A Mediational Model of Depression in Smell-Disordered Patients


January 2001

To: UCSD Anosmia Study Participants and Other Interested Parties
Re: Summary of Research Results

The following is a summary of results presented in a poster session at the 1999 Annual Meeting of ACHEMS (Association for Chemoreception Sciences) in Sarasota, Florida. Note that we are providing this summary of preliminary data because we were unable to complete the data collection and analysis due to lack of funds. We regret the delay in transmitting these results to you. Please direct any questions to: wendy.tayer@GTE.net.

Title: A Mediational Model of Depression in Smell-Disordered Patients.

Authors: Corinne Ossebaard, Wendy Tayer, Perry M. Nicassio and William Cain.

Summary:

The loss of smell may greatly alter quality of life. Many patients with olfactory disorders experience loss of pleasure in eating and sexuality as well as inability to detect dangers such as gas leaks. The emotional consequences of smell loss often are underestimated, particularly in the medical community. Anosmics show varying degrees of depressive symptoms such as feelings of helplessness, isolation in their condition, sad mood, loss of independence, and fatigue.

This study researched psychosocial aspects of smell disorders. Very little empirical information exists on the epidemiology, clinical etiology, effective treatments, and psychological as well as social reactions to being diagnosed with a smell disorder. Based on studies with other chronic illness populations in which helplessness (e.g., a learned belief that one does not have control over the outcomes of his/her behaviors) and depression are characteristic of the disease course, we tested a statistical model to increase understanding of the role of psychological processes in smell dysfunction. Note that our research was not experimental in design and therefore could not determine causal relationships among the variables. However, it was designed to help develop a clearer understanding of what psychological relationships are relevant in anosmia and whether they are predictive of one another, e.g., the degree of association between them. Briefly, our model predicted that the greater the degree of disease status (smell dysfunction), the greater the degree of learned helplessness, and in turn, the greater the degree of depression.

Our sample consisted of 81 smell-disordered patients from five countries recruited through nasal dysfunction clinics in the US and from the Anosmia Discussion List on the World Wide Web. All measures were self-administered and sent through the mail. Our sample was comprised of 51 females and 30 males. Ninety percent reported an educational level of some college or more, and 72% reported being employed. The average age of our participants was 50 years with a range of 18-75. The most commonly cited cause of nasal dysfunction was post-upper respiratory infection (31%) followed by head trauma (20%), nasal disease (20%) and unknown etiology (19%).

Our results offered continued evidence that depression is common among patients with smell dysfunction. One-fifth of our sample scored in the clinically depressed range on our depression measure. One-third of our anosmia patients reported extreme helplessness which is comparable to that seen among chronic illness samples such as arthritis patients. Our data supported the proposed model in which disease status is related to depression through helplessness. We found that disease status is not directly associated with depression, but that the relationship between these two variables is bridged by the learned helplessness factor. More simply put, our findings suggest that when smell-disordered patients perceive that they are unable to control outcomes related to their condition (helplessness), they are more likely to become depressed in the face of their condition.

In terms of implications, we believe that learned helplessness is the key factor in this analysis because is involves thought processes and belief systems which can be altered via psychotherapy. Thus, these results are a first step in suggesting viable psychological treatments for the depression associated with anosmia. Future research might explore other associated variables such as anxiety, the role of social support and other belief systems active in the experience of smell dysfunction.

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