Bakgrund: Patienter med emotionell instabil personlighetsstörning (EIPS) innebär en stor utmaning för den psykiatriska heldygnsvården. Specialistsjuksköterskorna upplever patienter med EIPS som påfrestande och svårare att vårda än andra patienter. Det innebär en utmaning inte bara för specialistsjuksköterskorna i deras yrke utan också för deras känslomässiga välbefinnande, vilket har en negativ inverkan på kvaliteten på den vård som ges. Syfte: Syftet med studien var att undersöka specialistsjuksköterskors copingstrategier för att vårda patienter med emotionell instabil personlighetsstörning inom psykiatrisk heldygnsvård.    Metod: Kvalitativ metod med induktiv ansats. Data samlades in genom 10 semistrukturerade intervjuer. Intervjuerna analyserades med hjälp av Burnards innehållsanalys. Resultat: Resultatet visar att specialistsjuksköterskorna använder sig av flertalet copingstrategier. Analysen resulterade i två kategorier och fem subkategorier. Kategorierna var: använda kunskap som stöd samt söka stöd hos kollegor. Subkategorierna presenteras under: att avleda, finna acceptans, finna trygghet i sin professionella roll; bekräftelse från kollegor och lämna över till kollegor.   Slutsats: Copingstrategierna hjälpte specialistsjuksköterskorna i vården av patienter med EIPS och visade sig vara viktiga för att bibehålla deras psykiska hälsa och fortsätta vårda patienterna. Resultatet antyder att copingstrategier spelar en viktig roll i specialistsjuksköterskornas yrkesutövning och att ämnet behöver lyftas fram. Mer utbildning om självkännedom och copingstrategier kan ge specialistsjuksköterskorna ytterliga redskap i att applicera fungerande strategier. / Background: Patients suffering from borderline personality disorder constitutes a great challenge to the psychiatric inpatient care. Mental health nurses experience these patients as more difficult to attend to than other patients. This imposes a challenge not only to the nurses in their profession but also to their emotional wellness thus imposing a negative influence on the quality of the care given.         Aim: The aim of this study was to examine the coping strategies used by the mental health nurse to care for patients suffering from borderline personality disorder within the realms of the psychiatric inpatient care. Method: Qualitative method with an inductive approach. Data was collected through 10 semi-structured interviews processed with the aid of Burnards method of content analysis. Result: The result shows a varied set of coping strategies used by the mental health nurses. The analysis resulted in two main categories and five subcategories. The main categories consist of: Seeking support in knowledge and seeking support from colleagues. The subcategories are presented under: to divert, to find acceptance, to find comfort in their professional role, confirmation from colleagues and tox§x     hand over tasks to colleagues.    Conclusion: Coping strategies helped the mental health nurses in their care of patients with borderline personality disorder and proved to be important to maintain their mental health and ability to provide care. The result implies that coping strategies play an important role in the professional practice of mental health nurses and needs to be emphasized. More education on self-awareness can provide mental health nurses with additional tools to apply effective strategies.

[pt] Este artigo examina dois aspectos inter-relacionados do transtorno de personalidade borderline (TPB): sua ligação com a inteligência geral e a eficácia da Terapia Comportamental Dialética (DBT) para indivíduos com dificuldades de aprendizagem. Em comparação com os grupos de controle, os indivíduos com TPB apresentaram pontuações de QI significativamente mais baixas. Além disso, foram identificadas deficiências cognitivas distintas, potencialmente impactando a regulação emocional e comportamental. Os resultados mostraram que os cursos de terapia adaptada de DBT podem trazer melhorias significativas nas habilidades essenciais da DBT, como regulação emocional, eficácia interpessoal e tolerância ao sofrimento. Compreender os aspectos cognitivos do TPB pode informar intervenções mais eficazes, enquanto terapias adaptáveis como a DBT podem atender às necessidades específicas de indivíduos com dificuldades de aprendizagem. Esta dissertação incentiva uma maior exploração da interação entre o funcionamento cognitivo e os resultados terapêuticos, particularmente em populações com transtornos de personalidade. / [en] This paper examines two interrelated aspects of borderline personality disorder it s link to general intelligence and the effectiveness of Dialectical Behaviour Therapy for individuals with learning disabilities. Compared to control groups, individuals with BPD displayed significantly lower IQ scores. Additionally, distinct cognitive impairments were identified, potentially impacting emotional and behavioural regulation. Results showed that adapted therapy courses of DBT can have significant improvements in core DBT skills like emotional regulation, interpersonal effectiveness, and distress tolerance. Understanding the cognitive aspects of BPD can inform more effective interventions, while adaptable therapies like DBT can address the unique needs of individuals with learning disabilities. This dissertation encourages further exploration of the interplay between cognitive functioning and therapeutic outcomes, particularly in populations with personality disorders.

Borderline-Persönlichkeitsstörung (BPS) ist eine schwere psychiatrische Störung, die durch tiefgreifende Probleme in Emotionsregulation und zwischenmenschlichen Beziehungen gekennzeichnet ist. Die gestörten Beziehungsmuster werden als ein Kernmerkmal von BPS betrachtet, obwohl die empirische Evidenz dafür weitestgehend fehlt. Bisherige Ergebnisse sind auf behavioraler und neuronaler Ebene bei BPS durch das häufig komorbide Auftreten einer posttraumatischen Belastungsstörung (PTBS) verzerrt. Eine vielversprechende Möglichkeit, die Beziehungsstörung von Patienten mit BPS näher zu untersuchen, bietet das multidimensionale Konzept der Empathie. Daher konzentriert sich die vorliegende Arbeit auf die Identifizierung behavioraler und neuronaler Korrelate kognitiver und emotionaler Empathie bei BPS Patienten und den Einfluss einer komorbiden PTBS auf diese. Die Ergebnisse zeigen, dass Patienten mit BPS Einschränkungen in beiden Facetten von Empathie zeigen, aber komorbide PTBS, intrusive Symptomatik und sexuelle Traumatisierung in der Vergangenheit mit schlechterer kognitiver Empathie einhergehen. Außerdem ist unter kognitiver Empathie die neuronale Aktivität im linken superior temporal Sulcus/Gyrus (STS/STG) bei BPS Patienten reduziert und mit der Ausprägung ihrer intrusiven Symptomatik assoziiert. Während emotionaler Empathie zeigen Patienten mit BPS im rechten insulären Kortex mehr Aktivität, die mit dem Hautleitwiderstand der BPS Patienten assoziiert ist. Die hier dargestellten Ergebnisse unterstützen ein Bild von BPS als eine Störung der emotionalen und kognitiven Empathie. Eine komorbid diagnostizierte PTBS scheint sich dabei zusätzlich verschlechternd auf die Fähigkeit zur kognitiven Empathie auszuwirken. Die veränderte Funktion von STS/STG und Insula könnte einen pathophysiologischen Vermittlungsmechanismus auf neuronaler Ebene für BPS darstellen, dabei scheinen die intrusiver Symptomatik und dem Grad der Erregung der Patienten eine wesentliche Rolle zu spielen. / Borderline personality disorder (BPD) is a severe psychiatric malfunction, which involves deficits in emotion regulation and interpersonal relationships. Especially the interpersonal problems are seen as a core feature in BPD, even if there is only weak empirical evidence. Furthermore, the current results on behavioral and functional alterations of patients with BPD are biased by the high rate of comorbidity with posttraumatic stress disorder (PTSD). The multidimensional concept of empathy seems to be an eligible framework for the interpersonal problems of patients with BPD. Hence, the present work focuses on the identification of behavioral and neural correlates of cognitive (i.e., social cognition) and emotional (i.e., empathic concern) empathy in patients with BPD. Moreover the influence of comorbidities (e.g., PTSD) on the behavioral and neural alterations of patients with BPD was explored. Patients with BPD showed impairments in both facets of empathy, but comorbid PTSD, intrusive symptoms, and history of sexual trauma were only associated with outcomes in cognitive empathy. In this condition the brain responses were significantly reduced in BPD patients compared to controls in the left superior temporal sulcus and gyrus (STS/STG), where this reduction was associated with levels of intrusive symptomatology in the BPD group. During emotional empathy, patients with BPD exhibited greater brain activation than controls in the right middle insular cortex, a response that was associated with skin conductance responses in the patients. Thus, these findings support a conceptualization of BPD as involving deficits in emotional as well as in cognitive empathy. A comorbid PTSD seems to impair the cognitive empathic outcome additionally. Findings at the neural level indicate that altered functioning of the STS/STG and insula represents pathophysiological mediators for BPD, with an important role for intrusive symptomatology and levels of arousal.

Die vorliegende kumulative Promotion umfasst drei veröffentlichte Publikationen, die im Rahmen der Berliner Borderline Versorgungsstudie (BBV-Studie) durchgeführt wurden. In Studie 1 wurde die effectiveness der ambulanten Dialektisch-Behavioralen Therapie (DBT) an N = 47 Patienten mit einer Borderline Persönlichkeitsstörung (BPS), die das DBT-Behandlungsjahr vollständig durchlaufen haben, untersucht. Im Prä-Post-Vergleich zeigten sich für die untersuchten Symptombereiche signifikante Veränderungen und die Effektstärken lagen überwiegend im mittleren Bereich. 77% der Patienten erfüllten nach einem Jahr DBT nicht mehr die diagnostischen Kriterien für eine BPS. In Studie 2 wurden die Krankheitskosten von N = 55 BPS-Patienten in dem Jahr vor der ambulanten DBT umfassend aus einer gesellschaftlichen Perspektive erhoben. Die durchschnittlichen Kosten lagen bei €26.882 (SD = €32.275). Davon gingen mit €17.976 (SD = €23.867) etwa 66% auf die direkten, mit €8.906 (SD = €15.518) knapp 34% auf die indirekten Kosten zurück. In Studie 3 wurden für die N = 47 DBT- compleater die Krankheitskosten im Jahr vor der Therapie mit denen während des DBT-Behandlungsjahres und mit denen während des ersten Katamnesejahres (N = 33) verglichen. Die durchschnittlichen Krankheitskosten lagen im Jahr vor der DBT bei €28.026 (SD = €33.081), während des DBT-Jahres bei €18.758 (SD = €19.450) und sanken innerhalb des Katamnesejahres weiter auf €14.750 (SD = €18.592). Die deutlichsten Kostenreduktionen zeigten sich im stationären Bereich. Hingegen konnten die indirekten Kosten kaum gesenkt werden. Insgesamt weist die vorliegende Promotion darauf hin, dass die ambulante DBT auch unter Versorgungsbedingungen in Berlin wirksam ist. Zudem besitzt die BPS auch in Deutschland eine hohe gesellschaftliche Relevanz. Die Krankheitskosten können deutlich gesenkt werden, wenn BPS-Patienten in einem DBT-Netzwerk behandelt werden. Hieraus ergeben sich erste Hinweise auf die Effizienz der ambulanten DBT. / This thesis includes three publications that were conducted as part of a Berlin wide treatment study (“Berliner Borderline Versorgungsstudie“). In study 1, we examined the effectiveness of dialectical behavior therapy (DBT) for borderline personality disorder (BPD) under the routine health care situation in Berlin. N = 47 patients completed the one-year treatment and provided data. Our findings demonstrate significant improvements on all measures with medium effect sizes. Moreover, at the end of the first treatment year, 77% of the patients no longer met the criteria for a BPD diagnosis. In Study 2, BPD-related cost-of-illness 12 months prior to outpatient DBT was assessed in a sample of N = 55 BPD-patients from a societal perspective. Total cost-of-illness was €26882 (SD = €32275) per patient. €17976 (SD = €23867; 66%) were direct costs and €8906 (SD = €15518; 34%) were calculated as indirect costs. In study 3, societal cost-of-illness of the N = 47 DBT completers was calculated for 12 months prior to DBT and further investigated during DBT-treatment year and during the following year. Total mean annual cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year and €14750 (SD = €18592) during the follow-up year for the N = 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions of inpatient treatment costs, while indirect costs barely decreased. In sum, the present thesis shows that outpatient DBT under routine mental health care conditions in Berlin leads to positive results. Furthermore, mean annual cost-of-illness of German BPD-patients exceed those of many other mental disorders meaning that BPD poses a high economic burden. Importantly, treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Correspondingly, outpatient DBT has the potential to be an efficient treatment.

Contexte : Les personnes atteintes de trouble de personnalité limite (TPL) présenteraient un déficit de mentalisation, soit la capacité de percevoir et interpréter les états mentaux chez soi et chez l’autre. Dans le cadre de la relation mère-bébé, un tel déficit est susceptible d’entraîner des perturbations relationnelles ayant des conséquences néfastes sur le développement de l’enfant. L’orientation mentale se mesure par le biais des verbalisations du parent au sujet des états mentaux de son enfant et constitue donc un reflet de la mentalisation du parent durant cette interaction. Toutefois, aucune étude n’a encore investigué l’orientation mentale chez des mères avec TPL durant l’interaction avec leur bébé. Objectif : Le but de cette étude était d’évaluer l’orientation mentale de 38 mères en interaction avec leur enfant âgé de 12 mois, incluant 10 mères atteintes de TPL et 28 sans diagnostic psychiatrique. Méthode: L’orientation mentale maternelle fut évaluée à partir de vidéos d’interaction mère-enfant dans un contexte de jeu libre. Le TPL a été identifié à l’aide du Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Résultats: Les mères atteintes de TPL ne se sont pas distingué concernant la fréquence de commentaires faisant référence aux états mentaux de leur bébé. Toutefois, les commentaires mentaux des mères souffrant de TPL se sont avérés être 4.7 fois plus fréquemment jugés non-appropriés à l’état mental de l’enfant comparés à ceux des mères sans diagnostic psychiatrique. Conclusions : Les commentaires mentaux des mères atteintes de TPL semblent plus fréquemment empreints d’erreurs d’interprétation des états mentaux de leur enfant, ce qui pourrait poser un risque pour le développement de l’enfant. / Background. Mothers with Borderline Personality Disorder (BPD) have been theorized to have decreased mentalization ability, which is the capacity to perceive and interpret mental states. This could potentially increase the risk for troubled relationships with their infants and therefore have adverse consequences on the social and emotional development of the child. Mind-mindedness (MM), assessed through the mother’s references to her infant’s mental states during an interaction, is one aspect of maternal behavior that relies heavily on the mother’s mentalizing ability. However, research has yet to examine MM in mothers with BPD. Aims. Our objective was to assess the MM ability of 38 mothers during interactions with their 12 month-old infants, including 10 with BPD and 28 without a psychiatric diagnosis. Method. Trained observers assessed maternal MM from 2 minutes of videotaped mother-infant free play. BPD was assessed by the Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II). Results. Mothers with and without BPD did not differ in the frequency of comments referring to infant mental states. However, the mind- related comments made by mothers with BPD were 4.7 times more frequently judged as non- attuned to her infant’s mental state by a trained observer compared with those of controls without a psychiatric diagnosis. Conclusions. Mothers with and without BPD appear equally likely to envision and refer to mental states in their infants. However, mothers with BPD appear more likely to misread the mental states of their infants. This could put the child at risk for adverse developmental outcomes.

Cette thèse examine le rythme veille-sommeil et son association avec l’instabilité émotionnelle, l’agressivité et l’impulsivité dans le trouble de personnalité limite (TPL) à l’adolescence. Dans un premier temps, la revue de la littérature sur les perturbations objectives du sommeil dans le TPL a mis en lumière plusieurs difficultés similaires, évaluées par polysomnographie, à celles observées dans la dépression adulte. De 1980 à 2010, aucune recherche n’a examiné le rythme veille-sommeil, aucune n’a étudié les adolescents TPL et plusieurs n’ont pas contrôlé l’état dépressif comme facteur de confusion. De ce constat, il s’avérait pertinent de mener une étude sur le rythme veille-sommeil dans le TPL à l’adolescence en l’absence de dépression co-occurrente. L’adolescence comportant plusieurs caractéristiques physiologiques, psychologiques et sociales, tenir compte des aspects développementaux était essentiel. Dans un second temps, un protocole de recherche fût mis en place à la Clinique des troubles de l’humeur et le recrutement a été réalisé auprès d’adolescents souffrant d’un TPL et sans état dépressif actuel. Ils devaient porter pendant plus de neuf jours (période comprenant deux fins de semaine) un actigraphe, appareil non invasif évaluant l’alternance veille-sommeil dans l’environnement naturel. L’abandon précoce au traitement étant prévalent chez les patients TPL, la fiabilité de l’étude a été examinée afin de déterminer les raisons favorisant et celles nuisant au recrutement et à la collecte des données. La réflexion sur les aspects méthodologiques de l’étude actigraphique a permis d’expliquer les limites de ce type de protocole. Dans un troisième temps, le rythme veille-sommeil des adolescents TPL (n=18) a été caractérisé et comparé à celui des jeunes ayant un trouble bipolaire (n=6), trouble psychiatrique partageant plusieurs manifestations communes avec le TPL, et à celui des adolescents sans trouble de santé mentale (n=20). Les résultats suggèrent que l’adolescent TPL passe plus de temps en éveil durant la période de repos que les jeunes appartenant aux deux autres groupes. De plus, les adolescents TPL présentent une plus grande variabilité inter journalière des heures de lever et du temps total de sommeil que les autres adolescents. Ils se réveillent une heure de plus, et dorment donc une heure supplémentaire, que les adolescents sans trouble mental lors des journées sans routine. Dans un quatrième temps, les analyses corrélationnelles entre les données actigraphiques et les scores aux questionnaires auto-rapportés évaluant l’instabilité émotionnelle, l’agressivité et l’impulsivité suggèrent que plus l’adolescent TPL passe du temps éveillé alors qu’il est au lit, plus il déclare présenter des comportements agressifs, surtout physiques, durant le jour. En résumé, cette thèse contribue à la littérature scientifique en explorant pour la première fois le rythme veille-sommeil et son lien avec les manifestations symptomatiques dans le TPL à l’adolescence. Les résultats suggèrent fortement l’importance d’évaluer et de traiter les problèmes du rythme veille-sommeil que présentent ces jeunes lors de la prise en charge. / This dissertation examines sleep-wake patterns and their associations with emotional instability, aggressiveness, and impulsivity in adolescents with Borderline Personality Disorder (BPD). First, a literature review showed in BPD adults similar objective sleep disturbances, as assessed with polysomnography, to those observed in adult depression. Between 1980 and 2010, no study has examined sleep-wake patterns, none has recruited BPD adolescents, and many did not control depression as a confounding factor. Considering these limitations, it became relevant to conduct a study on sleep-wake patterns in euthymic adolescents with BPD. Having a developmental perspective in mind is crucial since adolescence presents many physiological, psychological and social characteristics. Second, a research protocol was set up at the Mood Disorders Clinic. Adolescents with BPD and without current depression were recruited. They wore for nine days or more (period covering two weekends) an actigraph, a non-invasive device assessing ecologically sleep-wake patterns. Because treatment dropout is highly prevalent in BPD adolescents, study feasibility was examined to determine the reasons promoting and those interfering with recruitment and data collection. Reflections on methodological aspects of this study allowed explaining the limits of this type of research protocol. Third, sleep-wake patterns in BPD adolescents (n=18) was characterised. They were compared to youth with Bipolar Disorder (n=6), a mental disorder sharing many common manifestations with BPD, and to adolescents without mental disorder (n=20). Results suggest that BPD adolescents spend more time awake during the rest interval than teenagers from the two other groups. Furthermore, BPD adolescents present higher interdaily variability for rising time and total sleep time than the other adolescents. They wake up an hour later, therefore sleeping one more hour, than adolescents without mental disorder on schedule-free days. Fourth, correlation analyses between actigraphy data and self-report questionnaire scores assessing emotional instability, aggressiveness, and impulsivity suggest that time spent awake during time in bed is associated with more daily physical aggressiveness in BPD adolescents. To summarise, this dissertation adds to the current scientific literature by exploring for the first time sleep-wake patterns and its associations with symptomatic manifestations of BPD in adolescents. From these results, it is highly recommended to assess and treat their sleep-wake disturbances during their therapeutic care.

Une proportion significative de mères d’enfants pris en charge par la protection de la jeunesse souffrirait d’un trouble de personnalité limite (TPL). En effet, les difficultés parentales associées à ce trouble prédisposent davantage à des situations d’abus ou de négligence envers leurs enfants. Cependant, il existe peu d’information sur les difficultés et les besoins de ces mères dans ce contexte particulier. Cette étude qualitative a été réalisée auprès de 30 mères avec un TPL et dont au moins un enfant était suivi par le Centre jeunesse de Montréal-Institut universitaire. La présente étude a permis de mieux décrire les difficultés des mères en lien avec leur TPL, leurs enfants et leur situation conjugale. Leurs expériences des services en protection de la jeunesse ont révélé des suivis instables et peu adaptés à leurs difficultés. Les mères ont abordé l’importance des qualités relationnelles des intervenants à l’établissement d’une collaboration de la part des intervenants et l’importance de mettre en place des services spécifiquement dédiés aux parents. Il semblerait pertinent d’adapter les services de protection de la jeunesse afin d’inclure des interventions qui ciblent les difficultés spécifiques des parents qui ont un TPL, notamment en ce qui a trait à leurs habiletés parentales. / A significant proportion of mothers who have children in the care of the Youth Protection Services have borderline personality disorder (BPD). However, there is very little information on the needs and difficulties of these mothers in this special context. This qualitative study was conducted among 30 mothers who have BPD and who have at least one child followed by Centre jeunesse de Montréal-Institut universitaire, a Youth Protection Service. The study provided a description of the difficulties those mothers have associated with their personality disorder, their children and their couple relationship. Their experiences of services offered by Youth Protection suggested that the follow up received were unstable and not suitable for their difficulties and their needs. Mothers have addressed the importance of interpersonal skills of caseworkers to develop better collaboration and the importance of putting in place specifically dedicated services to parents. It would appear pertinent to adapt Youth Protection Services in order to include interventions that target the specific difficulties of parents with BPD, notably regarding parenting skills.

The issue of psychiatric co-morbidity is a serious public health problem occurring more and more frequently in the treatment of addiction and bringing with it various complications and often premature termination of treatment. The scoring system with a fixed set regime is still being used as the main instrument for treatment of addicted clients on the most specialized departments of psychiatric hospitals, although the effectiveness of the scoring system has not yet been clinically verified. The aim of this pilot study is to demonstrate and verify of the individual cases of clients with different categories of dual diagnosis, how they perceive the balance of the sanctions and rewards and fair setting in the context of the scoring system. Other goals are to find out and verify what is the influence of the scoring system on the motivation to change the behavior and success of treatment, what weaknesses clients with dual diagnosis perceive in this system and how they represent the treatment system, which would make them more fit and motivated to change behavior. Further, this study seeks to establish whether difficulties and obstacles on the way to stand up and go through the scoring system are different for individual dual diagnoses. A qualitative approach is used in the research part of the thesis....

Abstract Maternal depressed mood during pregnancy is common, but studies on the offspring of antenatally depressed mothers, with a long follow-up, are scarce. The aim was to study whether the adult offspring of antenatally depressed mothers are at an elevated risk of psychoses, depression, bipolar disorder, antisocial and borderline personality disorder, and schizotypal and affective traits. Parental severe mental disorder was considered as both a genetic and environmental risk factor for mental disorders. The data are based on the unselected, prospective, population-based Northern Finland 1966 Birth Cohort of 12,058 live-born children. The data were collected beginning from pregnancy and ending mid-adulthood. The mothers were asked about their mood during pregnancy at the antenatal clinic at 24–28 gestational weeks. Of the mothers, 13.9% rated themselves as depressed (11.8%) or very depressed (2.1%) during pregnancy. Parents’ severe, hospital-treated mental disorders, and the cohort members’ mental disorders were identified mainly by using the Finnish Care Register for Health Care. In this study, the adult offspring of antenatally depressed mothers had an increased risk of depression, and the male offspring for antisocial personality disorder, compared to cohort members without antenatally depressed mothers. The offspring with both maternal antenatal depressed mood and parental severe mental disorder had a markedly elevated risk of schizophrenia and depression, compared to cohort members without one or both of the risk factors. This is the first study where the offspring of antenatally depressed mothers were followed till mid-adulthood, also taking into account parental severe mental disorders. Based on the findings, the prevention of and early intervention in antenatal depression, especially in families with severe mental illness, might present an opportunity to reduce the risk of mental disorders in the offspring. / Tiivistelmä Äitien raskausajan masennus on yleistä, mutta pitkiä seurantatutkimuksia raskausaikana masentuneiden äitien lapsista on vähän. Tutkimuksen tavoitteena oli selvittää, onko raskausaikana masentuneiden äitien aikuisilla jälkeläisillä kohonnut riski sairastua skitsofreniaan, masennukseen, kaksisuuntaiseen mielialahäiriöön, epäsosiaaliseen tai epävakaaseen persoonallisuushäiriöön, ja ilmeneekö heillä enemmän skitsotyyppisiä tai affektiivisia piirteitä. Vanhempien vakavien mielenterveydenhäiriöiden katsottiin olevan sekä mahdollisia geneettisiä että ympäristöön liittyviä riskitekijöitä jälkeläisten mielenterveyshäiriöille. Tutkimus perustuu yleisväestöön pohjautuvaan, prospektiiviseen Pohjois-Suomen vuoden 1966 syntymäkohorttiin, johon kuuluu 12 058 elävänä syntynyttä lasta. Kohortin jäseniä on seurattu sikiöajalta keski-ikään, aina 49 ikävuoteen saakka. Äitien raskaudenaikaista mielialaa tiedusteltiin raskausviikoilla 24–28 neuvolassa. 13,9 % äideistä raportoi mielialansa masentuneeksi (11,8 %) tai hyvin masentuneeksi (2.1%) raskausaikana. Vanhempien vakavat mielenterveydenhäiriöt ja kohortin jäsenten mielenterveyshäiriöt selvitettiin pääosin hoitoilmoitusrekisteritiedoista. Tutkimuksessa raskaudenaikana masentuneiden äitien lapsilla havaittiin kohonnut depressioriski sekä kohonnut epäsosiaalisen persoonallisuushäiriön riski miehillä, verrattuna kohortin jäseniin, joiden äitien mieliala ei ollut masentunut raskausaikana. Kohortin jäsenillä, joiden äideillä oli raskausajan masennusta ja toisella vanhemmista vakava mielenterveyshäiriö, oli kohonnut riski sairastua skitsofreniaan ja depressioon, verrattuna heihin, joilla oli vain yksi tai ei kumpaakaan näistä riskitekijöistä. Tämä on ensimmäinen tutkimus, jossa raskausaikana masentuneiden äitien lapsia on seurattu keski-ikään saakka, huomioiden myös vanhempien vakavat mielenterveydenhäiriöt. Tutkimuksen tulosten perusteella äidin raskausajan masennusoireiden varhaisen tunnistamisen ja hoidon voitaisiin ajatella vähentävien jälkeläisten mielenterveysongelmien riskiä, etenkin perheissä, joissa on vakavia mielenterveysongelmia.

INTRODUÇÃO: a resiliência é um construto associado às características pessoais que permitem a um indivíduo adaptar-se e superar situações adversas. Uma pessoa mais resiliente é aquela com maiores habilidades de se adaptar sob estresse, a despeito da carga de dificuldades enfrentada e de um contexto desfavorável no entorno. A Dispositional Resilience Scale (DRS-15) e a Connor-Davidson Resilience Scale (CD-RISC) tentam aferir a resiliência individual e já tiveram suas propriedades testadas em vários países da América do Norte, África, Europa e Ásia. OBJETIVO: traduzir, realizar a adaptação para o contexto cultural brasileiro e verificar a confiabilidade e a validade das escalas DRS-15 e CD-RISC. MÉTODO: uma metodologia com as etapas seqüenciais de tradução/retro-tradução/adaptação cultural/estudo de confiabilidade/estudo de validade foi utilizada. A adaptação cultural foi executada por um grupo de especialistas em epidemiologia, linguística, psiquiatria e tratamento da dor. A compreensão das versões culturalmente adaptadas foi testada com 65 pacientes adultos do grupo de avaliação pré-anestésica e do ambulatório geral de ansiedade do Hospital das Clínicas da FMUSP. Retro-traduções das versões finais foram aprovadas pelos autores principais das escalas originais. O estudo de validade foi conduzido pela aplicação conjunta de ambas as versões brasileiras das escalas, do Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), do Self-report questionnaire (SRQ), da escala de incapacitação de Sheehan (SDS) e da Escala Graduada de Dor Crônica (CPG-Br) a 575 pacientes e acompanhantes adultos da mesma população. A confiabilidade teste-reteste foi avaliada por uma segunda aplicação das escalas de resiliência a 123 participantes, entre 7 e 14 dias após a entrevista inicial. RESULTADOS: entre os participantes da fase de validação, a idade média foi de 44 anos (amplitude de 18-93), com predomínio de mulheres (74%), e média de dez anos de estudo. A maioria dos entrevistados (93%) pertencia aos estratos socioeconômicos B e C. Três fatores e quatro fatores foram identificados por análise fatorial exploratória para as versões da DRS-15 e CD-RISC, respectivamente. O coeficiente alfa de Cronbach foi de 0,71 para a DRS, e de 0,93 para a CD-RISC, indicando melhor consistência interna para a segunda. A confiabilidade teste-reteste retornou coeficientes de correlação intra-classe de 0,81 e 0,86 para a DRS e CD-RISC, respectivamente. A correlação entre as duas escalas foi de 0,52. Observaram-se correlações negativas significativas entre os escores das escalas de resiliência e os escores para cinco das seis dimensões do ISSL, assim como para com os escores do SRQ e SDS (p < 0,001). Não houve correlação entre as escalas de resiliência e a CPG-Br. A CD-RISC encontrou correlações mais fortes que a DRS para com as variáveis de comparação externa. As duas escalas discriminaram resiliência menor para os pacientes dos ambulatórios psiquiátricos, em comparação aos dos ambulatórios não-psiquiátricos. Entre os pacientes psiquiátricos, os escores de resiliência foram significativamente menores para os pacientes com transtorno Borderline de personalidade, em comparação aos pacientes com transtorno de estresse pós-traumático. CONCLUSÃO: propriedades de consistência interna, estabilidade temporal e validade foram satisfatoriamente demonstradas para as versões brasileiras da DRS e da CD-RISC em uma amostra de pacientes e acompanhantes adultos dos ambulatórios do Hospital das Clínicas de São Paulo / INTRODUCTION: Resilience is a construct related to the personal characteristics that allow an individual to adapt and overcome adversity. A more resilient person is the one that exhibits greater abilities to adapt under stress, despite the burden of difficulties and of an unfavorable context. The Dispositional Resilience Scale (DRS-15) and the Connor-Davidson Resilience Scale (CD-RISC) are two scales to measure individual resilience, both of which have had psychometrics evaluated by researchers from the US, Africa, Europe and Asia. OBJECTIVE: To verify the reliability and validity of culturally adapted Brazilian Portuguese versions of the DRS-15 and CD-RISC. METHODS: The following stepwise methodology was used: translation / back translation / cultural adaptation / reliability study / validation study. Cultural adaptation was performed by an expert committee of epidemiologist, linguists, psychiatrist and pain specialists. Comprehension of the culturally adapted versions was tested through 65 interviews with adult patients from the pre-anesthetic consultation ambulatory and general ambulatory for anxiety disorders of Hospital das Clínicas of FMUSP. Back-translations of the culturally adapted versions were fully approved by the authors of the original scales. Validation studies were carried out by concurrent application of both the adapted versions of resilience scales, the Brazilian Stress Symptoms Inventory for Adults (ISSL), the Self-report Questionnaire (SRQ), the Sheehan Disability Scale (SDS) and the Chronic Pain Grade (CPG-Br) to 575 participants (outpatients and companions) from the same population. Test-retest reliability was studied by means of a second interview with 123 subjects, which took place between 7 and 14 days after the first one. RESULTS: Subjects of the validation phase were mostly women (74%), with an average of 44 years of age (18-93) and 10 years of formal schooling. There was a predominance of socioeconomic levels B or C (93%) on an A to E scale. Exploratory factor analyses resulted in a three-factor for the DRS and a four-factor solution for the CD-RISC. Alpha coefficients of 0.71 for the DRS and 0.93 for the CD-RISC indicated better internal consistency for the latter. Temporal stability was regarded as excellent, with intra-class correlation coefficients of 0.81 and 0.86 for the DRS and CD-RISC, respectively. Correlation coefficient between the two scales was 0.52. Significant negative correlations were observed between the scores of both resilience scales and five out of six dimensions of the ISSL, and so as between the resilience scales scores and those of the SRQ and SDS (p < 0.001). No correlation was observed between the resilience scales and the CPG-Br. The CD-RISC was more competent than DRS to depict such correlations. Both scales were able to discriminate differences in resilience scores of non-psychiatric and psychiatric patients, the latter presenting with lower scores. The group of borderline patients significantly presented with lower resilience scores in comparison with those of the post-traumatic stress disorder patients. CONCLUSION: Good reliability and validity were demonstrated with the Brazilian Portuguese versions of the DRS and CD-RISC as tested on a sample of adult ambulatory patients and their adult companions at Hospital das Clínicas, São Paulo