Ways of coping and MHLC in hospitalized depressed patients admittes trough the emergencies departments or consultations

Gigot, Catherine [UCL] Reynaert, Christine [UCL] Zdanowicz, Nicolas [UCL]

(eng) BACKGROUND: In a previous study, we compared the family relationships of patients hospitalized in a psychiatry unit from either psychiatric consultations or after passing emergency room (E.R.). The intensity of depression was statistically comparable in both groups. What distinguishes patients transiting emergencies is that their families and couples are more cohesive and adaptable. In this study, we compare both groups in terms of coping mechanisms and multidimensional health locus of control (MHLC). SUBJECTS AND METHODS: All patients (N=2172) with a major depressive disorder admitted to our department between 01/01/2010 and 31/12/2012 are included in an open study. They completed the Beck's Depression Inventory, the Olson's Family Adaptability and Cohesion Scale, visual analogue scales of stress, the ways of coping checklist, and the MHLC scale. RESULTS: Patients admitted through emergencies are found to have less belief in chance (CHLC) (t=2.488; p=0.014), distance themselves more from their problems (t=-2.187; p=0.03), but reappropriate them less positively (t=2.355; p=0.019) than those admitted through consultations. A logistic regression model including variables identified in the previous study (adaptability in the original family and the couple's lived stress) gives a risk factor (odds ratio) of 14.7 which means that a patient who would combine the different risk factors would be 14.7 times more likely to go through emergency. CONCLUSIONS: How to explain that depressive patients with more favorable factors considered: to believe less in chance, distancing from their problems, and having a better family support, are more likely to go to the E.R.? We make the suggestion that those factors exactly slowed down patients in their care application at first, allowing the depression to worsen. It is only once they would have depleted their reserves that they would reach the emergency room on their own initiative or encouraged by their families, themselves overwhelmed by the situation. Further study should take into account the duration of the episode before arrival at the hospital.