The Role of Perception of Control in Predicting Depression Among Individuals With Mental Illness After Psychiatric Hospital Discharge

Purpose Discharge from psychiatric hospitals is a critical point for patients, as they may be at greater risk of experiencing discontinuity of care. Few researchers, however, have examined cognitive factors associated with patients’ psychological well-being during the early phase of transition. One of the important cognitive traits linked to psychological well-being is an individual’s perceived control. Evidence and theories suggest that an impairment of perception of control is associated with depression. Some argue that perception of control is a stable personality trait. Others suggest that factors external to the individual shape one’s perception of control. Thus, perception of control was decomposed into two parts (i.e., an enduring as well as a malleable component [Keeton, et al., 2008]) and tested separately examining the longitudinal relationship between individual perception of control and depressive mood among discharged psychiatric patients.

Methods This research used the MacArthur Violence Risk Assessment Study, a six-wave study by 524 post-discharge psychiatric patients over one year. Depressive mood was measured using the Brief Psychiatric Rating Scale. Perception of control was a constructed four-item scale. Alpha reliabilities for this scale ranged from .703 to .812 for each wave, and exploratory factor analysis yielded one factor for each six time point. The four items include: (1) How often have you felt that you were unable to control the important things in your life?; (2) How often have you found that you could not cope with all the things you had to do?; (3) In the last two months, how often have you been angry because of things you could not control?; and (4) How often have you felt difficulties were piling up so high that you could not overcome them?  Hierarchical Linear Modeling techniques were employed within this analysis. To capture the component of an enduring and a changing perception of control in these growth models, time-invariant predictors in Model 1 included aggregate perception of control with control variables at level 2. In Model 2, we tested perception of control as a time varying covariate to estimate a different growth rate at a certain point in time.

Results Perception of control was a significant predictor of depression among discharged patients over the course of one year. The enduring perception of control was significantly related to depressive mood both at the initial level (B = 1.53, p <.001) and individual growth rates (B = -.16, p <.001). The malleable perceived control was not a significant predictor for individual changes over time.

Implications Our results suggest that having high sense of control is a protective cognitive factor for psychiatric patients during a difficult life transition. This finding is generally consistent with findings from studies of non-institutionalized populations. When considering potential interventions for ensuring continuity of care, our finding holds particularly compelling implications for mental health: The mental health of post-discharge psychiatric patients stands to benefit from the incorporation of psycho-educational components that can bolster perception of control.