الفهرس 
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Abstract
SUMMARY
Major depressive disorder (MDD) is an important public health issue with a lifetime prevalence of 10% in the general population. The impact of depression on quality of life is comparable with or greater than that of chronic medical illness, depending on the severity of symptoms. MDD is the second leading disease causing functional impairment, disability and workforce loss worldwide, which is associated with diminished life quality, and significant physical and psychosocial impairment.
Depression negatively impacts a myriad of facets of an individual’s life including functioning, satisfaction with work, relationships, leisure, physical health, mental health, sexual functioning, sleep patterns, future outlook and overall sense of fulfillment or contentment with one’s life. Studies have demonstrated that patients with MDD have significant impairments in QOL.
A growing body of evidence suggests that psychotherapy used in conjunction with medication gives better results in the patient’s condition in terms of symptom reduction and quality of life improvement. Therefore, Psychiatric mental health nurses have a key role in enhancement of quality of life of depressed patients through focus on nursing care measures utilized through
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supportive psychotherapy and helping the patients suffering from depression to improve adaptation by whatever means available and to teach them supportive techniques to help them to overcome symptoms of depression which consequently; improve quality of life.
Aim of the Study:
The aim of this study was to enhance quality of life and decrease depressive symptoms for patients with depression through utilization of supportive psychotherapy.
This aim was achieved through:
Assessing the severity of depressive symptoms of patients with depression.
Assessing the quality of life for patients with depression.
Accordingly, developing and implementing supportive psychotherapy program for meeting the identified needs of depressed patients to enhancing their quality of life and decreasing depressive symptoms.
Evaluating the effectiveness of supportive psychotherapy on quality of life among depressed patients under study.
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Hypothesis:
Depressed patients who participate in a supportive psychotherapy program will have better outcomes on their posttest scores regarding quality of life and depressive symptoms.
Research setting:
This study was conducted in the outpatient clinics at Al-Abbassia Mental Health Hospital.
Subjects:
Sample type:
A purposive sample was obtained from all available patients with major depressive disorder who met the inclusion criteria during their follow-up visits to the previously mentioned setting.
Sample size:
The current study was conducted on 40 patients with major depressive disorder who met the inclusion criteria during their follow-up visits to the previously mentioned setting.
Inclusion criteria:
- Adult patients who were diagnosed as being
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major depressive disorder (MDD) according to the “International Classification of Diseases [ICD-10].
- Sex: both sexes (males and females)
- Free from other psychiatric disorders.
- Free from significant psychological co morbidities as psychotic depression, personality disorder and significant cognitive impairment (brain injury or dementia)
- Don’t currently participate in any other type of psychotherapy.
Tools of data collection:
Tools used for data collection were the following:
A. Socio-demographic sheet interview questionnaire sheet
B. Beck’s Depression Inventory (BDI-II)
C. World Health Organization-Quality of Life (WHOQOL)
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A) Socio-demographic interview questionnaire sheet (Appendix I):
This questionnaire was constructed by the researcher after reviewing related literature in the field of depression. This interview questionnaire comprised three parts: The first part is concerned with the socio demographic characteristics of study subjects, which include, age, sex, marital status, level of education and occupation. The second part includes data related to patient’s history of depression. The third part includes data related to patients’ knowledge about depression.
Scoring system for knowledge related to depression:
The knowledge related to depression consists of 8 questions, the responses are scored from 0 to 1 (0) for incorrect answer and (1) for correct answer. Knowledge was considered satisfactory if percent was 50% or more and considered unsatisfactory if percent was less than 50%.
B) Beck’s Depression Inventory (BDI-II) (Appendix II):
Beck’s Depression Inventory was developed by a group of researchers (Beck, Steer, & Brown, 1996). The Beck Depression Inventory is a 21-items presented in multiple choice formats which measures the degree of depression in adults. Each of the 21-items of the BDI-II attempts to assess a specific symptom or attitude. Each category
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purports to describe a specific behavioral manifestation of depression and consists of a graded series of four self-evaluative statements.
Scoring system:
The statements are rank ordered to reflect the range of severity of the symptom from neutral to maximum severity. Each of the items consisted of 4 self-reported statements graded in severity from 0 (absent) to 3 (severe). None of the items were reverse-coded. The total scores were obtained by summing the scores from the 21 items to arrive at scores ranging from 0 to 63. As reported in the BDI-II manual, the depressive symptoms scores are interpreted as:
Normal: 0 – 10
Minimal depression: 11 – 13
Mild depression: 14 – 19
Moderate depression: 20 – 28
Severe depression: 29 – 40
Extreme depression: Over 40
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Environment. It contains 5 items and includes home environment, access to health services, financial resources, information and skills and opportunities for recreation.
Scoring system:
Each question from each domain of the scale was rated from 0 to 100 marks; all scores are oriented such that higher values denote better quality of life, after reversing the scoring for negative items, and the scores of each item were summed-up and the total divided by the number of items.
The quality of life levels for patients with depression was classified as the following:
Poor: 0 – 33.3
Average: 33.4 – 66.6
Good: 66.7 – 100
D- Supportive psychotherapy Program (Appendix IV):
The supportive psychotherapy program was developed in Arabic language by the researcher after reviewing the past and current related literature to meet the patients identified needs through helping them to overcome the internal and external obstacles in order to facilitate a return to normal living.
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The present supportive psychotherapy program was conducted in three phases:
First: Preparatory and designing phase:
This phase aims at planning for a supportive psychotherapy program through setting its objectives, preparing its contents and activities, and designing the methodology and media such as colored posters and guiding module and conducting a pilot study.
Second: Implementing phase:
This phase was begun by data collection, then implementation of supportive psychotherapy program for enhancement of quality of life. Subjects involving in the study were interviewed and assessed two times; before program to obtain baseline data and after implementing program to evaluate the effectiveness of implementing the program on depressed patients.
Third: Evaluation phase:
Upon the completion of supportive psychotherapy program, the post test was done for depressed patients to estimate the effect of the supportive psychotherapy program on enhancement of quality of life among depressed patients under study using the same pre program tools.
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Results:
The main findings of this study showed that:
1. Slightly less than two fifth of patients understudy were in age group 29 -40 years, three fifths of them were female, slightly more than three fifth were single and slightly more than half of them reside rural areas.
2. There is a highly statistical significance difference between pre and post -intervention as regards the total knowledge about depression among depressed patients understudy (p=≤0.001).
3. There is a highly statistical significance difference between pre and post –intervention as regards total level of depression among depressed patients under study (p=≤0.001).
4. There is a highly statistically significant difference between pre-post program implementation as regards total score of quality life domains among depressed patients under study (p=≤0.001).
5. There was highly statistically significant relation after program implementation between total score of quality of life and the age of the patients, were the highest mean score of quality of life was among the age group(21 - < 29 )
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6. There was a highly statistically significant relation between residence and BDI and total score of QOL before program implementation (p=≤0.001). Meanwhile, there were no statistically significant relation between residence and total score of quality of life of patients under study after program implementation (P>0.05).
7. There was a highly statistically significant relation between patients’ knowledge, depressive symptoms and quality of life and their marital status before program implementation (p=≤0.001). Meanwhile, there were a highly statistically significant relation between the patients’ depressive symptoms and marital status after program implementation (P< 0.01).
8. There was a highly statistically significant relation between patients’ knowledge, depressive symptoms, and quality of life and their working status before program implementation (P< 0.01). Meanwhile, there were no statistically significant relation between patients’ knowledge and working status after program implementation (P>0.05).