Influence de la résistance aux hallucinations auditives sur la dépression: étude au moyen du questionnaire révisé des croyances a propos des voix (with English summary)

(English version below)

Objectifs. — Cette recherche vise à étudier l’influence de la résistance aux hallucinations auditives sur la dépression dans un groupe de patients atteints de schizophrénie, au moyen de la version francophone du Beliefs About Voices Questionnaire Revised.

Méthode. — Trente-huit patients souffrant de schizophrénie et présentant des hallucinations auditives ont été évalués à l’aide de l’échelle des syndromes positifs et négatifs (PANSS), de l’échelle de dépression de Calgary (CDSS) et du questionnaire révisé des croyances à propos des voix (BAVQ-R), qui mesure les dimensions de Malveillance, de Bienveillance, d’Omnipotence, de Résistance et d’Engagement dans le rapport des patients à leurs hallucinations auditives.

Résultats. — Les dimensions Résistance et Malveillance sont fortement corrélées à la dépression. Mais la résistance aux voix est la seule dimension qui influe sur la dépression. Par ailleurs, les patients déprimés résistent davantage à leurs hallucinations auditives. De plus, la résistance émotionnelle, contrairement à la résistance comportementale, est responsable de la dépression chez les patients souffrant d’hallucinations. La version francophone du BAVQ-R pré-sente une consistance interne satisfaisante et de bonnes validités concourante et de  construit. Elle retrouve les corrélations entre les dimensions Malveillance et Résistance, et entre lesdimensions Bienveillance et  Engagement.

Conclusion. — La résistance aux voix, particulièrementla résistance émotionnelle, constitue un facteur important de la symptomatologie dépressivechez les patients souffrant de schizophrénie. La version francophone du BAVQ-R présente despropriétés psychométriques satisfaisantes.

Summary

Objective. —Beliefs about voices and reactions to voices have been proposed as important variables influencing the course of depression in schizophrenia. Consequences of auditory hallucinations are different according to identity, goals, omnipotence, omniscience, and meanings attributed to voices by the client. Ten to 15 % of the general population experience auditory hallucinations during lifetime without any distress or need for medical care. In addition, neither frequency of voices, nor their topography, influence the emotional consequences of auditory hallucinations experiences, but the relationships to voices. The Revised Belief about Voices Questionnaire analyzes voices along 5 dimensions: malevolence, benevolence, omnipotence, resistance, and engagement. Malevolent voices are related to depression, whereas benevolent voices engender more positive emotions. Subjects usually engage with benevolent voices, and resist to malevolent voices. But resistance strategies are barely efficient and often back-fire. Patients resisting to their voices consider them more malevolent and present with moredepressive symptoms. This research aims at studying the influence of resistance to auditory hallucinations on depression in a group of patients suffering from schizophrenia and experiencing auditory hallucinations, using the Revised Beliefs About Voices Questionnaire (BAVQ-R). It also provides a study of the psychometrics properties of the French language version of the BAVQ-R.

Method. — Thirty-eight patients suffering from paranoid schizophrenia, undifferentiated schizophrenia or schizoaffective disorder, have been tested with the French versions of the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Positive and Negative Syndrome Scale (PANSS),and the Calgary Depression Scale for Schizophrenia (CDSS). Each patient presented with auditory hallucinations during the week before evaluation, with a minimum score of 3 on P3 itemof PANSS. Mean age was 39.39 years (SD 11.33); mean duration of symptoms was 13.92 years(SD 10.81), and patients’ mean history of hospitalizations was 7.66 (SD 9.24). Each patientwas receiving an antipsychotic medication at the time of evaluation, with a mean chlorpromazine equivalent dose of 806.69 mg/d (ET 539.51); 18.5 % of patients were receiving serotonin reuptake inhibitor, and 31.57 % once committed a suicide attempt.

Results. — The French version of the BAVQ-R presents with a satisfying internal consistency (Cronbach’s alpha = 0.74). Similar to the original version, Malevolence and Resistance, and Benevolence and Engagement dimensions are strongly correlated (r = 0.73, and r = 0.90, P < 0.05,respectively). The BAVQ-R scores correlate with the CDSS (r = 0.40, P < 0.05) and the PANSS General Psychopathology subscale scores (r = 0.44, P < 0.05), but not with the Positive and Negative subscales (r = 0.17, and r = 0.13, P > 0.05, respectively). Correlations and forced entry multiple regressions analyses show that Resistance and Malevolence are both strongly correlated todepression, but Resistance is the only dimension that influences depression. Moreover, clients presenting with depressive symptoms resist more to their auditory hallucinations. Finally, emotional resistance, in comparison to behavioral resistance, is responsible for depression in people suffering from auditory hallucinations.

Conclusion. — Emotional resistance to auditory hallucinations constitutes the most important variable influencing depression in schizophrenia comparing to what the voices say or are supposed to know, their malevolence or benevolence. Demonstration of the influence of resistance to voices on depression would help the development of new therapeutic practices.