Illness perception and its influence in outcome and disability in patients with treatment resistant depression receiving rTMS treatment

Background: Depressive disorders are a significant burden to patients and society, possibly leading to catastrophic damage to one's life. Unfortunately, many of these patients become resistant to treatment. Therefore, identifying possible aspects that can influence treatment responsiveness and return to life activities has become essential. Illness perceptions have been associated with many different conditions, including depression, treatment adherence, functionality, and coping behaviours. Objectives: The objectives of this study were to describe illness perceptions in a sample of patients with treatment-resistant depression (TRD) undergoing repetitive transcranial magnetic stimulation (rTMS) treatment; to evaluate its correlation with changes in the level of disability and changes in depression symptoms after treatment; to identify the possible influence of treatment on illness perceptions changes over time. Methods: Participants with a history of treatment-resistant depression were referred from primary and secondary care to receive treatment with rTMS. Measurements were done at baseline and after treatment using BIPQ, HRSD-17, and Sheehan Disability Scale (SDS). Patients were followed for a total of 16 to 18 weeks. Results: The sample consisted of 62 participants. The majority were female with severe depression. Identity, consequences, concern, and emotional representations were very high before treatment and strongly associated with one another. Life stressors, genetics, and trauma were the most perceived causes of depression. There was an indication that identity and other dimensions could explain some of the variances in HRSD-17 scores after rTMS, and perceived identity could also explain the variance in work/school, social, and family/home scores. rTMS appeared to be correlated with changes in illness dimensions after treatment. Conclusions: Depression takes over a patient's perception and life experience affecting social, professional, and personal life aspects. Most illness perceptions in TRD patients are severe and can mildly explain changes in symptoms and functioning over time. Changes in illness perception are part of the common-sense model's dynamic feedback and could partially be attributed to treatment in this sample.Medicine, Faculty ofExperimental Medicine, Division ofMedicine, Department ofGraduat