Immature defense mechanisms predict poor response to psychotherapy in major depressive patients with comorbid cluster B personality disorder

Objective: To evaluate the impact of defense mechanisms at baseline on depressive symptoms after brief psychotherapies and after 6-months of follow-up among depressed patients with and without cluster B personality disorders (PDs). Methods: This quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. The Millon Clinical Multiaxial Inventory-III was applied to assess PD, the Defense Style Questionnaire 40 was used to analyze defense mechanisms, and the Beck Depression Inventory was used to measure the severity of depressive symptoms. Adjusted analysis was performed by linear regression. Results: The final sample consisted of 177 patients diagnosed with major depressive disorder, of whom 39.5% had cluster B PDs. Immature defenses at baseline significantly predicted the persistence of depressive symptoms at post-intervention and at 6-months of follow-up only in patients with PDs. Conclusion: In depressed patients with cluster B PDs, immature defenses predicted a poor response to brief therapies. The assessment of immature defenses at baseline can help identify patients at greater risk of poor therapeutic results and enable more appropriate treatment choices.

Impact of resilience on the improvement of depressive symptoms after cognitive therapies for depression in a sample of young adults / Impacto da resiliência na melhora dos sintomas depressivos após terapias cognitivas para depressão em uma amostra de adultos jovens

Abstract Introduction Few studies have evaluated positive measures for therapeutic response. Thus, the objective of this study was to assess the effects of resilience on severity of depressive and anxious symptoms after brief cognitive psychotherapy for depression. Methods This was a clinical follow-up study nested in a randomized clinical trial of cognitive therapies. The Resilience Scale was applied at baseline. The Hamilton Anxiety Rating Scale (HARS) and the Hamilton Depression Rating Scale (HDRS) were used at baseline, post-intervention, and at six-month follow-up. Results Sixty-one patients were assessed at baseline, post-intervention and at six-month follow-up. Resilience scores were significantly different between baseline and post-intervention assessments (p<0.001), as well as at baseline and at six-month follow-up (p<0.001). We observed a weak negative correlation between baseline resilience scores and HDRS scores at post-intervention (r=-0.295, p=0.015) and at six-month follow-up (r=-0.354, p=0.005). Furthermore, we observed a weak negative correlation between resilience scores and HARS scores at post-intervention (r=-0.292, p=0.016). Conclusion Subjects with higher resilience scores at baseline showed a lower severity of symptoms at post-intervention and at six-month follow-up.

Resumo Introdução Poucos estudos têm avaliado medidas positivas de resposta terapêutica. Assim, o objetivo deste estudo foi verificar os efeitos da resiliência na severidade dos sintomas depressivos e ansiosos após psicoterapia cognitiva breve para depressão. Métodos Trata-se de um estudo de intervenção clínica aninhado a um ensaio clínico com dois diferentes modelos de terapia cognitiva. A Resilience Scale foi aplicada no baseline, enquanto que a Hamilton Anxiety Rating Scale e a Hamilton Depression Rating Scale foram utilizadas no baseline, após a intervenção e no acompanhamento de seis meses. Resultados Sessenta e um pacientes foram avaliados no baseline, no pós-intervenção e no acompanhamento de seis meses. Os escores de resiliência foram significativamente diferentes entre as avaliações de baseline e pós-intervenção (p<0,001), bem como no baseline vs. acompanhamento de seis meses (p<0,001). Observamos uma correlação negativa fraca entre os escores de resiliência no baseline e os escores de sintomas depressivos no pós-intervenção (r=-0,295; p=0,015) e em seis meses de acompanhamento (r=-0,354; p=0,005). Além disso, observamos uma correlação negativa fraca entre os escores de resiliência e sintomas ansiosos no pós-intervenção (r=-0,292; p=0,016). Conclusão Indivíduos com maiores escores de resiliência na avaliação pré-tratamento apresentaram uma menor severidade de sintomas no pós-intervenção e no acompanhamento de seis meses.

Suicide risk and childhood trauma in individuals diagnosed with posttraumatic stress disorder / Risco de suicídio e trauma na infância em indivíduos diagnosticados com transtorno de estresse pós-traumático

Abstract Introduction Posttraumatic stress disorder (PTSD) develops after exposure to a potentially traumatic event. Its clinical condition may lead to the development of risk behaviors, and its early detection is a relevant aspect to be considered. The aim of this study was to assess the association between childhood trauma and suicide risk in individuals with PTSD. Method This was a cross-sectional study conducted with individuals aged 18 to 60 years who were evaluated at a mental health research outpatient clinic. PTSD diagnosis and suicide risk identification were performed using specific modules of the Mini International Neuropsychiatric Interview (MINI-Plus). The Childhood Trauma Questionnaire (CTQ) was used to evaluate traumatic events in childhood. Results Of the 917 individuals evaluated, 55 were diagnosed with PTSD. The suicide risk prevalence in individuals with PTSD was 63.6%. Emotional neglect and emotional abuse scores tended to be higher in the suicide risk group (p<0.2). Conclusion Our findings showed a higher prevalence of suicide risk in individuals with PTSD and support the hypothesis that the investigation of childhood traumatic experiences, especially emotional neglect and abuse, may help in the early detection of suicide risk in individuals with PTSD.

Resumo Introdução O transtorno de estresse pós-traumático (TEPT) desenvolve-se após exposição a evento traumático grave. É uma condição clínica que pode levar ao desenvolvimento de comportamentos de risco, e sua detecção precoce é um aspecto relevante a ser considerado. O objetivo deste estudo foi verificar a associação entre trauma na infância e risco de suicídio em indivíduos com TEPT. Método Este foi um estudo transversal conduzido com indivíduos de 18 a 60 anos de idade avaliados em um ambulatório de pesquisa e extensão em saúde mental. O diagnóstico do TEPT e a identificação do risco de suicídio foram realizados através dos módulos específicos da Mini International Neuropsychiatric Interview (MINI-Plus). O Childhood Trauma Questionnaire (CTQ) foi utilizado para avaliar eventos traumáticos na infância. Resultados Dos 917 indivíduos avaliados, 55 foram diagnosticados com TEPT. A prevalência de risco de suicídio em indivíduos com TEPT foi de 63,6%. Os escores de negligência emocional e abuso emocional mostraram tendência a estarem mais elevados no grupo com risco de suicídio (p<0,2). Conclusão Nossos achados mostram a alta prevalência de risco de suicídio em indivíduos com TEPT e suportam a hipótese de que a investigação de experiências traumáticas na infância, especialmente a negligência e o abuso emocionais, poderá auxiliar na identificação precoce do risco de suicídio em indivíduos com TEPT.