СВЯЗЬ МЕЖДУ ЛИЧНОСТНЫМИ РАССТРОЙСТВАМИ И ДЕПРЕССИЕЙ В ПОЖИЛОМ ВОЗРАСТЕ

СВЯЗЬ МЕЖДУ ЛИЧНОСТНЫМИ РАССТРОЙСТВАМИ И ДЕПРЕССИЕЙ В ПОЖИЛОМ ВОЗРАСТЕ

Научная статья

Крстеска Р.*

ORCID: 0000-0002-1273-1842,

Психиатрическая больница ФО "Скопье", Скопье, Северная Македония

* Корреспондирующий автор (r_krsteska[at]yahoo.com)

Аннотация

Введение: в связи с ростом числа пожилых людей во всем мире медики всё больше обращают внимание на феномен старения и психические расстройства среди пожилого населения. Депрессия в пожилом возрасте является, пожалуй, самой частой причиной эмоционального расстройства, снижая качество жизни пожилых людей. Медики долгое время проявляли интерес к влиянию личностных расстройств на возникновение данного вида депрессии, однако личностные расстройства среди пожилых людей в значительной степени неизучены и требуют дополнительных исследований.

Целью исследования являлся анализ связи между структурой личности пожилых людей и депрессией в пожилом возрасте.

Методы исследования: в исследовании приняли участие 60 пациентов, которые соответствовали критериям депрессивного расстройства МКБ-10, а также 60 человек, у которых оно не наблюдалось. Возраст всех участников был старше 60 лет. В исследовании использовались клинические беседы, непосредственные наблюдения, а также шкала гериатрической депрессии и критерии МКБ-10 для специфических расстройств личности (F60).

Результаты: в группе с изучаемым диагнозом 33,33% имели зависимую структуру личности, 21,67% - тревожную, 13,33% - обсессивно-компульсивную структуру личности, и 11,67% - гистрионную структуру личности. Авторы исследования пришли к выводу, что пациенты исследуемой группы, по сравнению с контрольной, по структуре личности демонстрируют статистически значимую разницу (р <0,01) между респондентами, имеющими депрессию в пожилом возрасте, и с респондентами без данного вида расстройства.

Заключение: результаты исследования выявили связь между конкретной структурой личности и депрессией в пожилом возрасте. Данная связь представляет собой фактор риска возникновения данного расстройства. Эта информация и будущие исследования могут улучшить распознавание подверженных риску пожилых пациентов, а также своевременное выявление изучаемого расстройства и планирование соответствующих фармакологических и нефармакологических методов лечения.

Ключевые слова: структура личности, депрессия в пожилом возрасте, пожилые люди.

THE ASSOTIATION OF PERSONALITY DISORDERS AND LATE LIFE DEPRESSION (LLD)

Research article

Krsteska R.*

ORCID: 0000-0002-1273-1842,

PHO Psychiatric hospital "Skopje", Skopje, North Macedonia

* Corresponding author (r_krsteska[at]yahoo.com)

Abstract

Introduction: With the growing number of older people around the world, clinicians are turning their attention to aging and mental disorders in the elderly. Late life depression is perhaps the most frequent cause of emotional distress and decreases the quality of life in elderly people. Long time the clinicians are interested in the influence of personality disorders on the onset of LLD. Personality disorders in elderly people are largely understudied. More research is needed in this area.

Objective: The aim of our study was to analyze the association between personality structure in elderly people and LLD.

Subjects and Methods: Our study covered 60 patients with LLD who fulfilled the ICD-10 criteria for depressive disorder and 60 people where LLD was excluded. All entrants had 60 or over years of age. We used: clinical interviews, direct observations, the Geriatric Depression Scale and criteria by the ICD-10 for Specific personality disorders (F60).

Results: In the examined group with LLD 33.33% had the dependent structured personality, 21.67% an anxious personality, 13.33% obsessive compulsive personality structure, and 11.67% histrionic personality structure. We concluded that patients in the examined group compared to the control group in terms of personality structure show a statistically significant difference (p <0.01) between respondents with and respondents who do not have LLD.

Conclusion: Our study found an association among specific structure of personality and LLD, which represents a risk factor for the onset of LLD. This information and future studies may improve the recognizing older people who could be at risk, the timely detection of LLD and the planning of appropriate pharmacological and non-pharmacological treatments.

Keywords: personality structure – late-life depression LLD – elderly.

Introduction

The rapidly growing number of older people around the world is drawing attention to aging and mental disorders. LLD is one of the most common causes of emotional distress and certainly reduces the quality of life [1]. Long time the clinicians are interested in the influence of personality disorders on the onset of LLD. Personality structure can predict the onset of LLD [2]. Krsteska et al. detected a significant interrelationship between low self-esteem, dependence and pessimism with LLD [3]. Heinz et al. pointed out that the personality structure of the elderly has not been sufficiently explored. They analyzed data from 11 studies that found that individuals with a dependent structure were more common in the elderly with depression. This indicated the need for future research [4]. Abrams et al. noted that personality disorders in the elderly can have a negative impact on social and interpersonal functioning after an acute depressive episode, and can also have an impact on the treatment of LLD [5].

Considerably more researches in this area are warranted. 

Objective

The aim of this study was to analyze the association between the personality structure in older people and late life depression.

Subjects and Methods

The study covered 60 older people with LLD who fulfilled ICD-10 criteria for depressive disorder and 60 people where depression was excluded. All entrants had 60 or more of 60 years of age. We used: clinical interviews, direct observations, the Scale for Geriatric Depression and standard by the ICD-10 for Specific personality disorders (F60) [6]. 

Results with discussion

We evaluated the personality structure in all participants related to the criteria of the ICD-10 for Specific personality disorders (F60).

Table 1 shows the data for personality structure of all entrants in the study in related to the clinical criteria for Specific personality disorders (ICD-10 F60), based on data obtained from the respondents and their relatives (Table 1).

In the examined group, the most represented are the persons, who have a dependent structure of personality (33.33%), then an anxious structure of personality (21.67), obsessive compulsive (13.33) and histrionic structure of personality (11.67). In the control group all entrants didn’t have LLD, 88% of the respondents (against 13.33% in the examined group) gave data for positive personality features in terms of openness, communication, independence, and the absence of criteria for personality structure disorders in regard to ICD 10. We found that personality disorders classified related to ICD-10 (existence of at least 3 of the 7 diagnostic criteria), with highly statistically significant (p <0.01) among the respondents with and without LLD.

 

Table 1 – Personality disorders of the respondents in both groups

Personality disorders (ICD-10)	Examined group		Control group
	N	%	N	%
Positive personality traits (openness, independence)	8	13.33	53	88.33
Passive-aggressive personality disorder F 60.8	1	1.67	0	0
Dependent personality disorder F 60.7	20	33.33	5	8.33
Anxious (avoidant) personality disorder F 60.6	13	21.67	0	0
Anankastic personality disorder F 60.5	8	13.33	2	3.33
Histrionic personality disorder F 60.4	7	11.67	0	0
Emotionally unstable personality disorder F 60.3	3	5.00	0	0
Total	60	100	60	100

Note: Dmax=0.75 p<0.01**  

Our findings are close to those of Camus et al. who found that the prevalence of personality disorders in older people recovered from depression was 65% with the dependent and avoidant disorders as more frequent [7].

According to many authors a dependent structure of personality is generally more frequent in older persons with depression [4], [7] and our data suggested that a dependent structure is prevailing.

Second in representation are persons with anxious (avoidant) structure, followed by an obsessive-compulsive and a histrionic structure. These personality disorders classified in ICD-10, were with highly statistically significant, differ among the respondents with LLD and respondents without of LLD are risk factors for the emergence of LLD.

Our data correlated with more investigations in this area. Duberstein revealed that personality structure may be predictors of the onset of LLD [2]. Steunenberg et al. also in their study with 6 years follow-up found that in participants, who developed depressive symptoms, personality features were predictors of the LLD, even more strongly than factors correlated to well-being or social factors [8]. Researchers recommend more investigation on association between personality structure, age and the first onset of depression. This is a particularly important question for older men, given their high suicides and the fact they often do so when a depressive episode first appears in their lives. The obsessional features seem to affect suicide risk, possibly because they may undermine an ability to adapt to the changes brought by aging [9].

Grill et al. concluded that people with comorbidity of depression and personality disorder had a significantly higher risk of recurrence of depression than those without personality disorder [10]. Morse and Lynch indicated a growing awareness that many elderly persons suffer from chronic depression, and they often had concomitant personality disorders. Beside insufficiently studied, older persons with personality disorders have been with less response to the treatment, and also for relapse of LLD [11]. People with disorder of personality structure more frequent had continuation or relapse of significant depressive symptoms than those who didn’t have a disorder of personality structure [12].

As in other studies, our finding may help general practitioners to pay attention to their patients with these personality structures in order to predict and detect the onset оf LLD. It can also help psychiatrists be cautious for patients with LLD and personality disorder as they have more common continuation or new episode of LLD.

Many authors suggest existence of a strong relation between LLD and personality disorder, but the literature is also insufficient in regard to the treatment [13]. Dafsari et al. investigated the impact of personality structure on depressive symptoms and the treatment outcome [14]. The success of treatment of LLD would be greater if the existence of a personality disorders was diagnosed, because it is known that these individuals respond less to the therapy. So it important manages both, the LLD and the personality disorder.

Our study contributes to make clear the association of personality and LLD. In any case, further studies are needed to clarify the links between personality, age and LLD. 

Conclusion

Our summery was in line with the clinical information about the association between the specific personality structure and LLD. According to other authors we concluded that personality disorders are frequent in our sample with LLD. We found that the risk factor for the development of LLD was the existence of a dependent-structured and an anxious-structured personality, but also obsessive-compulsive and histrionic-structured personality.

The study enhances the understanding of the risk factors for LLD. These findings may help general practitioners to predict the onset оf LLD. Studies on this topic may also have an impact on more effective treatment and improvement in the planning of appropriate pharmacological and non-pharmacological treatment. 

Конфликт интересов Не указан.

Conflict of Interest None declared.

Список литературы / References

1. Blazer D.G. Depression in Late Life: Review and Commentary / D.G. Blazer // The Journals of Gerontology Series A. - 2003. - Vol. 58. - Issue 3-, P. M249–M265.
2. Duberstein P.R. Personality Study Shows Risk of First Depression Episode Late In Life / P.R. Duberstein. – [Electronic resource]. – URL: http://www.eurekalert.org/pub_releases/2008-04/uorm-pss041108.php (accessed 14.03.2021)
3. Krsteska R. The relationship between some personality traits and late life depression / R. Krsteska, D. Batic, A. Gorgevic // International Research Journal. -2017.
4. Heintz H.L. Dependent Personality in Depressed Older Adults: A Case Report and Systematic Review / H.L. Heintz, A.L. Freedberg, D.G. Harper // Journal of Geriatric Psychiatry and Neurology.-2020.
5. Abrams R. C. Personality Disorder Symptoms and Functioning in Elderly Depressed Patients / R. C. Abrams, L.A. Spielman, G.S. Alexopoulos et al. // Am J Geriatr Psychiatry.-1998.-Vol. 6.-Issue 1-, P. 24-30.
6. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO, 1992.
7. Camus V. Are personality disorders more frequent in early onset geriatric depression? / V. Camus, Lima C.A.de M., M. Gaillard et al. // Journal of Affective Disorders.-1997.-Vol.46.-Issue 3-, P.297-302.
8. Steunenberg B. Personality and the onset of depression in late life / B. Steunenberg, A.T. Beekman, D.J. Deeg et al. // J Affect Disord.-2006.-Vol.92.-Issue 2-3-,P.243-51.
9. Hawton K. Suicide / K. Hawton, K. van Heeringen // Lancet.-2009.-Vol.373-Issue 9672-, P.1372–81. DOI: 10.1016/S0140-6736(09)60372-X.
10. Grilo M.C. Personality Disorders Predict Relapse After Remission From an Episode of Major Depressive Disorder: A 6-Year Prospective Study / M.C. Grilo, L.R. Stout, C.J. Markowitz et al. // J Clin Psychiatry. -2010.-Vol.71-Issue 12. P.1629–1635.
11. Morse J.Q. Personality disorders in late life / J.Q. Morse, T.R. Lynch // Curr Psychiatry Rep.-2000.-Vol.2- P. 24-31. DOI: 10.1007/s11920-000-0038-y.
12. Morse J.Q. A preliminary investigation of self-reported personality disorders in late life: prevalence, predictors of depressive severity, and clinical correlates // J.Q. Morse, T.R. Lynch // Aging Ment Health. -2004.- Vol.8- Issue 4-P.307–15.
13. Devanand D P. Comorbid psychiatric disorders in late life depression / D P. Devanand // Biol Psychiatry.-2002.-Vol.52- Issue 3-P.236-42 DOI: 10.1016/s0006-3223(02)01336-7.
14. Dafsari F.S. Cognitive behavioural therapy for the treatment of late life depression: study protocol of a multicentre, randomized, observer-blinded, controlled trial (CBTlate) / F.S. Dafsari, B. Bewernick, M. Biewer et al.// BMC Psychiatry.-2019.-Vol.19-Article number 423. DOI: 10.1186/s12888-019-2412-0.