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Abstract:

Objectives: In years 2001-2003, 54 inpatients treated at the Haematology Department of the Jagiellonian University in Cracow for de novo diagnosed acute leukemia, were under observation. A degree of depressive disorders, hopelessness, A. Antonovsky’s Sense of Coherence and patients perceptions of the family functioning, in prospective, clinical trial were estimated. The aim of the study was: first to analyze the corelations beetween psychological factors described above and the course of leucaemia, secondly to assess the stability of Antonovsky’s Sense of Coherence (SOC) in acute and critical stress of diagnosis and chemotherapy in the first three months of acute leukemia and thirdly, to investigate the relationship between depression, hopelessness, Sense of Coherence, and family function perception of the patients with prognosis for 1-year survival. Inclusion criteria: males and females, age: 18-65, written, informed consent, de novo diagnosed acute leukemia (myelogenous, lymphoblastic or biphenotype), Karnofsky’s index: at least 80 points on day of admission, no psychiatric disorders (despite depression) in anamnesis, ability to fill in self-report instruments used in the study. Exclusion criteria: withdrawal of informed consent, loss of the ability to fill in self-report instruments, changes in primary hematological diagnosis, need for continuation of hematological ; treatment in another city. Measure instruments: Beck Depression Inventory - Short Form (BDI-SF), Hamilton Depression Rating Scale (HDRS), Beck Hopelessness Scale, Sense of Coherence Questionaire (SOC-29), Manfred Cierpka Family Questionaire. Timing of observation: Clinical observation and instrumental rating for depression and hopelessness, was carried out 3 times: 1st in 4th week, 2nd in 8th week, 3rd in 12th week after admission to the ward of hematology, after finishing of the consecutive course of chemotherapy in the stable clinical and somatic state. Clinical observation and instrumental rating for Sense of Coherence, was carried out 2 times: 1st in 4th week, 2nd in 12th week after admission to the ward of hematology. Subjective perception and assessment of family functioning of the patients was carried out once, in 4th week of the study. The diagnostic criteria of depressive disorders in leukemia proposed in this study: “The three steps procedure”: 1) BDI-SF value >8 pts 2) clinical observation (HDRS and CGI-S) confirming the self-report of depression, 3) the symptoms of depression are reported repeatedly in at least two out of three consecutive examinations in period of observation. Characteristic of the study group: The participants were 54 patients, with de novo diagnosed acute leukemia, who filled in all inclusion criteria. Finally, 5 person did not accomplish ; ed the study because of an early death during first course of chemotherapy, 4 person did not achieve a complete hematological remission and were not included to final statistical analysis, because of significant differences in somatic condition and recommended treatment in comparison to the “complete remission group”. 9 patients were excluded from the study accordingly to presented above exclusion criteria. 36 patients, who obtained complete hematological remission (CR - group) after 3-4 courses of standard or high-dose chemotherapy, finished the entire, one year observation. These CR-group was statisticaly analyzed in the study. The data obtained from these analysis are presented below. Results: 1. Depressive symptoms were observed in 55% of the CR - population. 2. Significant and similar negative correlations were seen between values of the total SOC and depression scores in booth 4th and 12th week measure-points (r= -0.59). 3. The mean SOC value in observed population was surprisingly high and comparable to the control. The mean value was 144,9 (range: 94 - 188) in 4th week and 149,5 (range: 101 – 191) in 12th week respectively. 4. There was a significant positive correlation observed between consecutive evaluations of total SOC in 4th and 12th week of the study (r=0.53). The most significant correlation (r=0.59) was demonstrated for the manageability of SOC. ; 5. There was a statistical significance for differences (p=0,008) in self-reported value of total SOC, between non-depressed patients and the control observed. Similar differences (p=0,004) were seen for manageability of SOC. 6. Significant and similar differences of SOC were observed between depressed and non-depressed patients in both consecutive examinations, alike in 4th (p=0,03) and in 12th week (p=0,009) of the study. 7. Also significant changes in values of total SOC were observed during the period of observation between non-depressed and depressed group. The second measurement in non-depressed group has shown a significant increase in total SOC compare to the first examination. 8. The second measurement in depressed group has shown no significant increase in total SOC value compare to the first examination. 9. The manageability of SOC measured in 12th week of the study was constantly higher and permanently stable in comparison to the 4th week measure-point. However a significant increase in values of two subsequent components of SOC was seen, i.e. meaningfulness (p=0,022) and comprehensibility (p=0,020). 10. There was no statistical significance between both depression scores, hopelessness, perceptions of family functioning or SOC scores and course of the hematological disease and 1-year survival in this study. 11. There was no corelation between hemat ; ological parameters (type of leukemia, type of chemotherapy, and presence or absence of hematological risc factors) and apparence or level of depressive symptoms in observed population. 12. Worse perception of family functioning was corelated with higher depression level in observed population. Conclusions: 1. The three step procedure used in this study seems to be a sufficient method for diagnosing depression in population of leukemic patients; 2. A high prevalence (55%) of depressive symptoms assessed in this population on early stages of the hematological treatment may have implications for psychiatric and psychosocial interventions in these group of cancer patients; 3. The high SOC scores at the beginning of the treatment and an increase of total SOC and its compounds (meaningfulness, comprehensibility and meaningfulness) in next two months of observation seems to have a prognostic value for absence of coincidental depressive disorders in leukemic patients; 4. The only statistically confirmed demografic factor to be associated with the development of depression in the population of patients with acute leukemia in the first three months of treatment is the advanced patient’s age, which can have practical implications in planning psychological care; 5. This study did not confirmed a prognostic value of the presence of depressive disorders, hopelessness, perception ; of family functioning and SOC for 1-year survival in acute leukemia.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

psychiatria ; onkologia ; hematologia

Degree grantor:

Wydział Lekarski

Promoter:

Zięba, Andrzej

Date issued:

2004

Identifier:

oai:dl.cm-uj.krakow.pl:1293

Call number:

ZB-100425

Language:

pol

Access rights:

tylko w bibliotece

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Last modified:

Jul 7, 2022

In our library since:

Nov 21, 2012

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