[The influence of religiosity on depressive disorders and suicidal behavior]

[Psychopathology of depressive-delusional states with religious content]

OBJECTIVE

Identification of psychopathological characteristics of depressive-delusional states with religious content, development of a typology, determination of formation features, nosological assessment.

MATERIAL AND METHODS

A total of 79 patients (47 female, 32 male, mean age 27±6.5 years) with depressive-delusional states with religious content within the affective and schizophrenia spectrum disorders were studied. Clinical-psychopathological, psychometric (PANSS, HDRS, S. Huber CRS) and statistical methods were used.

RESULTS

Based on the psychopathological structure, specific mechanisms of development of delusions and themes of the religious experiences, three types of depressive-delusional states were identified: type 1 - with a predominance of depressive delusions congruent with affect and delusional ideas of guilt, sinfulness, abandonment of God (14 patients, 17.7%; 6 women, 8 men; mean age 28±4.5 years; HDRS score 33±5.6, the total PANSS score 71±5.3, the PANSS positive subscale score 15.8±3.7); type 2 - with the addition of incongruent delusional constructs, persecutory disorders and acute sensory delusions to the existing depressive religious delusion, with the phenomenon of confessional ambivalence (27 patients, 34.2%; 16 women, 11 men; mean age at attack manifestation 25±9 years; HDRS score 29.6±4.4, the total PANSS score 87±6.2, the PANSS positive subscale score 23.5±4.2); type 3 - depressive-paranoid states with a predominance of Kandinsky-Clerambault syndrome of religious content (38 cases, 48.1%; 20 women, 18 men; mean age at attack manifestation 23.4±2.5 years; HDRS score 32.7±3.7, the total PANSS score 102±7.3, the PANSS positive subscale score 32.5±4.5).

CONCLUSION

The study of depressive-delusional states with religious content has shown their clinical-psychopathological heterogeneity. The religious experiences served as a pathoplastic factor, which essentially modified the clinical-psychopathological picture of the disease due to presence of the specific religious phenomena. The identified types of depressive-delusional disorders with religious content had different diagnostic value.

[Endogenous depressions with religious experience]

OBJECTIVE

To identify the specifics of psychopathology and phenomenology of religious experience in depressed patients, for early diagnosis of mental disorders masked by a «religious facade», and prevention of suicidal activity.

MATERIAL AND METHODS

The study included 115 patients (41 men, 74 women) with depression contained religious distress in affective disorders (38 observations) and schizophrenia (77 observations), F31.3, F31.4, F32.1, F32.2, F33.1, F33.2 and F20.0, F20.4, F21 according to ICD-10.

RESULTS

According the psychopathological structure of depressive states, five types of depression were identified. The predominant type was melancholic depression (61%). Based on characteristics of religious experience, types of depressions were distinguished as follows: with congruent religious ideas of guilt and sinfulness; with the loss of «living» faith, God-forsakenness; with overvalued doubts about the choice of faith; and with «spiritual hypochondria».

CONCLUSION

Mental disorders, in particular depressive states, which have a religious «facade» often remain unrecognized due to the specific religious content, which often leads to severe and sometimes irreversible consequences as suicidal activity. Thus, these conditions require early diagnosis and specific approaches to the treatment.

Religious Coping, Hopelessness, and Suicide Ideation in Subjects with First-Episode Major Depression: An Exploratory Study in the Real World Clinical Practice

BACKGROUND

This study aimed to evaluate the potential relationships between religious coping, hopelessness, and suicide ideation in adult outpatients with the first episode of major depressive disorder (MDD).

METHODS

Ninety-four adult outpatients with MDD were assessed through the Hamilton Depression Rating Scale (HAM-D), the Beck Hopelessness Scale (BHS), and the Scale of Suicide Ideation (SSI). Religious coping was assessed with the Italian version of the Brief RCOPE scale, consisting of seven positive coping items (PosCop) and seven negative coping items (NegCop).

RESULTS

The results showed that the Brief RCOPE PosCop scale exhibited a strong inverse correlation with HAM-D, BHS, and SSI, whereas HAM-D and BHS were positively correlated with SSI. Brief RCOPE NegCop scores were positively correlated only with SSI. Regression analysis with SSI as the dependent variable showed that higher Brief RCOPE PosCop scores were associated with lower suicide ideation, whereas higher HAM-D and BHS scores were associated with higher suicide ideation.

CONCLUSION

Positive religious coping may be a protective factor against the development of suicide ideation, perhaps counteracting the severity of depressive symptoms and hopelessness. The evaluation of religious coping should be performed in all subjects with MDD in everyday clinical practice. However, this study was preliminary, and limitations must be considered.