Journal of Korean Medical Science

  • 제33권45호
  • /
  • Pages.284.1-284.12
  • /
  • 2018
  • /
  • 1011-8934(pISSN)
  • /
  • 1598-6357(eISSN)
대한의학회 (Korean Acad Medical Sciences)
권호 표지
DOI QR코드

DOI QR Code

Mediating Role of Anxiety and Depression in the Relationship between Posttraumatic Stress Symptoms and Illness Intrusiveness

  • Kim, Nam Hee (Department of Psychiatry, National Center for Mental Health) ;
  • Kim, Seok Hyeon (Department of Psychiatry, Hanyang University College of Medicine) ;
  • Hyun, So Yeon (Department of Psychiatry, National Center for Mental Health) ;
  • Kang, Dae Ryong (Center of Biomedical Data Science, Yonsei University Wonju College of Medicine) ;
  • Oh, Min Jung (Department of Preventive Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Daeho (Department of Psychiatry, Hanyang University College of Medicine)
  • 투고 : 2018.06.21
  • 심사 : 2018.07.20
  • 발행 : 2018.11.05
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Posttraumatic stress symptoms (PTSS) in patients with psychological trauma lead to poor health-related quality of life. Understanding of the relationships among PTSS, anxiety, depression, and illness intrusiveness will guide the development of efficient approaches to enhance subjective well-being in patients with psychological trauma. This study investigated whether anxiety and depression mediate the relationship between PTSS and illness intrusiveness in the hope of providing more comprehensive and effective trauma treatment. Methods: Psychiatric outpatients who visited the trauma clinic of a university hospital (n = 260) participated in this study. Assessments were conducted for PTSS, anxiety, depression, and illness intrusiveness. Structural equation modeling and path analysis were performed to analyze the mediating effects of anxiety and depression on the relationship between PTSS and illness intrusiveness. Results: PTSS had both direct and indirect exacerbating effects on illness intrusiveness. Anxiety exhibited the largest direct exacerbating effect on illness intrusiveness. The indirect effects of PTSS on illness intrusiveness through anxiety alone and through a depression-to-anxiety pathway were significant, but the indirect effect through depression alone was not. Conclusion: The findings demonstrate that anxiety, both independently and as part of an interrelated pathway with depression, partially mediates the relationship between PTSS and illness intrusiveness. Appropriate interventions and a comprehensive approach to alleviate anxiety and depression could mitigate the negative effects of PTSS on illness intrusiveness in patients with psychological trauma.

키워드

과제정보

연구 과제 주관 기관 : Ministry of Health & Welfare

참고문헌

  1. Atwoli L, Stein DJ, Koenen KC, McLaughlin KA. Epidemiology of posttraumatic stress disorder: prevalence, correlates and consequences. Curr Opin Psychiatry 2015;28(4):307-11. https://doi.org/10.1097/YCO.0000000000000167
  2. Pietrzak RH, Goldstein RB, Southwick SM, Grant BF. Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord 2011;25(3):456-65. https://doi.org/10.1016/j.janxdis.2010.11.010
  3. Wang CH, Tsay SL, Bond AE. Post-traumatic stress disorder, depression, anxiety and quality of life in patients with traffic-related injuries. J Adv Nurs 2005;52(1):22-30. https://doi.org/10.1111/j.1365-2648.2005.03560.x
  4. Brady KT. Posttraumatic stress disorder and comorbidity: recognizing the many faces of PTSD. J Clin Psychiatry 1997;58 Suppl 9:12-5. https://doi.org/10.4088/JCP.v58n0102
  5. Gudmundsdottir B, Beck JG, Coffey SF, Miller L, Palyo SA. Quality of life and post trauma symptomatology in motor vehicle accident survivors: the mediating effects of depression and anxiety. Depress Anxiety 2004;20(4):187-9. https://doi.org/10.1002/da.20037
  6. Solomon Z, Mikulincer M. Posttraumatic intrusion, avoidance, and social functioning: a 20-year longitudinal study. J Consult Clin Psychol 2007;75(2):316-24. https://doi.org/10.1037/0022-006X.75.2.316
  7. Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118(8):622-9. https://doi.org/10.7326/0003-4819-118-8-199304150-00009
  8. Norman SB, Stein MB, Davidson JR. Profiling posttraumatic functional impairment. J Nerv Ment Dis 2007;195(1):48-53. https://doi.org/10.1097/01.nmd.0000252135.25114.02
  9. Birkley EL, Eckhardt CI, Dykstra RE. Posttraumatic stress disorder symptoms, intimate partner violence, and relationship functioning: a meta-analytic review. J Trauma Stress 2016;29(5):397-405. https://doi.org/10.1002/jts.22129
  10. Marshall RD, Olfson M, Hellman F, Blanco C, Guardino M, Struening EL. Comorbidity, impairment, and suicidality in subthreshold PTSD. Am J Psychiatry 2001;158(9):1467-73. https://doi.org/10.1176/appi.ajp.158.9.1467
  11. Zlotnick C, Franklin CL, Zimmerman M. Does "subthreshold" posttraumatic stress disorder have any clinical relevance? Compr Psychiatry 2002;43(6):413-9. https://doi.org/10.1053/comp.2002.35900
  12. Scott KM, Koenen KC, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Benjet C, et al. Associations between lifetime traumatic events and subsequent chronic physical conditions: a cross-national, cross-sectional study. PLoS One 2013;8(11):e80573. https://doi.org/10.1371/journal.pone.0080573
  13. Bowler RM, Kornblith ES, Li J, Adams SW, Gocheva VV, Schwarzer R, et al. Police officers who responded to 9/11: comorbidity of PTSD, depression, and anxiety 10-11 years later. Am J Ind Med 2016;59(6):425-36. https://doi.org/10.1002/ajim.22588
  14. Ginzburg K, Ein-Dor T, Solomon Z. Comorbidity of posttraumatic stress disorder, anxiety and depression: a 20-year longitudinal study of war veterans. J Affect Disord 2010;123(1-3):249-57. https://doi.org/10.1016/j.jad.2009.08.006
  15. Hashemian F, Khoshnood K, Desai MM, Falahati F, Kasl S, Southwick S. Anxiety, depression, and posttraumatic stress in Iranian survivors of chemical warfare. JAMA 2006;296(5):560-6. https://doi.org/10.1001/jama.296.5.560
  16. Zlotnick C, Warshaw M, Shea MT, Allsworth J, Pearlstein T, Keller MB. Chronicity in posttraumatic stress disorder (PTSD) and predictors of course of comorbid PTSD in patients with anxiety disorders. J Trauma Stress 1999;12(1):89-100. https://doi.org/10.1023/A:1024746316245
  17. Kang HJ, Bae KY, Kim SW, Shin HY, Shin IS, Yoon JS, et al. Impact of anxiety and depression on physical health condition and disability in an elderly Korean population. Psychiatry Investig 2017;14(3):240-8. https://doi.org/10.4306/pi.2017.14.3.240
  18. Rapaport MH, Clary C, Fayyad R, Endicott J. Quality-of-life impairment in depressive and anxiety disorders. Am J Psychiatry 2005;162(6):1171-8. https://doi.org/10.1176/appi.ajp.162.6.1171
  19. Devins GM. Using the illness intrusiveness ratings scale to understand health-related quality of life in chronic disease. J Psychosom Res 2010;68(6):591-602. https://doi.org/10.1016/j.jpsychores.2009.05.006
  20. Pittman JO, Goldsmith AA, Lemmer JA, Kilmer MT, Baker DG. Post-traumatic stress disorder, depression, and health-related quality of life in OEF/OIF veterans. Qual Life Res 2012;21(1):99-103. https://doi.org/10.1007/s11136-011-9918-3
  21. Gray MJ, Litz BT, Hsu JL, Lombardo TW. Psychometric properties of the life events checklist. Assessment 2004;11(4):330-41. https://doi.org/10.1177/1073191104269954
  22. First MB, Spitzer RL, Gibbon M, Williams JB. Structured Clinical Interview for DSM-IV Axis I Disorders-clinician Version (SCID-CV). Washington, D.C.: American Psychiatric Press; 1997.
  23. Weiss DS, Marmar CR. The impact of event scale - revised. In: Wilson JP, Keane TM, editors. Assessing Psychological Trauma and PTSD. New York, NY: Guilford Press; 1997, 399-411.
  24. Zung WW. A rating instrument for anxiety disorders. Psychosomatics 1971;12(6):371-9. https://doi.org/10.1016/S0033-3182(71)71479-0
  25. Zung WW. A self-rating depression scale. Arch Gen Psychiatry 1965;12(1):63-70. https://doi.org/10.1001/archpsyc.1965.01720310065008
  26. Taylor AB, MacKinnon DP, Tein JY. Tests of the three-path mediated effect. Organ Res Methods 2008;11(2):241-69. https://doi.org/10.1177/1094428107300344
  27. Hooper D, Coughlan J, Mullen M. Structural equation modelling: guidelines for determining model fit. Electron J Bus Res Methods 2008;6(1):53-60.
  28. Robb JC, Cooke RG, Devins GM, Young LT, Joffe RT. Quality of life and lifestyle disruption in euthymic bipolar disorder. J Psychiatr Res 1997;31(5):509-17. https://doi.org/10.1016/S0022-3956(97)00030-7
  29. Hossain JL, Ahmad P, Reinish LW, Kayumov L, Hossain NK, Shapiro CM. Subjective fatigue and subjective sleepiness: two independent consequences of sleep disorders? J Sleep Res 2005;14(3):245-53. https://doi.org/10.1111/j.1365-2869.2005.00466.x
  30. Devins GM, Bezjak A, Mah K, Loblaw DA, Gotowiec AP. Context moderates illness-induced lifestyle disruptions across life domains: a test of the illness intrusiveness theoretical framework in six common cancers. Psychooncology 2006;15(3):221-33. https://doi.org/10.1002/pon.940
  31. Devins GM, Beanlands H, Mandin H, Paul LC. Psychosocial impact of illness intrusiveness moderated by self-concept and age in end-stage renal disease. Health Psychol 1997;16(6):529-38. https://doi.org/10.1037/0278-6133.16.6.529
  32. Antony MM, Roth D, Swinson RP, Huta V, Devins GM. Illness intrusiveness in individuals with panic disorder, obsessive-compulsive disorder, or social phobia. J Nerv Ment Dis 1998;186(5):311-5. https://doi.org/10.1097/00005053-199805000-00008
  33. Devins GM, Edworthy SM, Guthrie NG, Martin L. Illness intrusiveness in rheumatoid arthritis: differential impact on depressive symptoms over the adult lifespan. J Rheumatol 1992;19(5):709-15.
  34. Carragher N, Mills K, Slade T, Teesson M, Silove D. Factor structure of posttraumatic stress disorder symptoms in the Australian general population. J Anxiety Disord 2010;24(5):520-7. https://doi.org/10.1016/j.janxdis.2010.03.009
  35. Harpaz-Rotem I, Tsai J, Pietrzak RH, Hoff R. The dimensional structure of posttraumatic stress symptomatology in 323,903 U.S. veterans. J Psychiatr Res 2014;49:31-6. https://doi.org/10.1016/j.jpsychires.2013.10.020
  36. Pietrzak RH, Feder A, Schechter CB, Singh R, Cancelmo L, Bromet EJ, et al. Dimensional structure and course of post-traumatic stress symptomatology in World Trade Center responders. Psychol Med 2014;44(10):2085-98. https://doi.org/10.1017/S0033291713002924
  37. de Ridder D, Geenen R, Kuijer R, van Middendorp H. Psychological adjustment to chronic disease. Lancet 2008;372(9634):246-55. https://doi.org/10.1016/S0140-6736(08)61078-8
  38. Beck JS. Cognitive Behavior Therapy: Basics and Beyond. 2nd ed. New York, NY: Guilford Press; 2011.
  39. Ehring T, Frank S, Ehlers A. The role of rumination and reduced concreteness in the maintenance of posttraumatic stress disorder and depression following trauma. Cognit Ther Res 2008;32(4):488-506. https://doi.org/10.1007/s10608-006-9089-7
  40. Hayes SC, Strosahl K, Wilson KG, Bissett RT, Pistorello J, Toarmino D, et al. Measuring experiential avoidance: a preliminary test of a working model. Psychol Rec 2004;54(4):553-78. https://doi.org/10.1007/BF03395492

피인용 문헌

  1. 불안 및 우울장애를 주요 진단으로 하는 정신건강의학과 외래환자 대상 한국판 질병침습도 평가척도의 요인 타당도 연구 vol.27, pp.2, 2018, https://doi.org/10.22722/kjpm.2019.27.2.77