Resiliência em pacientes com transtorno mental grave : estudo de correlação com desfechos clínicos e qualidade de vida

Introdução: Resiliência refere-se à capacidade humana de recuperar-se após situações estressoras, retornando ou reagindo com um funcionamento normal. No contexto dos transtornos mentais graves, podemos adaptar esse conceito entendendo como o individuo lida e cria estratégias para as diversas mudanças devido a sua condição mental. O objetivo desse estudo foi avaliar a resiliência em pacientes com transtorno mental grave e correlacionar esses dados com medidas de desfecho clínico. Além disso, foi objetivo secundário comparar os níveis de resiliência entre os diagnósticos e correlacionar os níveis de resiliência com os escores de qualidade de vida. Método: A partir de uma amostra consecutiva de 384 pacientes internados na unidade de internação psiquiátrica do Hospital de Clínicas de Porto Alegre, foram avaliados 48h após sua admissão na internação e reavaliados 72h antes do momento de alta. Foram utilizadas as escalas de resiliência (RS), qualidade de vida (WHOQOL-BREF), sintomas psiquiátricos (BPRS-Brief Psychopathological Rating Scale), gravidade clínica (CGI-Clinical Global Impression), funcionalidade (GAF-General Assessment Funtionality), comorbidades clínicas (CIRS-Cumulative Illness Rating Scale) além de questionários para avaliar dados sociodemográficos. Resultados: O escore de resiliência se diferenciou entre os grupos (F2,257= 5,07; p= 0,007), sendo mais alto nos pacientes com transtorno de humor bipolar 139,1 (± 24,9), em seguida nos pacientes com esquizofrenia 130,9 (± 27,3). Por último, em pacientes com depressão maior, que foi 123,8 (± 30,6). Na correlação simples entre resiliência e os desfechos clínicos BPRS (p=0,131), GAF (p=0,550) e CGI (p=0,980) e CIRS (p=0,516) não houve associação significativa com nenhum dos desfechos. 9 A partir da regressão linear multivariada foi possível encontrarmos uma associação entre resiliência e pontuação na escala de sintomas psiquiátricos quando ajustados para tentativa de suicídio, tempo de hospitalização, QI, numero prévio de hospitalizações psiquiátricas, sexo, idade, nível educacional, estado civil, depressão maior, transtorno de humor bipolar, esquizofrenia, escala de funcionalidade (GAF), escala de gravidade clínica (CGI), escala de comorbidade clínica (CIRS) e a escala de sintomas psiquiátricos (BPRS) (BPRS; β= -0,308; p= 0,003). No domínio de aceitação de vida e de self da escala de resiliência houve forte associação com os diagnósticos de transtorno de humor bipolar (β= 0,207; p= 0,038) e esquizofrenia (β= 0,320; p= 0,003). No domínio de competência pessoal da mesma escala, houve associação negativa significativa entre tentativa de suicídio e resiliência (β= -0,019; p= 0,038). Houve uma associação positiva entre os domínios de resiliência e qualidade de vida (r= 0,406; p<0,001) e o domínio psicológico foi o que apresentou maior força de associação (r= 0,545; p<0,001). Conclusão: Os pacientes com diagnóstico de depressão maior foram os que apresentaram os escores mais baixos na escala de resiliência. Após a realização da regressão linear multivariada, existiu uma associação entre o escore total de resiliência e a pontuação de sintomas psiquiátricos da escala BPRS, sendo, que quanto mais altos os escores de resiliência, menores os escores da escala BPRS. Foi encontrada associação entre tentativa de suicídio e resiliência, sendo essa associação inversamente significativa com o domínio de competência pessoal da escala de resiliência, ou seja, quanto maior a percepção de competência pessoal, menor a pontuação de sintomas psiquiátricos e menor a quantidade de tentativas de suicídio. Além disso, para finalizar, foi encontrada uma associação positiva entre qualidade de vida e resiliência, e o domínio que apresentou maior força de associação foi o psicológico.Introduction: Resilience refers to the human ability to recover from stressful situations, returning or reacting with normal functioning. In the context of serious mental disorders, we can adapt this concept by understanding how the individual handles and creates strategies to deal with adversity due to or not his mental condition. The aim of this study was to evaluate the resilience in patients hospitalized for acute aggravation of severe mental disorder and to correlate these data with measures of clinical outcome at discharge, like psychiatric symptoms, functionality, severity of the disease and clinical comorbidities. In addition, it was a secondary objective to compare resilience levels between different diagnoses and to correlate resilience levels with quality of life scores in order to better understand the repercussion that resilience has on life in these individuals. Method: From a consecutive sample of 384 patients hospitalized at the psychiatric hospitalization unit of the Hospital de Clínicas of Porto Alegre, between 2011 and 2013, they were assessed 48h after admission on admission and reassessed 72h prior to discharge. Scale of resilience (SR), quality of life (WHOQOL-BREF), psychiatric symptoms (BPRS-Brief Psychopathological Rating Scale), clinical severity (CGI-Clinical Global Impression), functionality (GAF-General Assessment Functionality), clinical comorbiities (CIRSCumulative Illness Rating Scale) and questionnaires to evaluate sociodemographic data. In the resilience scale used, the score between 25 and 175 points is considered, and the higher the score, the higher the level of resilience. In addition, the scale is subdivided into two domains: personal competence (self-confidence, independence, determination, invincibility, mastery, resourcefulness and perseverance) and acceptance of life and self (adaptability, flexibility, a sense of peace in the face of adversity, perspective of balance and acceptance of the consequences of life). 11 Results: The resilience score differed between groups (F2.257 = 5.07, p = 0.007), being higher in patients with bipolar mood disorder 139.1 (± 24.9), then in patients with schizophrenia 130.9 (± 27.3). And finally in patients with major depression that was 123.8 (± 30.6). In the simple correlation between resilience and the clinical outcomes BPRS (p = 0.131), GAF (p = 0.550), CIRS (p = 0.516) and CGI (p = 0.980) there was no significant association with any of the outcomes. From the multivariate linear regression it was possible to find an association between resilience and punctuation in the psychiatric symptoms scale when adjusted to suicide attempt, length of hospitalization, IQ, occupation, number of previous psychiatric hospitalizations, sex, age, education, marital status, major depression, bipolar disorder, schizophrenia, functionality (GAF), clinical impression (CGI) and psychiatric symptoms (BPRS). (BPRS; β = -0.308; p = 0.003). In the domain of life and self acceptance of the resilience scale there was a strong association with the diagnoses of bipolar mood disorder (β = 0.207, p = 0.038) and schizophrenia (β = 0.320; p = 0.003). In the domain of personal competence of the same scale, there was a significant negative association between suicide attempt and resilience (β = - 0.019; p = 0.038). There was a positive association between the domains of resilience and quality of life (r = 0.406, p <0.001) and the psychological domain presented the highest association strength (r = 0.545, p <0.001). Conclusion: Patients with major depression diagnosis were those with the lowest scores on the resilience scale. After the multivariate linear regression, there was an association between the total resilience score and the BPRS score of psychiatric symptoms, and the higher the resilience scores, the lower the scale scores BPRS. Patients with diagnoses of major depression were those with the lowest scores on the resilience scale. An association between suicide attempt and resilience was found, being this association inversely significant with the personal competence domain of the resilience scale, that is, the higher the perception of personal competence, the lower the score of psychiatric 12 symptoms and the smaller the number of people who attempted suicide. Finally, a positive association between quality of life and resilience was found, and the domain that presented the greatest strength of association was the psychological domain

Resiliência em pacientes com transtorno mental grave : estudo de correlação com desfechos clínicos e qualidade de vida

Introdução: Resiliência refere-se à capacidade humana de recuperar-se após situações estressoras, retornando ou reagindo com um funcionamento normal. No contexto dos transtornos mentais graves, podemos adaptar esse conceito entendendo como o individuo lida e cria estratégias para as diversas mudanças devido a sua condição mental. O objetivo desse estudo foi avaliar a resiliência em pacientes com transtorno mental grave e correlacionar esses dados com medidas de desfecho clínico. Além disso, foi objetivo secundário comparar os níveis de resiliência entre os diagnósticos e correlacionar os níveis de resiliência com os escores de qualidade de vida. Método: A partir de uma amostra consecutiva de 384 pacientes internados na unidade de internação psiquiátrica do Hospital de Clínicas de Porto Alegre, foram avaliados 48h após sua admissão na internação e reavaliados 72h antes do momento de alta. Foram utilizadas as escalas de resiliência (RS), qualidade de vida (WHOQOL-BREF), sintomas psiquiátricos (BPRS-Brief Psychopathological Rating Scale), gravidade clínica (CGI-Clinical Global Impression), funcionalidade (GAF-General Assessment Funtionality), comorbidades clínicas (CIRS-Cumulative Illness Rating Scale) além de questionários para avaliar dados sociodemográficos. Resultados: O escore de resiliência se diferenciou entre os grupos (F2,257= 5,07; p= 0,007), sendo mais alto nos pacientes com transtorno de humor bipolar 139,1 (± 24,9), em seguida nos pacientes com esquizofrenia 130,9 (± 27,3). Por último, em pacientes com depressão maior, que foi 123,8 (± 30,6). Na correlação simples entre resiliência e os desfechos clínicos BPRS (p=0,131), GAF (p=0,550) e CGI (p=0,980) e CIRS (p=0,516) não houve associação significativa com nenhum dos desfechos. 9 A partir da regressão linear multivariada foi possível encontrarmos uma associação entre resiliência e pontuação na escala de sintomas psiquiátricos quando ajustados para tentativa de suicídio, tempo de hospitalização, QI, numero prévio de hospitalizações psiquiátricas, sexo, idade, nível educacional, estado civil, depressão maior, transtorno de humor bipolar, esquizofrenia, escala de funcionalidade (GAF), escala de gravidade clínica (CGI), escala de comorbidade clínica (CIRS) e a escala de sintomas psiquiátricos (BPRS) (BPRS; β= -0,308; p= 0,003). No domínio de aceitação de vida e de self da escala de resiliência houve forte associação com os diagnósticos de transtorno de humor bipolar (β= 0,207; p= 0,038) e esquizofrenia (β= 0,320; p= 0,003). No domínio de competência pessoal da mesma escala, houve associação negativa significativa entre tentativa de suicídio e resiliência (β= -0,019; p= 0,038). Houve uma associação positiva entre os domínios de resiliência e qualidade de vida (r= 0,406; p<0,001) e o domínio psicológico foi o que apresentou maior força de associação (r= 0,545; p<0,001). Conclusão: Os pacientes com diagnóstico de depressão maior foram os que apresentaram os escores mais baixos na escala de resiliência. Após a realização da regressão linear multivariada, existiu uma associação entre o escore total de resiliência e a pontuação de sintomas psiquiátricos da escala BPRS, sendo, que quanto mais altos os escores de resiliência, menores os escores da escala BPRS. Foi encontrada associação entre tentativa de suicídio e resiliência, sendo essa associação inversamente significativa com o domínio de competência pessoal da escala de resiliência, ou seja, quanto maior a percepção de competência pessoal, menor a pontuação de sintomas psiquiátricos e menor a quantidade de tentativas de suicídio. Além disso, para finalizar, foi encontrada uma associação positiva entre qualidade de vida e resiliência, e o domínio que apresentou maior força de associação foi o psicológico.Introduction: Resilience refers to the human ability to recover from stressful situations, returning or reacting with normal functioning. In the context of serious mental disorders, we can adapt this concept by understanding how the individual handles and creates strategies to deal with adversity due to or not his mental condition. The aim of this study was to evaluate the resilience in patients hospitalized for acute aggravation of severe mental disorder and to correlate these data with measures of clinical outcome at discharge, like psychiatric symptoms, functionality, severity of the disease and clinical comorbidities. In addition, it was a secondary objective to compare resilience levels between different diagnoses and to correlate resilience levels with quality of life scores in order to better understand the repercussion that resilience has on life in these individuals. Method: From a consecutive sample of 384 patients hospitalized at the psychiatric hospitalization unit of the Hospital de Clínicas of Porto Alegre, between 2011 and 2013, they were assessed 48h after admission on admission and reassessed 72h prior to discharge. Scale of resilience (SR), quality of life (WHOQOL-BREF), psychiatric symptoms (BPRS-Brief Psychopathological Rating Scale), clinical severity (CGI-Clinical Global Impression), functionality (GAF-General Assessment Functionality), clinical comorbiities (CIRSCumulative Illness Rating Scale) and questionnaires to evaluate sociodemographic data. In the resilience scale used, the score between 25 and 175 points is considered, and the higher the score, the higher the level of resilience. In addition, the scale is subdivided into two domains: personal competence (self-confidence, independence, determination, invincibility, mastery, resourcefulness and perseverance) and acceptance of life and self (adaptability, flexibility, a sense of peace in the face of adversity, perspective of balance and acceptance of the consequences of life). 11 Results: The resilience score differed between groups (F2.257 = 5.07, p = 0.007), being higher in patients with bipolar mood disorder 139.1 (± 24.9), then in patients with schizophrenia 130.9 (± 27.3). And finally in patients with major depression that was 123.8 (± 30.6). In the simple correlation between resilience and the clinical outcomes BPRS (p = 0.131), GAF (p = 0.550), CIRS (p = 0.516) and CGI (p = 0.980) there was no significant association with any of the outcomes. From the multivariate linear regression it was possible to find an association between resilience and punctuation in the psychiatric symptoms scale when adjusted to suicide attempt, length of hospitalization, IQ, occupation, number of previous psychiatric hospitalizations, sex, age, education, marital status, major depression, bipolar disorder, schizophrenia, functionality (GAF), clinical impression (CGI) and psychiatric symptoms (BPRS). (BPRS; β = -0.308; p = 0.003). In the domain of life and self acceptance of the resilience scale there was a strong association with the diagnoses of bipolar mood disorder (β = 0.207, p = 0.038) and schizophrenia (β = 0.320; p = 0.003). In the domain of personal competence of the same scale, there was a significant negative association between suicide attempt and resilience (β = - 0.019; p = 0.038). There was a positive association between the domains of resilience and quality of life (r = 0.406, p <0.001) and the psychological domain presented the highest association strength (r = 0.545, p <0.001). Conclusion: Patients with major depression diagnosis were those with the lowest scores on the resilience scale. After the multivariate linear regression, there was an association between the total resilience score and the BPRS score of psychiatric symptoms, and the higher the resilience scores, the lower the scale scores BPRS. Patients with diagnoses of major depression were those with the lowest scores on the resilience scale. An association between suicide attempt and resilience was found, being this association inversely significant with the personal competence domain of the resilience scale, that is, the higher the perception of personal competence, the lower the score of psychiatric 12 symptoms and the smaller the number of people who attempted suicide. Finally, a positive association between quality of life and resilience was found, and the domain that presented the greatest strength of association was the psychological domain

Resilience in severe mental disorders : correlations to clinical measures and quality of life in hospitalized patients with major depression, bipolar disorder, and schizophrenia

Purpose: To evaluate resilience in severe mental disorders and correlate it with clinical measures and quality of life. Methods: Resilience (Resilience Scale, RS) and quality of life (WHOQOL-BREF questionnaire) were prospectively evaluated in a sample of 384 hospitalized patients diagnosed with severe mental disorders (depression, bipolar disorder and schizophrenia). Clinical outcomes were measured using the Global Assessment of Functioning Scale (GAF), Clinical Global Impression (CGI), Cumulative Illness Rating Scale (CIRS), Hamilton Scale-Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). Results: Resilience measure showed a difference between the three clinical groups analyzed in the study, with lower scores in depressed patients than in bipolar disorder or schizophrenia patients. There was a trend toward a correlation between resilience and depressive symptoms (Hamilton Scale-Depression; P = 0.052; rs = − 0.163). The scores in the resilience scale’s personal competence domain presented a tendency of association with general psychiatric symptoms (Brief Psychiatric Rating Scale; P = 0.058; r = − 0.138). There was a significantly positive association between resilience and all domains of quality of life (r = 0.306–0.545; P < 0.05). Sociodemographic data like age, education, intelligence quotient, sex, and marital status were associated with resilience. Conclusion: Depressive patients had low scores on the resilience scale compared to patients with other disorders. Resilience was positively associated with quality of life. Therefore, it deserves special attention, as it promotes more positive outcomes and improves patients’ quality of life with severe mental disorders

La correspondencia de Valencia : diario de noticias : eco imparcial de la opinión y de la prensa: Año XLI Número 17608 - 1918 Noviembre 11

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 200