-city African American adolescents. J Fam Psychol 2003; 17:108-120.
9. Anderson SA, Sabatelli RM. Differentiating differ- entiation and individuation: Conceptual and operational challenges. Am J Fam Ther 1990; 18:32-50.
10. Galatzer-Levy RM, Colder BJ (Eds.). The Essential Other: A Developmental Psychology of the Self. New York, Basic Books, 1993, p.18-28.
11. Lewinsohn P.M, Clarke GN, Seeley JR, Rohde P. Major depression in community adolescents: age at onset, episode duration, and time to recurrence. J Am Acad Child Adolesc Psychiatry 1994;33:809-818.
12. Puig-Antich, Goetz D, Davies M. A controlled family history study of prepubertal major depressive disorder. Arch Gen Psychiatry 1989; 46:406-418.
13. Petersen AC, Sarigiani PA, Kennedy RE. Adolescent depression: why more girls? Youth Adolesc 1991; 20:247-269.
14. Steinberg L, Silverberg SB. The vicissitudes of autonomy in early adolescence. Child Dev 1986; 57:841-851.
15. Hortaçsu N. Cross-cultural comparison of need importance and need satisfaction during adolescence: Turkey and the United States. J Genet Psychol 1997; 158:287-296.
16. Chen ZY. Ethnic similarities and differences in the association of emotional autonomy and adolescent outcomes: comparing Euro-American and Asian-American adolescents. Psychol Rep 1999; 84:501-516.
17. Pavlidis K, McCauley E. Autonomy and related- ness in family interactions with depressed adolescents. J Abnorm Child Psychol 2001; 29:11-21.
18. Burt CE, Cohen LH, Bjorck JB. Perceived family environment as a moderator of young adolescents’ life stress adjustment. Am J Community Psychol 1988; 16:101-122.
19. Barber BK, Olsen JE, Shagle SC. Associations between parental psychological and behavioral control and youth internalized and externalized behaviors. Child Dev 1994; 65:1120-1136.
20. Blatt SJ, Wein SJ, Chevron E, Quinlan DM. Parental representations and depression in normal young adults. J Abnorm Psychol 1979; 88:388-397.
21. Rey JM. Perceptions of poor maternal care are associated with adolescent depression. J Affect Disord 1995; 34:95-100.
22. Constantine MG. Perceived family conflict, parental attachment, and depression in African American female adolescents. Cultur Divers Ethnic Minor Psychol 2006; 12:697-709.
23. Milne LC, Lancaster S. Predictors of depression in female adolescents. Adolescence 2001; 36:207-223.
24. Armsden GC, McCauley E, Greenberg MT, Burke PM, Mitchell JR. Parent and peer attachment in early adolescent depression. J Abnorm Child Psychol 1990; 18:683-697.
25. Blatt SJ, Homann E. Parent child interaction in the etiology of dependent and self critical depression. Clin Psychol Rev 1992; 12:47-91.
26. Arieti S, Bemporad JR. The psychological organi- zation of depression. Am J Psychiatry 1980; 137:1360-1365.
27. Blatt SJ, Zuroff DC. Interpersonal relatedness and self-definition: Two prototypes for depression in normal young adults. Clin Psychol Rev 1992; 12:527-562.
28. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fourth ed. (DSM-IV). Washington D.C., American Psychiatric Press, 1994.
29. Kaufman J, Birmaher B, Brent D. Schedule for affective disorders and schizophrenia for school age children - present and lifetime version (KSADS-PL) initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36:980-988.
31. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4:561-571.
32. Hisli N. Beck Depresyon Envanteri’nin geçerliği üzerine bir çalışma. Psikoloji Dergisi 1988; 6:118-122.
33. Spitzer R, Williams J, Gibbon M. Structured Clinical Interview for DSM-III-R, Version NP. New York, New York Psychiatric Institute Biometrics Research Department, 1987.
34. Schaefer ES, Bell RQ. Development of a parental attitude research instrument. Child Dev 1958; 29:339-361.
35. Öner N (Ed.). Türkiye’de Kullanılan Psikolojik Testler, Bir Başvuru Kaynağı. İkinci basım. İstanbul, Boğaziçi Üniversitesi Yayınları, 1996, s.1-25.
36. Akdemir D, Gökler B. Bipolar duygudurum bozuk- luğu olan anne babaların çocuklarında psikopatoloji. Türk Psikiyatri Dergisi 2008; 19:133-140.
37. Hall LA, Rayens MK, Peden AR. Maternal factors associated with child behavior. J Nurs Scholarsh 2008; 40:124-130.
38. G Keskin, O Çam. Ergenlerin ruhsal durumları ve anne baba tutumları ile bağlanma stilleri arasında- ki ilişkinin incelenmesi. Anadolu Psikiyatri Derg 2008; 9:139-147.
39. Colarusso CA. The third individuation. Psychoanal Study Child 1990; 45:179-194.
40. Bilgin M, Cenkseven F, Satar S. An analysis of parent-female adolescent relationships in female adolescent suicides. Crisis 2007; 28:190-197.
41. West ML, Spreng WS, Rose SM, Adam KS. Relationship between attachment-felt security and history of suicidal behaviors in clinical adolescents. Can J Psychiatry 1999; 44:578-582.
42. Sonuvar B. Ergenlerde özkıyım ve özkıyım girişimleri. Ergenlikte Ruhsal Sorunlara Yaklaşım, Ege Psikiyatri Sürekli Yayınları 1997; 2:495-497.
43. Jorm AF, Morgan AJ, Wright A. First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents. BMC Psychiatry 2008; 8:42.
44. Kutlu L, Batmaz M, Bozkurt G, Gençtürk N, Gül A. Annelere çocukluklarında uygulanan ceza yöntemleri ile çocuklarına uyguladıkları ceza yöntem- leri arasındaki ilişki. Anadolu Psikiyatri Derg 2007; 8:22-29.
45. Ritsher JE, Warner V, Johnson JG, Dohrenwend BP. Inter-generational longitudinal study of social class and depression: a test of social causation and social selection models. Br J Psychiatry 2001; 40(Suppl):s84-90.
46. Özmen D, Dündar PE, Çetinkaya AÇ, Taşkın O, Özmen E. Lise öğrencilerinde umutsuzluk ve umutsuzluk düzeyini etkileyen etkenler. Anadolu Psikiyatri Derg 2008; 9:8-15.
47. Valentino K, Cicchetti D, Rogosch FA, Toth SL. Memory, maternal representations, and internalizing symptomatology among abused, neglected, and nonmaltreated children. Child Dev 2008; 79:705-719.