Family Functioning, Illness-Related Self-Regulation Processes, and Clinical Outcomes in Major Depression: A Prospective Study in Greece.

Major depressive disorder (MDD) is a common, seriously impairing, and often recurrent mental disorder. Based on the predictions of the Circumplex Model of Marital and Family Systems and the Common-Sense Self-Regulation Model, the aim of the present prospective study is to examine the predictive value of clinical outcomes of a process model in which associations between perceived family functioning and patient's clinical outcomes (i.e., symptom severity and suicide risk) are mediated by illness representations and coping strategies. A total of 113 patients with a clinical diagnosis of MDD (16.8% males and 83.2% females) aged 47.25 ± 13.98 years and recruited from the outpatient department and the mobile mental health unit of the Psychiatric Clinic of the University Hospital of Heraklion in Crete, Greece, and from a Greek online depression peer-support group participated in the study. Family functioning was assessed in terms of cohesion and flexibility (Family Adaptability and Cohesion Evaluation Scales IV) at baseline. Illness representations (Illness Perception Questionnaire-Mental Health) and coping strategies (Brief Cope Orientation to Problems Experienced) were measured about five months later (5.04 ± 1.16 months). Symptom severity (Beck Depression Inventory) and suicidality (Risk Assessment Suicidality Scale) were measured about 10 months after the baseline assessment (9.56 ± 2.52 months). The results indicated that representations about MDD impact and symptom severity serially mediated the association between family cohesion and suicide risk in MDD. Furthermore, family cohesion was found to be linked with maladaptive coping through MDD impact representations. Family-based psychotherapeutic interventions specifically designed to target unhealthy family functioning, along with negative illness perceptions and dysfunctional coping, could be further developed and explored as adjunctive therapy to standard treatment in MDD.

Mental Health Professionals' Attitudes Towards People with Severe Mental Illness: Are they Related to Professional Quality of Life?

The present study examines whether attitudes of mental health professionals (MHPs) towards severe mental illness are associated with professional quality of life. The Attitudes towards Severe Mental Illness (ASMI), the Maslach Burnout Inventory (MBI), and the Professional Quality of Life Scale-5 (ProQOL-5) were completed by 287 MHPs in Greece (25.4% males, 74.6% females). The results indicate that MHPs hold predominantly positive attitudes towards people with severe mental illness. Nonetheless, MHPs' attitudes are deemed to be stereotypical according to ASMI concerning treatment duration, prospects of recovery, and whether patients are similar to other people. Higher scores in emotional exhaustion, depersonalization, compassion fatigue and ProQOL-5 burn out dimension were significantly associated with MHPs' unfavorable attitudes, whereas higher scores in compassion satisfaction and personal accomplishment were associated with MHPs' positive attitudes. Assessing compassion fatigue, compassion satisfaction and burnout levels could help identify the processes involved in the development or maintenance of MHPs' stigmatizing attitudes.

Positive and negative affect and well-being in cardiac patients and their spouses: the mediating role of illness representations.

OBJECTIVE: The aim of this study was to examine whether illness representations of control and consequences mediate the relation of cardiac patients' affect to well-being. A further aim was to examine this indirect relationship at a dyadic level (i.e. patient and spouse). DESIGN AND MAIN OUTCOME MEASURES: One hundred and four patients with a cardiovascular disease and their spouses participated in the study. Positive and negative affect was assessed at baseline; illness representations were assessed 2 months later, and physical and psychological well-being 4 months later. RESULTS: Illness representations generally mediated the impact of patients' and spouses' affect on well-being, while several actor and partner effects were found. However, it was only positive affect that was indirectly related to well-being, while the representations of personal and treatment control chiefly acted as mediators. The effects were stronger for patients than spouses, as well as for physical well-being. CONCLUSION: The results underline the strong connection between illness-related self-regulation and the overall person/environment interaction as depicted by affect. They also indicate the need to integrate theories on adaptation to illness, with models describing adaptation of couples to stressful conditions, and specific theories about the role of emotion in adaptation to illness.