الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 100 |  |  |
| | | from | 100 | | |
Abstract
Recently, the concept of recovery from mental illness has gained more attention. However, achieving recovery is considered to be the main goal for every patient but is not an easy one to reach. Many factors are incorporated in the process of recovery, some of them having the nature of facilitating, others considered to be hindering. In this respect adequate assessment and description of recovery, hope and stigma resistance levels among patients with depressive disorders might help psychiatric nurses to develop strategies to increase their levels, which in turn can contribute to a successful recovery process. Moreover, this study can help psychiatric nurses to gain better understanding of recovery and its correlates factors among patients with depressive disorders.
The present study aimed to determine levels of recovery, hope and internalized stigma resistance among patients with depressive disorders and investigate the relationship between them.
This study utilized a descriptive correlational research design. It was conducted at the Outpatient Clinic of El-Maamoura Hospital for Psychiatric Medicine and the psychiatric Outpatient Clinic of the Main University Hospital in Alexandria.
The study subjects comprised of 150 outpatients having depressive disorders for longer than one year with no comorbidity (in a stable or post-acute phase of their illness) and able to communicate in coherent manner.
Five tools were used for data collection:
Tool I: A Socio-Demographic and Clinical Data Structured Interview Schedule for patients with depressive disorders. It was developed by the researcher. Socio-demographic data included items such as; age, sex, marital status.The clinical data covered items such as duration of illness, type of therapy, and medication compliance.
Tool II: Hamilton Rating Scale for Depression (HRSD- 17):
The HRSD was developed by Hamilton (1960) to assess depression severity and changes in depressive symptoms. It is a clinician- rating scale consists of 17 items, eight items are scored on a 5-point scale, ranging from 0 to 4 while, the other nine items are scored on a 3-point scale, ranging from 0 to 2.
Tool III: Recovery Assessment Scale-Revised (RAS-R):
RAS-R is a 24-item scale developed by Corrigan et al. (2004) to assess various aspects of recovery from mental illness. Items of the RAS-R are rated on a 5-point likert scale (from 1=strongly disagree to 5=strongly agree). The scale covers five domains (subscales): personal confidence and hope, willingness to ask for help, goal and success orientation, reliance on others and not dominated by symptoms.
Tool IV: Beck Hopelessness Scale (BHS):
The BHS was developed by Beck et al. (1974) to measure negative attitudes about the future. The scale consists of 20 items in the form of true or false statements, where true =0 and false=1.
Tool V: Internalized Stigma of Mental Illness (ISMI) Scale:
The ISMI scale was developed by Ritsher et al. (2003) for measuring the level and nature of internalized stigma of mental illness. It consists of 29 items grouped into 5 subscales; Alienation, Stereotype Endorsement, Discrimination Experience, Social Withdrawal and Stigma Resistance .Our study focused on stigma resistance subscale which measures a person’s ability to resist or counter act internalized stigma of mental illness, therefor patients responded only to the 5 items relating to the Stigma Resistance subscale which is a 4–point-Likert scale (1=strongly disagree to 4=strongly agree).
Study steps:
o Official written permissions from appropriate authorities were obtained.
o Tool I (A Socio-Demographic and Clinical Data Structured Interview Schedule) was developed by the researcher.
o Arabic translation of the study tools II (HRSD- 17), III (RAS-R), IV (BHS) and V (ISMI Scale - Stigma resistance sub scale) was done.
o The study tools were presented to a jury composed of five experts in the field of Psychiatric Nursing and Mental Health, to examine the content validity of the tools and proved to be valid.
o A pilot study was conducted on 10 outpatients with depressive disorders to assess the clarity, applicability and the time needed to complete the study tools.
o Reliability of the study tools II (HRSD- 17), III (RAS-R), IV (BHS) and V (ISMI Scale – Stigma resistance sub scale ) were tested and proved to be reliable (Cronbach’s alpha =0.730 : 0.742: 0.824: 0.946) respectively .
o In the outpatient clinic, Aconvenience sampling technique was used to collect a representative sample of outpatient with depressive disorders.
o All patients’ medical charts were screened to identify patients who meet the predetermined inclusion criteria.
o All patients who met inclusion criteria in the up mentioned steps were recruited. Each patient was met on individual basis: relationship is established, aim of study was explained and informed consent is secured.
o All the protective precautions were considered, for the researcher and patient, during each interview including; checking body temperature, wearing mask using disinfectants and keeping a distance.
o Finally, total number of patients recruited from the outpatient clinic of El-Maamoura Hospital for Psychiatric Medicine were 100 and for the psychiatric outpatient clinic of the Main University Hospital were 50 patient
o The data were collected over a period of nine months, starting from January 2020 until September 2020 due to COVID- 19 and closing of the out patients clinics for 4months.
o The data were computerized and verified using the SPSS (Statistical Package for Social Science) to perform tabulation and statistical analysis.
The following were the main results of the present study:
• The Socio-demographic characteristics of the studied patients (n=150):
- One half of the studied patients were males and the other half were females (50% each).
- Their age ranged between 21 and 59 years, with the greatest percentage (45.3 %) of patients were in the age group ranging between 30 to less than 40 years.
- Most of them were married (65.3%) and nearly half of them had basic education (42%).
- Around half (46.7 %) of the studied patients were housewives, 35.3% were currently working and majority of them (93.3 %) lived in urban areas.
- The majority of the studied patients (95.3%) were living with their families and most of them reported having sufficient income (74%).
• The clinical characteristics of studied patients (n=150):
- More than one half of patients (58.0 %) had a duration of illness less than 5 years.
- Most of the studied patients were not hospitalized before (79.3%), 83.9 % of them were hospitalized for once.
- All the studied patients (100%) previously received psychiatric treatments; including psychotropic medications, psychotherapy and electroconvulsive therapy.
- Most of the studied patients (81.3%) were compliant to their medications, while the main cause of non – compliance was medications` side effects (75%).
- About three quarters of the studied patients (75.3%) had no family history of mental illness, while 24.6% had a positive family history of mental illness.
- Regarding the availability of support , 74.7% of the studied patients received support, most of them (84.8%) received financial support, while only 12.0% received emotional support.
Distribution of the studied patients according to their levels and mean scores of depression (n= 150):
- The total score ranged between 8 and 29, with a mean score of 16.50 ± 5.569 and a mean percentage score of 31.8 %.
- 36.7% of the studied patients had moderate level of depression, 27.3% had severe level while 24.0% of them had mild level and only 12.0 % had very severe level of depression.
• Distribution of the studied patients according to their levels and mean scores of recovery (n= 150):
- The total mean score of recovery ranged between 54 and 99, with a mean score of 82.23 ± 12.57, and a mean percentage score of 68.52%.
- About three quarters of the studied patients (76 %) had moderate level of recovery.
-As regards the subscales of recovery, the highest percentage of patients had moderate levels of ”reliance on others”(66.0%), ”personal confidence and hope” (55.3%) and ”not dominated by symptoms”(44%) while, the highest percentage of them had low level of ”willingness to ask for help”(66%) and the highest percentage of the studied patients recorded high level on ”goal and success orientation” (54.7%).
• Distribution of the studied patients according to their total levels and mean scores of hopelessness (n= 150).
- Around one third (33.3%) of the studied patients had no hopelessness, 32.7 % had mild hopelessness, 18% had moderate hopelessness and only 16% had severe hopelessness level.
• Distribution of the studied patients according to their total levels and mean scores of internalized stigma resistance (n= 150).
- Most of the studied patients had moderate level of internalized stigma resistance (67.3% ), while 26% of them had low level and only 6.7% had high internalized stigma resistance.
• The correlation matrix between the studied patients’ total mean scores of depression, recovery, hopelessness, and internalized stigma resistance (n= 150):
- A significant negative correlation was found between depression and recovery (r= - 0.191, p= 0.019).
- A statistically significant positive correlation was found between depression and hopelessness (r= 0.298, p= 0.000).
- Depression was negatively but not statistically significantly correlated with internalized stigma resistance (r= - 0.009, p= 0.912).
- A statistically significant negative correlation was found between recovery and hopelessness (r= - 0.741, p= 0.000).
- A statistically significant positive correlation was also found between recovery and internalized stigma resistance (r = 0.653, p= 0.000).
- A statistically significant negative correlation was found between hopelessness and internalized stigma resistance (r= - 0.685, p= 0.000).
• The relationship between the studied patients’ depression mean scores and their socio- demographic & clinical characteristics ( n=150):
- Male patients were found to have higher mean scores of depression (17.65±5.446) than female patients (15.35±5.486).
- Patients who aged from 50 to less than 60 years had the highest mean score of depression (20.16±5.242)
- Patients who had university education had highest mean score of depression (18.44±6.335).
- Retired patients obtained the highest mean score of depression (20.00±0.000).
- As for patients` income, patients who had insufficient income had higher mean score of depression (19.03±5.56) than those who had sufficient income (15.61±5.316).
- Patients who received electroconvulsive therapy had the he highest mean score of depression (19.23±6.749).
- Patients who did not receive support during their illness had higher mean score (20.05±6.865) than who received support (15.29±4.487).
• The relationship between recovery mean scores of the studied patients and their socio - demographic characteristics & clinical characteristics (n =150):
- Divorced patients had the highest recovery mean score (86.71±5.880), while widowed patients obtained the lowest recovery mean score (54.00±0.000).
- Patients with university education had the highest recovery mean score (91.06±6.668), whereas patients who only can read and write had the lowest mean score (76.52±16.53).
- Working patients obtained the highest recovery mean score (84.66±12.74), while retired patients had the lowest mean score of recovery (54.00±0.000).
- Patients who had sufficient income had higher mean score of recovery (84.86±10.24) than those who had insufficient income (74.74±15.46).
- Patients who had illness since 10 years to less than 15 years had the highest mean score of recovery(88.50±4.871 while, Patients who had illness since 20 years and more had the lowest recovery mean score.
- Patients who visited the clinic for 10 to less than 15 times had the highest recovery mean score (87.18±12.66) while, Patients who visited the clinic for 5 times to less than 10 times had the lowest mean score of recovery (74.83±17.97).
- Patients who were not hospitalized before had higher mean score of recovery (83.27±11.80) than those who were hospitalized.
- Patients who received electroconvulsive therapy had the highest recovery mean score (77.69±15.01).
- Patients who were compliant to their medications had higher mean score of recovery (83.55±11.56) than those who were non- compliant (76.50±15.22),
- Patients who received support during illness had higher recovery mean score of recovery (84.96±10.01) than who did not receive support (74.18±15.73).
• The relationship between hopelessness mean scores of the studied patients’ and their socio- demographic & clinical characteristics (n = 150):
- Widowed patients had the highest hopelessness mean score (14.0±0.000).
- Patient who can read and write obtained the highest mean score of hopelessness (11.1±7.263.
- Patients who lived in urban areas had higher mean score of hopelessness than those who lived in rural areas (7.64±5.378) and (3.80±1.751) respectively.
- Patients who had insufficient income had higher mean score of hopelessness than patients who had sufficient income (9.15±6.089 ) and ( 6.76±4.871) respectively.
- Patients who had illness since 20 years and more had the highest mean score of hopelessness (14.0±0.000).
- Patients who were hospitalized before had higher mean score of hopelessness than those who were not hospitalized before (9.87±5.162) and 6.73±5.161) respectively.
- Patients who received psychotherapy had the highest mean score of hopelessness (14.50±5.488).
- Patients who were non - compliant to their medication had higher mean score of hopelessness (9.54±6.893) than those who were compliant (6.89±4.761).
- Patients who did not receive support during their illness had higher mean score of hopelessness compared to those who received (9.55±5.254) and (6.64±5.132) respectively.
• The relationship between internalized stigma resistance mean scores of the studied patients’ and their socio- demographic &clinical characteristics (n = 150):
- Divorced patients obtained the highest mean score of internalized stigma resistance (16.71±2.138).
- University educated patients had the highest mean score of internalized stigma resistance (16.50±2.066).
- Patients who had illness since 10 years to less than 15 years had the highest mean score of internalized stigma resistance (16.00±1.809).
- Patients who received electroconvulsive therapy had the highest mean score of internalized stigma resistance (13.85±2.603).
- Patients who were compliant to their treatment had higher mean score of internalized stigma resistance (14.28±2.623) than those who were non-compliant (13.07±3.810).
It was concluded that most of the studied patients had moderate level of recovery and recovery is correlates positively with internalized stigma resistance and negatively with depression and hopelessness.
The main recommendations are:
I- Recommendations geared toward psychiatric nurses:
Psychiatric nurses should assess the presence of recovery, hope and internalized stigma resistance among patients with depressive disorders periodically.
Educational workshops are needed to provide nurses with better understanding and explanation of the nature of the recovery process and factors facilitating its achievement.
Psychiatric nurses should create a positive recovery environment through strengthening hope and increasing stigma resistance level among their patients.
Psychiatric nurses should learn and implement various psychotherapies to instill hope and alleviate depression and increase stigma resistance in both community-based and in patient settings such as Hope Therapy Protocol, Cognitive behavioral therapy and Acceptance and commitment therapy.
II- Recommendations for patients with depressive disorders:
Increasing patients` awareness about their disorder and how to increase their stigma resistance abilities in order to overcome stigma attached to mental illness.
Psycho- educational interventions should be provided for the patients and their families to help them gain knowledge about recovery process and develop skills on how to increase their hope and stigma resistance.
III- Recommendations for future research:
Future empirical studies to investigate the effect of specific therapeutic interventions on hope, internalized stigma resistance and recovery levels among patients with depressive disorders.
Prospective longitudinal studies are important to gain more insight and deep understanding about factors affecting recovery from depressive disorders.
Future research is needed to identify positive factors that contribute to hope, stigma resistance and reduce depression among patients with depressive disorders.