Journal of Affective Disorders Reports (Apr 2021)

Illness representations in depression and their association with clinical and treatment outcomes: A systematic review of the literature

  • Giorgos Mavroeides,
  • Katerina Koutra

Journal volume & issue
Vol. 4
p. 100099

Abstract

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Purpose: Illness representations are key determinants of depressive symptoms in patients with mental and physical disorders. Leventhal's Common Sense Model (CSM) - the leading psychological model of self-regulation - is used to understand people's responses to illness. The CSM proposes a dynamic interaction between illness representations, self-management, and health outcomes. This systematic review is the first to examine the associations of the CSM's illness representations with clinical and treatment-related outcomes in patients with depression and to identify factors that mediate or moderate the aforementioned associations. Methods: We carried out a comprehensive literature search on PubMed, ScienceDirect, PsycINFO, Scopus, Google Scholar, and Web of Science databases. Eleven studies investigating the association between illness representations and depression outcomes were identified. Results: Negative representations of identity, control, consequences, coherence, and chronic timeline were associated with poorer depression outcomes, including higher severity of depression, higher anxiety level, poorer patient psychosocial functioning, and longer treatment duration. Furthermore, various beliefs about the causes of depression were differentially associated with outcome variables. Limitations: The search was limited to English language and grey literature was not examined. Conclusion: Having a thorough understanding of depression and appraising it as an acute and controllable illness, with a limited number of symptoms and consequences is associated with better outcomes, and an overall better illness experience. The findings of this review have the potential to inform clinical interventions in depression based on illness representations. Further research is required to establish causal relations between illness representations and depression outcomes.

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