© Borgis - Nowa Medycyna 1/2017, s. 18-26
*Katarzyna Martowska1, Małgorzata Kołodziejczak2, Anna Matczak1
Temperamental characteristics and depressive symptoms in patients with mild proctological diseases based on research in 50 patients. A preliminary report
Cechy temperamentu a symptomy depresyjne u chorych z łagodnymi chorobami proktologicznymi na podstawie badań 50 pacjentów. Doniesienie wstępne**
1Institute of Psychology, Faculty of Christian Philopsophy, Cardinal Stefan Wyszyński University in Warsaw
Head of Institute: Professor UKSW, Jan Cieciuch, MD, PhD
2Warsaw Proctology Centre, Saint Elizabeth’s Hospital, Mokotów Medical Centre, Warsaw
Head of Centre: Associate Professor Małgorzata Kołodziejczak, PhD
Wstęp. Na łagodne choroby proktologiczne cierpi znaczna część społeczeństwa. Pacjentami często są ludzie młodzi, w pełni aktywni zawodowo. Choroby proktologiczne dotyczą sfery intymnej, często mają charakter przewlekły i znacznie obniżają jakość życia pacjenta, mając też wpływ na jego psychikę.
Cel pracy. Celem badań było określenie cech temperamentu osób chorujących na łagodne choroby proktologiczne oraz ocena, które z tych cech są czynnikami prognostycznymi częstości występowania symptomów depresyjnych.
Materiał i metody. Materiał stanowiła grupa hospitalizowanych pacjentów w oddziale Warszawskiego Ośrodka Proktologii chorujących na łagodne choroby proktologiczne, w tym 25 mężczyzn i 25 kobiet w wieku od 19 do 56 lat oraz grupa porównawcza osób zdrowych, 25 mężczyzn i 25 kobiet w wieku od 23 do 56 lat.
Grupę przebadano kwestionariuszami mierzącymi cechy temperamentu (KSR) oraz częstość występowania symptomów depresyjnych (KSD).
Wyniki. Pacjenci proktologiczni charakteryzowali się wyższą perseweratywnością i regularnością niż zdrowi. Istotnymi czynnikami prognostycznymi częstości występowania symptomów depresyjnych okazały się: reaktywność, perseweratywność i regularność – wyjaśniają one 59% zmienności wyników uzyskiwanych w KSD (Kwestionariuszu Symptomów Depresyjnych).
Wnioski. Cechy temperamentu, które świadczą o małym zapotrzebowaniu na stymulację i małych możliwościach jej przetwarzania, mogą stanowić czynnik prognostyczny pojawienia się symptomów depresyjnych u pacjentów z łagodnymi chorobami proktologicznymi. Z kolei regularność, dzięki której jednostka ogranicza dopływ stymulacji, może mieć korzystne znaczenie dla samopoczucia. Wyniki badań mogą wspomagać działania profilaktyczne i terapeutyczne prowadzone wobec pacjentów.
Introduction. Mild proctological diseases affect a large proportion of the population, often young and professionally active individuals. They invade patient’s intimate sphere, are often chronic and significantly reduce the quality of life as they affect patient’s mental condition.
Aim. The aim of the study was to determine temperamental characteristics in patients with mild proctological diseases as well as to evaluate which of these characteristics are prognostic factors for the incidence of depressive symptoms.
Material and methods. Patients hospitalised at the Department of the Warsaw Proctology Centre who were affected by mild proctological diseases, including 25 men and 25 women aged between 19 and 56 years, and healthy controls including 25 men and 25 women aged between 23 and 56 years, participated in the study.
A questionnaire for temperamental characteristics and a questionnaire measuring the incidence of depressive symptoms (DSQ) were used in the study.
Results. Proctological patients showed higher perseveration and regularity compared to healthy individuals. Reactivity, regularity and perseveration are significant prognostic factors for the incidence of depressive symptoms – they account for 59% of the variation in DSQ findings.
Conclusions. Temperamental characteristics indicating low stimulation demand and low stimulation processing potential may be a prognostic factor for depressive symptoms in patients with mild proctological diseases. Regularity, which helps an individual limit the stimulation inflow, may prove beneficial for the well-being. Our findings may support preventive and therapeutic interventions in patients.
Mild proctological diseases affect a large proportion of the population, often young and professionally active individuals. They invade patient’s intimate sphere, are often chronic and significantly reduce the quality of life as they affect patient’s mental condition. Since the work is published in a surgical journal, we will first discuss the concepts on the relationship between temperamental characteristics and the health status of an individual as well as explain the basic psychological terms used in the study, such as reactivity, regularity, perseveration, understimulation and overstimulation.
Concepts used to explain the correlations between the temperamental characteristics and the individual’s state of health include the Regulatory Theory of Temperament by Jan Strelau (1) and the Transactional Model of Temperament by Andrzej Eliasz (2). Both of these concepts emphasise that temperament is a component of a complex stimulation regulatory system, and that the temperamental characteristics determine the amount of stimulation needed (activity) and the stimulation processing capability (reactivity). Activity is described as a tendency for high-stimulatory behaviours and a search for highly stimulating situations. It may be interpreted as a sign of a significant need for stimulation. Reactivity is described as a tendency towards strong reactions to emotional stimuli, that is high emotional excitability and low emotional resistance. This characteristic determines the poor ability to cope with stimulation as it often contributes to suboptimal stimulation. The concept of Jan Strelaua emphasises that high reactivity is generally accompanied by high perseveration. Perseveration is described as a tendency towards continuous thinking about earlier experiences (emotionally intense events in particular) as well as excessive focusing on the past. Like emotional reactivity, perseveration also limits the ability to cope with stimulation as it leads to excessive stimulatory accumulation. Regularity is a characteristic that may limit the inflow of stimulation. This characteristic is described as a tendency to follow a regular lifestyle, and thus avoid excitation resulting from the variability of events. It may be therefore assumed that if strong emotional reactivity and high perseveration are accompanied by low activity and high regularity or weak emotional reactivity and low perseveration are accompanied by high activity and low regularity, the structure of temperament is harmonised, i.e. the behaviour of an individual (activity and regularity) is adjusted to his/her ability to cope with the situation (determined by emotional reactivity and perseveration). Otherwise, a non-harmonised temperament structure develops, i.e. the behaviour of an individual leads to overstimulation (it goes beyond the capability to process stimulation) or understimulation (as a result of failure to use one’s own capabilities). In the long run, the dissociation of temperamental characteristics may lead to health consequences (3). For instance, it was found that a temperament structure with a tendency towards overstimulation may be a risk factor in coronary heart disease or peptic ulcer disease. On the other hand, it may be assumed that long-term adverse events, such as a disease, may also lead to changes in temperament; this particularly applies to stress-inducing diseases.
Such diseases may include proctological conditions, such as haemorrhoidal disease, anal fissure, fistula or anal abscess. The severe discomfort associated with this type of diseases results from severe pain as well as anxiety about the therapeutic process and potential complications (e.g. faecal incontinence or even ostomy in some cases). The intimate nature of symptoms and their adverse effects on social functioning are also important. It often happens that patients do not discuss their symptoms with doctors or family members, as they are too ashamed to talk about it. All these factors may lead to severe mental discomfort and a tendency to isolation. This has been confirmed in a number of studies. For example, higher tendency to depression was found in the group of patients with proctalgia and chronic pelvic pain (4, 5). The presence of a psychological factor was observed in 65% of patients with defaecation problems and constipation (6). Psychological disorders such as eating disorders, rumination (obsessive thoughts), pain syndrome, anxiety/depression, depression combined with pain syndrome, eating disorders combined with anxiety/depression and pain syndrome were found in these patients. In the light of current data, it can be concluded that mental disorders increase the risk of proctological conditions as well as become secondarily exacerbated due to disease-related stress. The awareness of the psychological factor is all the more important as it also affects treatment, as confirmed by many researchers (7-9). Beneficial effects of relaxation techniques (mainly based on listening to music) on parameters such as postoperative pain levels and sleep quality were shown in patients undergoing coloproctological procedures (10).
Although publications on the psychological assessment of patients with functional bowel disease may be found in the literature (11), papers on mild proctological diseases are sparse. The aim of the present study is to enrich the psychological characteristics of patients with mild proctological diseases.
The aim of the paper was to determine temperamental characteristics of patients with mild proctological diseases as well as to assess which of these characteristics are predictors for depressive symptoms.
Material and methods
Study subjects and the course of research
We have evaluated 50 hospitalised patients with mild proctological diseases, including 25 men and 25 women aged between 19 and 56 years (mean age 34.64; SD = 7.83). The study also included a reference group of healthy individuals (25 men and 25 women) aged between 23 and 56 years (mean age 34.86 years; SD = 9.92). The study was not anonymous. All participants were informed on the purpose of the study, on the voluntary participation as well as the use of research findings.
A Reaction Mode Questionnaire (RMQ) by Anna Matczak and Katarzyna Martowska (12), based on the Regulative Theory of Temperament by Jan Strelau (1) was used to measure temperament characteristics. The questionnaire consists of 60 items, 15 for each score: reactivity (e.g. “I give up easily when faced with difficulties”, α = 0.84), activity (e.g. “I like it when there are a lot of things going on around me”, α = 0.76), perseveration (e.g. “When something bothers me, I cannot help thinking about it”, α = 0.87), and regularity (e.g. “I like having everything planned ahead to avoid unnecessary tensions”, α = 0.72). The subjects were asked to read the statements and decide whether a given statement was true or false for them. In the case of doubts, the respondent could choose “not sure” option. These validation studies have revealed the expected correlations between temperament characteristic measures, personality as well as social and emotional competencies.
The self-reported Depression Symptom Questionnaire (DSQ) by Anna Matczak and Katarzyna Martowska was used to measure the incidence of depressive symptoms (13). The questionnaire consists of 15 items, which represent definitions of different symptoms possibly indicating poor functioning of an individual, including anxiety, irritation, fatigue, hopelessness, lack of motivation for anything, sleeplessness, somnolence, lack of appetite, binge eating, reluctance to contact other people, reluctance to leave home, mood swings, crying, pain, death-related thoughts. Respondents were asked to determine whether and how often in the past month they experienced these symptoms using a three-point score: never (a score of 0), rarely (a score of 1), and often (a score of 2). As a result, a total score, which was the sum of scores for each item, was obtained. The higher the score, the worse the well-being. The reliability of the questionnaire estimated in a group of N = 689 was 0.80 according to Cronbach’s α coefficient. Correlation analysis revealed the expected correlations with the measures of negative emotionality, social competencies and temperamental characteristics.
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Płatny dostęp do wszystkich zasobów Czytelni Medycznej
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