Social Support and Quality of Life for Patients with Depressive Disorders

Introduction

Depression is the oldest and most frequently described psychiatric illness. The existence of depression has been documented since biblical times. Normal feelings of sadness are appropriate in many situations. It would be abnormal not to feel sad in certain situations, such as when a loved one dies or when other losses occur in a person's life. However, these feelings are usually short –lived and do not persist in altering the person's ability to function. When an individual's mood causes clinically significant distress or impairment in social or occupational functioning, a diagnosis of depressive disorder is warranted ⁽¹⁾.

It is impossible to convey adequately the personal pain and suffering experienced by an individual going through a severe depressive episode so, the manifestation of depressive phenomena is a complex, dynamic, biopsychosocial process involving lifespan and cultural aspects. All races, all ages, and both genders are susceptible to depressive episode, although some individuals are more vulnerable than others ⁽²⁾.  Because there is a notable connection between depressive disorder and suicide, early diagnosis and intervention may increase the chances of a favorable outcome ⁽³⁾.

Social support is defined as information leading the subject to believe that he is cared for, loved, esteemed, valued and belongs to a network of communication and mutual obligation ⁽⁴⁾. During the last 30 years, researchers have shown great interest in the phenomena of social support, particularly in the context of health. Prior work has found that those with high quality or quantity of social networks have a decreased risk of mortality in comparison to those who have low quantity or quality of social relationships⁽⁵⁾. Moreover, social isolation itself was identified as an independent major risk factor for all-cause mortality. Social support influences on morbidity, mortality, and quality of life in chronic disease populations, understanding the mechanisms responsible for such associations, and how we might apply such findings to design relevant interventions ⁽⁶⁾.

Social support is a vital and effective part of depression recovery; it can turn around damaging isolation, affect a person’s life focus, and generate solutions for depression management. The same author added that learning more about how this powerful social force can positively effect someone living with depression, when you are depressed, isolation turns you away from life, this creates a self-fulfilling cycle where you feel increasingly rejected and remain disconnected, increasing the chances that your connections might fade or weaken. This dangerous combination affects how you see your very existence. Instead of turning your vision toward growth and living, you become focused on avoiding the most pain. And unfortunately, death can easily become the leading candidate for pain relief ⁽⁷⁾.

The world health organization (WHO) defines QoL as ‘‘an individual’s perception of his/ her position in life in the context of the culture and value systems in which he/she lives and in relation to his/her goals, expectations, standards and concerns. Several authors have proposed models of QOL for people with mental illnesses. Patients with less severe depressive symptoms were found to have higher levels of functioning and satisfaction in daily activities, role functioning and social relationships ⁽⁸⁾.

Indicators of QOL include life satisfaction, self-esteem, general health, functional status, socioeconomic conditions, satisfaction of needs, one’s experience of life, and self-rated health status ⁽⁹⁾. People with depression suffer from persistent psychosocial and occupational impairments and diminished quality of life after recovering from acute episodes ⁽¹⁰⁾. So, Quality-of-life (QOL) assessment and improvement have recently been recognized as important components of health care, in general, and mental health care, in particular⁽¹¹⁾.

Significance of the Study

If projections prove accurate, then by 2020, depression will become the second cause of the global disease burden. Already depression affects around 121 million people (WHO 2011) with almost half of population of western world experiencing at least an episode of depression during their life-time ⁽¹²⁾.

According to health statistics in Minia Hospital for psychiatric health and addiction as a study area includes 19 patients admitted by recurrent depressive disorders and 94 patients admitted by bipolar mood disorder (2013). As well as, 15 patients are admitted by recurrent depressive disorders and 52 patients admitted by bipolar mood disorder (2014), with taking into account that the actual number of patients in this period missed and not documented due to new hospital reforms.

Depressive disorders constitute a large proportion in the global burden of disease, both in the developed and developing countries and increase the risk for suicide. Hence, the present study is under taken to assess social support and quality of life as perceived by patients with depressive disorders. As well as providing guidance and recommendations that should be reflected in psychiatric nursing education and practice.

Aim of the study

The aim of the current study was to assess social support and quality for patients with depressive disorders.

Research Questions:

• Is there a relation between social support and depression?
• Is there a relation between quality of life and depression?
• Is there a relation among social support and quality of life and depression?

Subjects and Methods

Research Design:

A descriptive correlational research design was used to assess social support and quality of life for patients with depressive disorders.

Setting:

This study was conducted in Minia Hospital for psychiatric health and addiction which founded in 1997, the capacity for the hospital was 53 beds. The hospital serves Minia governorate.

Subjects:

A convenience sample consisted of 100 depressed patients.

Inclusion Criteria:

Patients who were attending the psychiatric outpatient clinic of Minia Hospital for psychiatric health and addiction were selected according to the following criteria:

1. Patients of both sex were included.
2. Patient's age ranged from 20-55 years.
3. Patients diagnosed for all types of depression by the psychiatrist who was responsible for the treatment using DSM IV as a diagnostic criterion.

Exclusion Criteria:

1. Patients who diagnosed organic brain disease or mental retardation.
2. Patients with substance abused.

Tools of data collection:

Appendix 1:Socio – demographic Data Sheet:

It was developed by the researcher and included: personal data such as patient age, gender, level of education, occupation, marital status, diagnosis and number of previous hospitalization.

Appendix 2: Interpersonal Support Evaluation List (ISEL):

Interpersonal Support Evaluation List (ISEL) developed by Cohen 1983, it contains 40 items and designed to assess perceptions of social support. A 40 items scale made up of four subscales. The subscales are: 1) Tangible Support,2) Belonging support, 3) Self-esteem support and 4) Appraisal support(13).

Appendix 3: Quality of Life Scale:

The original scale was constructed by Lehman (1986) to assess QOL of psychiatric patients. It consists of (57) items divided into six domains or subscales.

The  first subscale, comprising 12 items covering the physical health, the second subscale consisted of 8 items reflecting self-care, the third subscale included 14 items, representing patient’s emotional status, the fourth one consisted of 13 items related to personal and social relationships, the fifth subscale included 5 items which assess the patient’s ability to making decision, to work to carry out the work duties, and the patient’s ability to taking responsibilities and the last subscale consisted of 5 items used to collect data about spiritual concerns and personal beliefs⁽¹⁴⁾.

Validity and Reliability

The tools were reviewed by three panels of experts in psychiatry and psychiatric nursing to test the content validity of the tools. Reliability of ISEL and QoL tool performed to confirms its consistency by test and retest were 0.954& .933 respectively.

Pilot Study

The pilot study was conducted on 10 patients (10%) who met the inclusion criteria was done to investigate and ensure the feasibility, objectivity, applicability, clarity and adequacy of the study tools and to determine possible problems in the methodological approach or tool. The results of the pilot study used to test the proposed statistical and data analysis methods. The tools were completed without difficulty, adding support to the validity of the instrument. The time required for completion of the interview questionnaire didn’t exceed than 30 minutes.  The pilot study was excluded from the main study sample. Pilot testing helped the investigator plan for data collection.

Ethical Consideration

A written initial approval was obtained from the ethics committee of the scientific research at Faculty of Nursing, Minia University. Written Informed consent was obtained from each participating patients after explaining the nature and benefits of the study. Each assessment sheet was coded and patient's names were not appearing on the sheets for the purpose of anonymity and confidentiality.

Data Collection Procedure

An official permission obtained from the director of Minia Hospital for psychiatric health and addiction. Patients who met the selection criteria were selected to participate in the study. Patients with depressive disorders were interviewed on individual basis to explain the nature and purpose of the study. Structured interviews were conducted in one room of the out-patient clinic; questions were asked and recorded by the investigator. Measures were taken to protect Patient's ethical rights.

An official permission obtained from the director of Minia Hospital for psychiatric health and addiction. Patients who met the selection criteria were selected to participate in the study. Patients with depressive disorders were interviewed on individual basis to explain the nature and purpose of the study. Structured interviews were conducted in one room of the out-patient clinic; questions were asked and recorded by the investigator. Measures were taken to protect Patient's ethical rights.

The researcher went to the outpatient unit 2 days per week (Tuesday, and Wednesday from 9 pm to 1 pm). The researcher had interviews with all patients with depressive disorders and collect data from them; this interview taken about 30 minutes with every patient.  Data collection was conducted over a twelve months’ period extending from November 2015 till December 2016.

Statistical analysis of data

The collected data were coded, categorized, tabulated, and analyzed using the Statistical Package for the Social Science (SPSS 20.0). Descriptive data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage. Data were presented using descriptive statistics in the form of percentages, frequency mean and standard deviation. Inferential statistical tests of significance such as Friedman’s ANOVA, Pearson correlation, and independent t-test were used to identify group differences and the relations among the study variables. Level of significance at p < 0.05 was used as the cut of value for statistical significance.

Results

Table 1:  Socio-demographic data of depressed patients (n= 100).

Table (1):  describes the socio-demographic data of the depressed patients namely age, level of education and marital status. Age range of the sample was 20 – 59 years old. Table (1) indicates that 40% of the depressed patient was 30 – 39 years with mean age 34.8±8.3.  Concerning patients' level of education, the same table indicates that, there were 33% of the depressed patients had diploma level of education. As regards marital status table (1) indicates that, 41% of depressed patients were married.

Fig. 1 Gender of depressed patients

Fig. 1 shows that, there were more than half (53%) of the depressed patients were males, while 47% of depressed patients were females

Fig. 2 Occupation of depressed patient

Fig. 2 shows that more than half of the studied sample who included in the study were unemployed (56%).

Table 2: Distribution of depressed patients according social support domains (n= 100)

-   There is someone I could turn to for advice about making career plans or changing my job.

-   If a family crisis arose, it would be difficult to find

someone who could give me good advice about how to handle it.

-   If I needed an emergency loan of 100 pounds,

there is someone (friend, relative, or acquaintance) I could get it from.

-   It would be difficult to find someone who would lend me their car for a few hours.

-   I am more satisfied with my life than most people are with theirs.

-   I am closer to my friends than most other people are to theirs.

-   If I wanted to go on a trip for a day, I would have a hard time finding someone to go with me.

-   No one I know would

throw a birthday party for me.

 Table 2 presents the four domains of social support, as regard to appraisal support, 55% of the studied sample felt that there was no someone could turn to for advice about making career plans or changing their job. with respect to tangible support, the majority of the studied sample (93%) said that it was difficult to find someone would lend them their car for a few hour. concerning the self esteem support, 73% of the studied sample mentioned that they were not closer to their friends. in relation to the belonging support, 87% of the studied sample did not know someone would throw a birthday party for them.

Fig 3 presents that 66% of depressed patient had low social support compared with 6% of them had high social support.

Table 3: distribution of depressed patients according quality of life domains (n= 100).

Quality of life

-   I can do any heavy work.

-   Participate in the activities of daily living and recreational activities (walking - clean – listen to Radio - watch TV- reading)

-   I have the ability to choose my clothes with an elegant way.

-   I eat very less than usual.

(Emotional state)

-    I am talking badly about myself.

-    I find I am able to express my feelings spontaneously.

-   I have the difficulty of planning for my future.

-   I can work a strong and continuing friendships.

-    I feel that a great responsibility to work on.

-   I have the difficulty in making my decisions.

-   I have faith that the work of the forces of human worship

-   I sense that God is capable of everything and is capable of my healing.

Table 3 presents the quality of life domains, as regard to physical health, the majority of the studied sample (85%) never can do any heavy work. in relation to personal care, 58% of them mentioned that they always eat very less than usual. Concerning emotional state subscale, 72% of them always talking badly about themselves and feel that they can never able to express their feelings spontaneously. Regarding the social and personal relationships which the majority of the studied sample (92%) can never work a strong and continuing friendship. With respect to the self reliance subscale, 83% of the studied sample always feel that a great responsibility to work on.

Fig. 4:  Distribution of depressed patients according to levels of QOL (n=100)

Figure 4: represents that, 50% of depressed patients had low QOL level followed by 39% of them had moderate QOL level and only 11% had high QOL level.

Table 4: Differences between age group according to social support domains among depressed patients (n= 100)

*Statistical significantly differences (P value < 0.05)

Table4: shows that, patients aged between 50- 59 years had higher total social support scores than other patient's ages as regard social support domains except self- esteem scores and there were no statistical significance differences between social support and its domains with age except appraisal domain in which P - value ≤ 0.02.

Table 5: Differences between age group according to quality of life domains among depressed patients (n=100)

Personal Care

Emotional state

Social and personal relationships 

Table 5 presents that, patients aged between 50- 59 years had higher total QOL scores than other patient's ages but with no statistical significance differences were found in which p- value ≥ 0.05.

Table 6: Differences between types of occupation according to social support domains among depressed patients. (n=100) 

Table 6 shows that, mean scores of total social support and its domains were higher among not working patients than working patients and there were no statistical significance differences between social support and its domains with occupation in which P - value > 0.05.

Table 7: Differences between types of occupation according to quality of life domains among depressed patients (n=100)

Personal Care

Emotional state

Social and personal relationships 

Table 7 illustrates that, mean scores of total QoL and its domains were higher among working patients than not working patients with no statistical significance differences were found in which P - value > 0.05.

Table 8: Correlation between social support and quality of life among studied group. (n=100)

Personal Care

Emotional state

Social and personal relationships 

** Correlation IS significant at the 0.01 level (2-tmled). *Correlation is significant at the 0.05 level (2-tailed).

Table 8 finds that there were statistically positive correlation between physical health with appraisal, tangible, belonging and totally social support (r = .288, P = .004, r = .264, P= .008, .r =.276, P = .005, and r = .279, P = .005 respectively). As regard, emotional state there were positive associations between it and social support & all its subscales (r = .252, P = .011, r= .243, P= .026, r =.246, P = .036, r .258, P = .010, and r =.264, P = .008 respectively). While in social & personal relationships there were positive associations between it and appraisal, belonging, totally social support (r = .252, P = .012, r = .262, P = .009, and r =.264, P = .008 respectively). Also, there were positive associations between QoL and social support & all its subscales except self esteem support (r = .275, P = .006, r = .252, P = .012, r =.265, P = .008, and r .266, P = .007 respectively).

As regard to QOL, there were statistically positive correlation between physical health with emotional state and social & personal relationships (r = .832, P = .000, and r = .786, P = .000 respectively), between emotional state and social & personal relationships (r = .774, P = .000) also, between totally QoL and social & personal relationships (r = .868, P = .000).

As regard to social support there were positive correlations between appraisal domain and tangible, belonging, and totally social support (r = .824, P = .000, r = .932, P = .000), tangible domain and belonging, and totally social support (r = .801, P = .000, r = .921, P = .000), also, between totally social support and self -esteem and belonging domain (r = .771, P = .000, r = .923, P = .000 respectively)

Also, there were positive correlation  between Self – reliance with social support and all subscale except self -esteem, and Religious with social support and all subscales (r= .287, p= .004, r = .293, p = .003, r = .252, p = .027, r = -.261, p= .0009 respectively)