God nok? Selvaktelse og interpersonlig fungering hos pasienter innen psykisk helsevern: Forholdet til diagnoser, symptomer og behandlingsutbytte
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The purpose of this thesis is to contribute to the understanding of self-esteem and interpersonal functioning in psychiatric outpatients. Self-esteem is commonly regarded as the evaluative aspects of the person’s self-perception, defined as the overall evaluation of one’s worthiness as a human being, or to what degree he or she feels her- or himself as “good enough”. Mental health research has documented statistically significant associations between low self-esteem and poor mental health. However, the nature of these associations is not well explored empirically in clinical samples. The aims of the current study were (1) to explore how self-esteem is associated with general symptomatic distress, psychiatric diagnosis and interpersonal problems, (2) to explore associations between self-esteem and interpersonal style, and (3) to explore if self-esteem and interpersonal style predicted treatment outcome and drop out rates in cognitive behaviourally based psychoeducational group treatment. The study was carried out on data collected in a local psychiatric outpatient clinic in Western Norway. All patients (n = 338) admitted for an intake interview over a 12-month period completed questionnaires assessing self-esteem (RSES), symptomatic distress (SCL- 90-R), and interpersonal problems (IIP-C) as part of the assessment. Clinical and diagnostic evaluations were conducted as usual, according to the ICD-10. In addition, Paper 3 comprises a subsample (n = 65) of patients who received cognitive behaviourally based psychoeducational group treatment (12 weekly sessions). The results showed that level of symptomatic distress and interpersonal problems predicted more of the variance in self-esteem than psychiatric diagnosis. When symptomatic distress and interpersonal problems were controlled for, only affective disorders (pure and comorbid) predicted lower levels of self-esteem on a statistically significant level (Paper 1). Furthermore, the results show that lower self-esteem was associated with higher levels of interpersonal problems in general. Lower self-esteem was first and foremost linked to frustrated agentic motives, as measured by the IIP-C. Also, the analyses revealed an interaction effect of agency and communion on self-esteem, indicating a need for balancing the two motive dimensions (Paper 2). Lastly, low self-esteem predicted poor outcome in terms of change in interpersonal problems. However, self-esteem was not associated with outcome as measured by the Global Severity Index derived from SCL-90-R. Fifty percent of the patients improved reliably during treatment (general symptomatic reduction), but only seven patients (13 %) met the criteria for clinically significant change. Considering interpersonal problems, 25 % of the patients reported a reliable reduction; eight of these (15 %) met the criteria for clinically significant change. Fourteen patients (22 %) did not complete treatment. Drop out was predicted by marital status (single) and low levels of interpersonal agency. Based on the findings, we conclude that psychological interventions should always consider the patient’s self-esteem, regardless of the psychiatric diagnosis. Further, therapeutic work with interpersonal problems should include self-esteem issues. We also conclude that the fostering of patient agency should be considered as an important goal in psychotherapy.
Paper 1: Nordic Psychology 60(1), Bjørkvik, J.; Biringer, E.; Eikeland, O. J.; Nielsen, G. H., Predicting self-esteem in psychiatric outpatients, pp. 43-57. Full text not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1027/1901-22188.8.131.52Paper 2: Scandinavian Journal of Psychology 50(3), Bjørkvik, J.; Biringer, E.; Eikeland, O. J.; Nielsen, G. H., Self-esteem and interpersonal functioning in psychiatric outpatients, pp. 259-265. Copyright 2009 The Authors, journal compilation 2009 The Scandinavian Psychological Associations. Published by Blackwell Publishing Ltd. Full text not available in BORA due to publisher restrictions. The published version is available at: http://dx.doi.org/10.1111/j.1467-9450.2009.00709.xPaper 3: Bjørkvik, J.; Eikeland, O. J.; Nielsen, G. H., 2009, Selvaktelse og interpersonlig stil som prediktorer for endring i psykoedukativ gruppebehandling. Full text not available in BORA.