BEHAVIOURAL ATTITUDES IN MAJOR DEPRESSION: A PILOT INVESTIGATION
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February 28, 2013
Vadim S. Rotenberg, A. Cholostoy, Abarbanel Mental Health Center, Bat-Yam 59100, Israel.
Homeostasis, 2004, 43: 16-18.
Behavioural attitudes in major depression: a pilot investigation - V.S.Rotenberg, A. Cholostoy -Homeostasis 43, 1, 2004 - Background. Search activity concept presents a new model of the role of behavior attitudes in psychopathology. According to this concept, depression is characterized by the renunciation of search. However, this hypothesis was not investigated before. Methods. The level of depression according to Hamilton test and the behavioral attitudes have been investigated in 20 Russian-speaking patients with major depression (12 women and 8 men).As a control group was used a group of 67 healthy Russian speaking subjects (44 women and 23 men). Results. In comparison to the control group, depressed patients are characterized by the prominent decrease in search activity and by an increased passive behavior. . .
Key words: Depression; behavior; search activity.
In our previous investigation (Rotenberg et al., 2001) we have estimated the behavioral attitudes of Russian-speaking new immigrants in Israel on different levels of distress caused by emigration. This investigation was based on the search activity concept (Rotenberg, 1984; 1993; 2000; 2003). According to this concept, psycho-physiological adaptation to the stressful environment depends on the subject's predominating behavior in indefinite, ambiguous situations with an unpredictable outcome. Such situations may induce one of four different types of behavior: 1. Search activity which is designed to change the situation or the subject's attitudes to it, with uncertainty regarding the results of this activity, but with constant monitoring of the results at all stages of activity; 2. Stereotyped behavior which uses habitual skills and algorithms with predictable results; 3. Chaotic (panicky) behavior which does not include monitoring of the results of activity and consequently is not flexible, and 4. Renunciation of search (passive behavior) manifesting itself in giving up, helplessness, depression and maladaptive anxiety. Experimental investigations (Rotenberg, Arshavsky, 1979 ) have shown that in stressful conditions only the search activity (process of search by itself) represents an efficient coping behavior and protects body from deteriorative factors and from psychosomatic disorders while renunciation of search decreases body resistance and predisposes subject to diseases. Renunciation of search is often a final outcome of panicky behavior (Rotenberg, Boucsein, 1993).
In our investigation of the process of adaptation of mentally healthy people to a new, different society (Rotenberg et al., 2001) we have found that men in general display a lower level of distress in comparison to women, and their level of search activity is higher and level of passive behavior is lower than in women. Those subjects who claimed that their life crisis related to emigration is still in progress displayed a significantly lower level of stereotyped activity, in comparison to subjects who had no crisis at all.
According to the theory, it might be predicted that the alterations of behavioral attitudes would be more prominent in mental disorders with obvious clinical manifestations. In the present study, behavioral attitudes of healthy Russian-speaking immigrants in Israel and in Russian-speaking immigrants suffering from depression were compared. As was already mentioned, according to the theory depression can be considered as a typical renunciation of search and we predicted that it would be characterized by a low search activity and a high level of passive behavior.
Twenty Russian-speaking patients with major depression (12 women and 8 men, mean age 42, SD=14.3 years) hospitalized in Abarbanel Mental Health Center were investigated. The study was approved by the Institutional Review Board and the Israeli Ministry of Health Committee for Studies in Human Subjects. Written informed consent was obtained from all participants following an explanation of the nature of the study. Diagnosis was established according to the DSM-IV criteria on the basis of the structured clinical interview. All patients were physically healthy and there were no non-psychiatric medical conditions responsible for their depression. All patients were treated with SSRI. The mean duration of illness was 12.9 years (SD=11.3). The mean number of previous hospitalizations was 1.89 (SD=1.99).
The control group contained 67 healthy Russian-speaking immigrants in Israel (44 women and 23 men) without any health complaints. Their mean age was 40.5 (SD=5.5) years. This group of subjects was selected from a sample of 201 Russian-speaking new immigrants in Israel that was investigated previously (Rotenberg et al., 2001). The criterion for selection of this control group was a lowest level of psychological distress measured by means of TBDI, self-reporting questionnaire for the measurement of psychological distress (Ritsner et al., 1995). The mean level of distress in this group was 0.79 (SD=0.15).
The participants were asked to complete the Behavioral Attitudes and Search Evaluation test (BASE). This test combines principles of both projective technique and a personality questionnaire (Venger et al., 1996; Rotenberg et al., 1998) and was validated on a group of Russian speaking new immigrants in Israel (Rotenberg et al., 2001). It includes description of 16 open situations with four possible reactions on each of them. The tested subject has to choose two reactions in each situation: the most appropriate from his/her point of view (scored +1) and the least appropriate (scored -1). The preferences of the subject provide an opportunity for quantitative measurement of each of the above behavioral attitudes: Search Activity (A), Stereotyped Behavior (ST), Chaotic Behavior (C), Renunciation of Search (P). The total score of the four scales can range from -16 to +16.
All test situations seem equally acceptable both ethically and pragmatically. An example to illustrate the general principle:
A group of hikers went to a cavern unfamiliar to them. Just as
they arrived inside the cavern, a landslide buried the exit. While
discussing the situation, the following suggestions arose:
In this situation, the answer A corresponds to search orientation because it suggests activity with unpredictable outcome, and fixation of all intermediate results (marking the way with stones). The answer B indicates chaotic tendency because it denies fixation of the results. The answer C" reflects passive attitude because it does not suggest any type of activity. The answer D" shows a tendency to stereotyped behavior: high level of activity without considering possible obstacles.
The Russian version of BASE was validated on Russian-speaking adults and adolescents.
The level of depression was measured using the 21-item Hamilton Rating Scale for depression (Hamilton, 1960). This test was applied on the same day as BASE.
The data were elaborated using the program Microsoft Excel. The significance of differences between subgroups was determined using the t-criterion.
RESULTS AND DISCUSSION
The mean score of the Hamilton Rating Scale for all depressed paients was 24.4 (SD=3.62), 24.5 (SD=4.02) for depressed women, 24.25 (SD=2.54) for depressed men. Difference between men and women was not significant.
In healthy subjects the score of search activity was +3.46 (SD=2.91), score of stereotyped activity +2.03 (SD=2.03), score of chaotic activity -1.61 (SD=3.62) and score of passive behavior -4.77 (SD=2.95). In depressed patients search activity scored -0.56 (SD=3.50), stereotyped activity +0.93 (SD= 3.92), chaotic activity scored -1.67 (SD=3.35) and passive behavior +1.30 (SD=4.30). In patients the search activity was significantly lower (p<0.0001) and passive behavior significantly higher (p<0.0001) than in healthy subjects. There was a non-significant tendency to higher stereotyped activity higher in healthy subjects.
The results of this preliminary study confirmed our initial hypothesis: in depressed patients of both genders search activity in depression was significantly lower and inclination towards passive behavior higher than in healthy subjects: depression can really be considered as renunciation of search. This was a pilot investigation and its limitation is the small number of the investigated patients. However, even in this small group the results are highly significant and are in the predicted direction.
The difference between mental health and depression according to behavioral attitudes, if confirmed in future investigations, may allow measuring the behavioral differences using BASE test for an approximate estimation of depressive tendencies in those cases when the direct evaluation of depression is unavailable. For instance, it was shown, that young males with covert depression and suicide attitudes often do not seek help and have a tendency to deny their mental problems (Burrows et al., 2002). In such cases the BASE test may be helpful, because it does not bear a stamp of the test oriented on mental health.
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