Yaşlılarda Depresyon ve Tekrarlayan Olumsuz Düşünce: Yürütücü İşlev Bozukluğunun Özgün Rolü

Yaşlılarda depresyon ciddi sonuçlara sebebiyet vermektedir, bu yüzden depresyona hassasiyet yaratan faktörleri anlamak, gerekli terapi yöntemlerinin geliştirilmesinde ve uygulanmasında faydalı olacaktır. Yaşlılıkta depresyona sebep olan risk faktörlerinden birisi yürütücü işlev bozukluklarıdır. Yürütücü işlevler üzerinde olumsuz etkisi olabilecek bir faktör geçmişte olmuş veya gelecekte olabilecek olaylara ilişkin kontrol edilemez, soyut, tekrarlayan ve genelde olumsuzluk içeren düşünme eğilimi olarak tanımlanan tekrarlayan olumsuz düşünce şeklidir. Bu araştırmanın amacı farklı yürütücü işlevlerin geriyatrik depresyon ve tekrarlayan olumsuz düşünce arasındaki ilişkide biçimlendirici etkisini araştırmaktır. Araştırmanın örneklemini 60-82 yaşları arasında 128 (63 kadın, 65 erkek) bağımsız yaşayan katılımcı oluşturmaktadır. Katılımcılara depresyon (Geriatrik Depresyon Ölçeği) ve tekrar eden düşünce eğilimini ölçen (Penn State Endişe Ölçeği) özbildirim ölçekleri ile inhibisyon (Stroop Renk-Kelime Testi) ve işler bellek kapasitesini ölçen (Sayı Dizisi Tersten) nöropsikolojik testler uygulanmıştır. Katılımcıların tamamı İstanbul’da ikamet etmektedir ve anadillerini Türkçe olarak belirtmişlerdir. Analizler, işler bellek kapasitesinin depresyon ve tekrarlayan olumsuz düşünce arasındaki ilişkiyi biçimlendirdiğini göstermiştir. Sonuçlara göre, düşük düzeyde tekrarlayan olumsuz düşünce gösteren katılımcılarda, işler bellek kapasitesinin depresyon üzerinde bir etkisi olmadığı bulunmuştur. Buna karşın, yüksek düzeyde tekrarlayan olumsuz düşünce gösteren yaşlılarda işler bellek kapasitesinin yüksek olması tekrarlayan olumsuz düşüncelerin olumsuz etkilerini yumuşattığı ve düşük depresyon puanları ile ilişkili olduğu belirlenmiştir. Ancak aynı biçimlendirici etki inhibisyon için bulunamamıştır. Elde edilen bulgular yaşlılıkta yüksek işler bellek kapasitesinin, depresyon ve tekrarlayan olumsuz düşünce arasındaki ilişkide tampon görevi üstlendiğini göstermiştir. Bu çalışmanın tekrarlayan olumsuz düşünce ve yütürücü işlev bozukluğunun da etkisiyle daha komplike bir hal alan geriyatrik depresyonun tedavisinde önemli bir yol gösterici olduğu düşünülmektedir.

Anahtar Kelimeler:

Geriyatrik depresyon, tekrarlayan olumsuz düşünce, yürütücü işlevler, işler bellek, endişe

Depression and Repetitive Negative Thinking among Older Adults: The Specific Role of Executive Dysfunction

Depression in older adults poses serious consequences, thus understanding vulnerability factors may contribute to the development and implementation of appropriate clinical interventions. Executive function deficits have been proposed as risk factors for geriatric depression. One possible factor that may facilitate the impact of executive function deficits is Repetitive Negative Thinking (RNT) patterns that had been defined as an inclination to entertain uncontrollable, abstract, repetitive, and mainly negative thoughts about events that took place in the past or will take place in the future. The present study aimed to test the moderator roles of different dimensions of executive function on the relationship between repetitive negative thinking and geriatric depression. A sample of 128 community-dwelling older adults (63 women, 65 men), between 60 and 82 years of age, were administered both self-report questionnaires measuring depression (Geriatric Depression Scale), and repetitive negative thinking (Penn State Worry Questionnaire) and neuropsychological tests measuring inhibition (Stroop Color-Word Test) and working memory (Digit Span Backward). All participants lived independently in Istanbul, and spoke Turkish as their native language. The results showed that working memory capacity significantly moderated the relationship between repetitive negative thinking and depression as predicted. However, the results did not indicate the same moderator effect of inhibition. The present data suggests that high working memory capacity is able to moderate the relationship between repetitive negative thinking and depression among older adults. This finding has important implications for clinical interventions targeting depression in older adults whose clinical presentations are complicated with repetitive negative thinking and executive dysfunction.

Keywords:

Geriatric depression, repetitive negative thinking, executive function, working memory, worry,

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