Evaluating psychological distress associated with life events under the traumatic experience threshold in patients with major depressive and bipolar disorder

Abstract

Patients with bipolar disorder (BD) and major depressive disorder (MDD) experience psychological distress associated with daily events that do not meet the threshold for traumatic experiences, referred to as event-related psychological distress (ERPD). Recently, we developed an assessment tool for ERPD, the ERPD-24. This tool considers four factors of ERPD: feelings of revenge, rumination, self-denial, and mental paralysis. We conducted a cross-sectional study between March 2021 and October 2022 to identify the differences and clinical features of ERPD among patients with MDD and BD and healthy subjects who did not experience traumatic events. Specifically, we assessed ERPD using the ERPD-24 and anxiety-related symptoms with the State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, and anxious-depressive attack. Regarding the ERPD-24 scores among the groups, as the data did not rigorously follow the test of normality, the Kruskal-Wallis test was used to compare the differences among the groups, followed by the Dunn-Bonferroni adjusted post-hoc test. Non-remitted MDD patients and BD patients, regardless of remission/non-remission, presented more severe ERPD than healthy subjects. This study also demonstrated the relationships between all anxiety-related symptoms, including social phobia and anxious-depressive attack and ERPD, in both BD and MDD patients and in healthy subjects. In conclusion, patients with non-remitted MDD and with BD regardless of remission/non-remission experience severe ERPD related to anxiety-related symptoms.

Figure 1

Study flowchart. Of the 126 patients screened, 111 were enrolled in this study.

Figure 2

ERPD-24 scores among the 6 groups. ERPD-24 scores (total and sub-categories: feelings of revenge, rumination, self-denial, mental paralysis) for the 6 groups: BD-manic/hypomanic, BD-depression, BD-remission, MDD-depression, MDD-remission, and healthy subjects (HS). The statistical analyses were used with the Kruskal–Wallis test to compare the differences between the groups, followed by the Dunn–Bonferroni adjusted post-hoc test for multiple comparisons. The crossbar of the box indicates the median, the box spans the interquartile range (25–75th percentiles), and the whiskers mark the minimum and maximum values, with outliers identified as individual points. *Comparison between BD-mania/hypomania and HS (p < 0.01); †Comparison between BD-depression and MDD-remission (p < 0.05); ‡Comparison between BD-depression and HS (p < 0.01); §Comparison between BD-remission and HS (p < 0.01); ||Comparison between MDD-depression and HS (p < 0.01); ¶Comparison between BD-mania/hypomania and BD-depression (p < 0.05). BD bipolar disorder, MDD major depressive disorder.