Quel rétablissement chez la personne âgée dépressive ? Effets d’un dispositif groupal d’autobiographie guidée

Abstract

Background

Ageing is often presented solely through the lens of loss and bereavement. When mental disorders occur in the elderly, the “deficit” approach results in the overconsumption of psychotropic drugs, implicitly confirming the lack of hope felt by others. The societal proposals for assisting people in death, that sometimes result from this, overshadow the profound experience of the elderly, where a number of studies have confirmed that it is possible to provide them with an outlook for hope. The recovery paradigm has contributed to bringing forth a new perspective for people with “severe” mental disorders, focused on “empowerment” and “connectedness” with the social world. Can this also be relevant for elderly people even though the pending horizon of death is an undeniable reality of their experience? Several studies have confirmed the value of this paradigm for informing interventions in this population, particularly through narrative programs.

Objectives

Based on a narrative group proposal of guided autobiography, we wanted to clarify to what extent the central dimensions of recovery such as hope, empowerment and “connection” could be taken into account and highlighted in the care of depressed elderly people.

Method

A ten-session group guided autobiography program, using written and oral communication, was developed and proposed to 3 groups of from 5 to 8 participants in a psychiatric day hospitalization unit for the elderly. In weekly one-and-a-half hour sessions, participants discussed and wrote about their life experiences in relation to a given theme. The 10 themes – one per session – had been selected through working with depressed elderly people during a pre-study meeting: Time, Family and Relatives, Work and Activity, Money, Sex and Gender, Food, Body and Health, Death, Travel, and Arts. Five participants in each group were able to complete the entire evaluation process. At the beginning and end of the program, their mood was evaluated with the Montgomery-Åsberg Depression Rating Scale, and relation to time was assessed by the Zimbardo Time Perspective Inventory. Observation grids were used to track the changes in people's participation and the characteristics of their texts. At the end of the 10 sessions, an interview was conducted with each person which was subsequently analyzed according to the Interpretative Phenomenological Analysis (IPA) method, in order to reconstitute their experience.

Results

In addition to the symptomatic improvement measured with the MADRS, the observation grids and The Time Perspective profiles suggest changes indicative of recovery processes in almost all the individuals. The analysis of the interviews also highlights evidence of experiential recovery.

Discussion

The therapeutic group proposal would appear to favor several dimensions of recovery, such as hope, connection and empowerment, for all the participants. However, the subjective appropriation and concrete implementation of a recovery process, in terms of meaning and reshaping of the Self, are, in every case, linked to an eminently singular life story, as shown by the texts produced, the modes of involvement of each person within the program, and the qualitative analysis of the interviews.

Conclusion

The recovery paradigm is effective with elderly people suffering from depression, provided that the care programs are developed with a consideration of the problems of ageing and the singularity of each person's experiences.