El papel de la valoración de los sucesos vitales estresantes en el Trastorno Depresivo Mayor / The role of stressful life events appraisal in major depressive disorder

RESUMEN Introducción: El Trastorno depresivo mayor (TDM) es una enfermedad multifactorial en la que, por interacción con diversas variables, se incrementa la vulnerabilidad a padecerla. Diversos modelos han explicado las interacciones, como el de diátesis-estrés. Vivir eventos estresantes no siempre lleva a la aparición del TDM, y se ha planteado que la atribución y la valoración de los eventos estresantes podrían ser un mejor predictor de la aparición de los síntomas. Objetivo: Determinar la asociación y el poder predictivo de la frecuencia y la valoración de eventos vitales estresantes en la presencia de sintomatología del TDM. Métodos: Estudio de casos y controles con 120 pacientes psiquiátricos y 120 personas de la población general. Se utilizó una entrevista clínica estructurada y el Cuestionario de Sucesos Vitales de Sandín y Chorot. Los datos se analizaron con pruebas no paramétricas y regresión logística binaria. Resultados: El grupo de casos obtuvo significativamente más altos en afecto negativo, frecuencia de eventos estresantes, nivel de estrés percibido, valoración negativa de la situación y percepción de no control. El modelo de regresión logística binaria indicó que la baja percepción de control frente al evento estresante es el factor más determinante, seguido por la evaluación negativa del evento. Conclusiones: Las atribuciones realizadas sobre los eventos estresantes son determinantes en la presentación del TDM, en especial la valoración del control percibido frente a los sucesos vitales, en concordancia con los modelos etiológicos del TDM de diátesis cognitiva al estrés.

ABSTRACT Introduction: Major depressive disorder (MDD) is a multifactorial disease in which, due to the interaction of several variables, the vulnerability of suffering from it increases. Several models, such as the diathesis-stress model, have explained these interactions. However, experiencing stressful events does not always lead to the development of MDD, and the attribution and appraisal of stressful events contributing to further development of depression symptoms has been considered as a possible explanation. Objective: To determinate the association and the predictive power of the frequency and appraisal of stressful life events to predict MDD symptomatology. Methods: Case-control study with 120 psychiatric patients and 120 people from the general population. A structured clinical interview and the life events questionnaire (Sandín and Chorcot) were used to evaluate the sample. The data were analysed with non-parametric tests and binary logistic regression. Results: The psychiatric patients reported significantly higher levels of negative affect, frequency of stressful life events, perceived stress, negative appraisal of the situation and lack of perceived control. The binary logistic regression model indicated that poor perception of control of the stressful event is the most determining factor, followed by negative evaluation of the situation. Conclusions: The attributions that are made regarding a stressful event are variables that predict MDD, specifically the assessment of the perceived control over the situation. These results concur with the aetiological models of MDD, such as the cognitive diathesis-stress model.

The role of stressful life events appraisal in major depressive disorder. / El papel de la valoración de los sucesos vitales estresantes en el Trastorno Depresivo Mayor.

INTRODUCTION: Major depressive disorder (MDD) is a multifactorial disease in which, due to the interaction of several variables, the vulnerability of suffering from it increases. Several models, such as the diathesis-stress model, have explained these interactions. However, experiencing stressful events does not always lead to the development of MDD, and the attribution and appraisal of stressful events contributing to further development of depression symptoms has been considered as a possible explanation. OBJECTIVE: To determinate the association and the predictive power of the frequency and appraisal of stressful life events to predict MDD symptomatology. METHODS: Case-control study with 120 psychiatric patients and 120 people from the general population. A structured clinical interview and the life events questionnaire (Sandín and Chorcot) were used to evaluate the sample. The data were analysed with non-parametric tests and binary logistic regression. RESULTS: The psychiatric patients reported significantly higher levels of negative affect, frequency of stressful life events, perceived stress, negative appraisal of the situation and lack of perceived control. The binary logistic regression model indicated that poor perception of control of the stressful event is the most determining factor, followed by negative evaluation of the situation. CONCLUSIONS: The attributions that are made regarding a stressful event are variables that predict MDD, specifically the assessment of the perceived control over the situation. These results concur with the aetiological models of MDD, such as the cognitive diathesis-stress model.