Jiang Y, Xia KK, Lin ZY. Effects of suggestion therapy on mood and sleep quality in middle-aged women with depression. World J Psychiatry 2025; 15(3): 100009 [DOI: 10.5498/wjp.v15.i3.100009]
Corresponding Author of This Article
Zhi-Yuan Lin, General Psychiatry, The Seventh People’s Hospital of Wenzhou, No. 552 Xishan East Road, Ouhai District, Wenzhou 325000, Zhejiang Province, China. linzhy1234@163.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Jiang Y performed the primary literature and data extraction; Xia KK analyzed the data and wrote the manuscript; Lin ZY was responsible for revising the manuscript for important intellectual content; and all authors read and approved the final version.
Institutional review board statement: The study was reviewed and approved by the Seventh People’s Hospital of Wenzhou.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Yuan Lin, General Psychiatry, The Seventh People’s Hospital of Wenzhou, No. 552 Xishan East Road, Ouhai District, Wenzhou 325000, Zhejiang Province, China. linzhy1234@163.com
Received: October 31, 2024 Revised: December 7, 2024 Accepted: January 6, 2025 Published online: March 19, 2025 Processing time: 117 Days and 19.8 Hours
Abstract
BACKGROUND
Depression is one of the most common mental disorders, with high rates of disability, particularly among women.
AIM
To explore the effects of suggestion therapy on anxiety, mood, and sleep-quality in middle-aged women with depression treated with escitalopram.
METHODS
Overall, 102 female patients with depression aged 35-49 years were divided into control and experimental groups. The control group received oral escitalopram therapy, starting at a dose of 5 mg/day, which was gradually increased to 10-20 mg/day after 1 week for a total of 8 weeks. The experimental group received the suggested therapy based on the control group. The Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Profile of Mood States-Short Form, and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression, anxiety, mood status, and sleep quality.
RESULTS
Before treatment, there were no significant differences in the SDS, SAS, Profile of Mood States, and PSQI scores between the two groups (P > 0.05). After treatment, compared to the control group and baseline, the SDS, SAS, tension-anxiety, depression-dejection, and confusion-bewilderment scores in the experimental group significantly decreased (P < 0.05), whereas sleep efficiency, sleep disturbance, hypnotics, and PSQI scores significantly increased (P < 0.05).
CONCLUSION
Suggestion therapy combined with escitalopram treatment can reduce the severity of depression and anxiety, change mood status, and improve sleep quality in middle-aged women with depression.
Core Tip: Depression is one of the most common mental disorders associated with high rates of disability, especially among women. This study aimed to determine the effect of suggestion therapy combined with escitalopram on depression in middle-aged women and to explore its effects on their mental state and sleep quality. The results of the clinical experiments can provide a scientific basis for improving the treatment of depression in middle-aged women.
Citation: Jiang Y, Xia KK, Lin ZY. Effects of suggestion therapy on mood and sleep quality in middle-aged women with depression. World J Psychiatry 2025; 15(3): 100009
Depression is one of the most common mental disorders with a high disability rate, especially in women[1]. Research has shown that patients with depression in China have obvious somatic symptoms, mainly changes in body weight, sleep disorders, and decreased energy, with a higher proportion of these symptoms appearing in women compared to that in men[2]. Middle-aged women experience the stages of early perimenopause, late perimenopause, and postmenopause, during which female gonads gradually decline, hormone levels change rapidly, and women face pressure from family, work, and other aspects, leading to a high risk of depression[3,4]. Escitalopram is a commonly used medication for depression, with good clinical efficacy and tolerability[5,6]. However, it has disadvantages, such as slow onset of action and dose-dependent QT interval prolongation[7,8]. Studies have shown that escitalopram alone may not achieve the desired treatment goals for depression, and its combination with other treatment options is recommended. Suggestion therapy utilizes verbal, physical, or other means, and can also be combined with other treatment methods to unconsciously influence the patient with positive suggestions[9], so that they accept certain views, beliefs, attitudes, or instructions from a mental health professional without subjective will, thereby relieving psychological stress and burden, and achieving the goal of eliminating disease symptoms or enhancing the effectiveness of a certain treatment method[10-12]. This therapy is noninvasive, safe, and easily accepted by patients.
Presently, clinical treatment methods for depression include drug therapy, physical therapy, psychotherapy, and exercise therapy. While drug therapy is mainly used, the effect of single-drug therapy is not significant in most patients. In addition, research on the treatment of depression among middle-aged women is evident. Thus, in this study, we aimed to determine the effects of suggestion therapy combined with escitalopram in the treatment of depression in middle-aged women and explore its impact on the psychological state and sleep quality of patients. The results obtained from the clinical experiments can provide a scientific basis for the clinical treatment of depression in middle-aged women.
MATERIALS AND METHODS
Clinical data
From October 2021 to October 2023, 102 patients aged 35-50 years were recruited by our hospital and randomly divided into control and experimental groups according to the random number table method, with 51 cases in each group. In the control group, there were 17 males and 34 females, and their age ranged from 35 to 50 years, with an average age of (39.67 ± 3.42) years. The duration of illness ranged from 5 to 16 months, with an average of (9.94 ± 3.03) months. Eight patients studied only till junior high school, 14 patients studied till high school, and 29 patients had obtained university education and above. In the experimental group, there were 15 males and 36 females, with ages ranging from 35 to 50 years and an average age of (41.02 ± 4.22) years. The duration of illness ranged from 5 to 15 months, with an average of (9.96 ± 3.01) months. Seven participants studied till junior high school, 11 participants studied till high school, and 33 participants had obtained university education and above. There were no statistically significant differences in the clinical data between the two groups, indicating comparability. This study was approved by the Medical Ethics Committee of our hospital.
Diagnosis criteria
The patients met the International Classification of Diseases-10 criteria for depressive episodes without psychotic symptoms (F32.2). Typical symptoms included: (1) Depressed mood; (2) Loss of interest or pleasure; and (3) Fatigue or energy loss. Common symptoms were as follows: (1) Reduced ability to concentrate and focus; (2) Decreased self-esteem and confidence; (3) Self-blaming and feelings of worthlessness (even in mild episodes); (4) A pessimistic view of the future; (5) Thoughts or behavior of self-harm or suicide; (6) Sleep disturbances, and (7) Decreased appetite. They did not undergo treatment with antipsychotic medications, antidepressants, mood stabilizers, or electroconvulsive therapy in the past month. The patients also met diagnostic criteria: Depression scale score ≥ 53 and diagnosed by two experienced clinical psychologists (including one expert above the rank of associate chief physician). Middle-aged women aged 35-49 years, with stable vital signs, no severe language or hearing difficulties, no intellectual developmental delay, and a certain expressive ability, signed an informed consent form.
Methods
Control group: The control group received oral treatment with a starting dose of escitalopram 5 mg/day, which was gradually increased to 10-20 mg/day after 1 week, for a total treatment duration of 8 weeks.
Experimental group: The experimental group received implicit therapy on the basis of the control group[9,12]: (1) Observe the mental state of patients, communicate with relatively listless patients through language, use positive guiding topics such as “rosy complexion”, “bright eyes”, “improved mental state compared to before”, etc. During communication, it is necessary to identify the reasons for the patient’s poor mental state and provide corresponding nursing measures to resolve them; (2) Provide drug combination therapy for patients with poor sleep quality, such as using vitamin C, and imply to the patient during medication, “you will fall asleep quickly after taking the medication”, “this type of medication has very good effects and works quickly”, etc.; (3) Hold irregular symposiums using the modeling implication method, invite recovered patients to narrate their treatment process, focusing on cooperating with treatment, relying on strong willpower, maintaining good psychological qualities to ultimately achieve recovery, sharing personal experiences, introducing experiences, and encouraging patients; and (4) In the process of language and modeling implications, positive implication therapies are interspersed, such as behavioral implications, medication efficacy implications, and body implications.
Experimental indicators
The Self-Rating Depression Scale (SDS) was used to assess depression among patients and their family members[13]. The scale contains 20 items (10 positive and 10 negative) and is scored using a 1-44 scoring method. The total score is the sum of all item scores, with mild depression ranging between 53-62 points; moderate depression, 63-72 points; and severe depression, ≥ 73 points. The Self-Rating Anxiety Scale (SAS) was used to assess anxiety in patients and their family members before and after nursing care[14]. The scale consists of 20 questions, including five positive and 15 negative questions, with scores ranging from 1 to 44. The total score is the sum of all item scores, with mild anxiety indicated with 50-59 points; moderate anxiety, 60-69 points; and severe anxiety, ≥ 70 points. The Profile of Mood States-Short Form (POMS) assesses mood states[15], with a total of 30 items rated on a 0-4 scale. The subscales for tension-anxiety, depression-dejection, fatigue-inertia, confusion-bewilderment, and anger-hostility were negative, with each having 20 items, and lower scores indicating a better mood. The vigor-activity subscale is positive, with 20 items, and higher scores indicating a better mood. The Pittsburgh Sleep Quality Index (PSQI) scoring method was used to evaluate the sleep quality of the two groups[16], including the quality of sleep, sleep onset latency, sleep duration, sleep efficiency, sleep disturbances, hypnotic medication, and daytime dysfunction score, totaling 21 points. The score is inversely related to sleep quality, with higher scores indicating poorer sleep quality.
Statistical analysis
Using SPSS 22.0 statistical software for statistical analysis, normally distributed metric data are expressed as mean ± SD. The independent sample t-test was used for between-group comparisons, and paired sample t-test was used for within-group comparisons before and after treatment. P < 0.05 indicated statistical significance.
RESULTS
Changes in anxiety and depression scores before and after treatment in two groups
There were no significant differences in SDS and SAS scores between the two groups of patients before treatment (P > 0.05). Compared to before treatment, the SDS and SAS scores of both groups of patients significantly decreased after treatment (P < 0.05), and the SDS and SAS scores in the treatment group were significantly lower than those in the control group (P < 0.05). This indicates that the implied therapy significantly alleviated the depressive and anxious symptoms of the patients (Table 1).
Table 1 Changes in anxiety and depression scores before and after treatment in patients.
Group
Case
SDS before treatment
SDS after treatment
t-test
P value
SAS before treatment
SAS after treatment
t-test
P value
Control group
51
72.33 ± 4.53
54.73 ± 3.07
24.162
0.000
60.24 ± 5.67
55.25 ± 3.16
6.038
0.000
Study group
51
73.59 ± 5.62
50.63 ± 2.56
26.325
0.000
61.53 ± 6.34
52.82 ± 2.89
8.838
0.000
t-test
1.241
7.316
1.086
4.054
P value
0.218
0.000
0.280
0.000
Changes of mood state before and after treatment in two groups
Compared with before treatment, the control group of patients showed significant decreases in tension-anxiety, depression-dejection, disorient-confusion scores, and a significant increase in vigor-activity scores after treatment (P < 0.05). The experimental group showed significant decreases in tension-anxiety, depression-dejection, fatigue-sluggishness, disorient-confusion anger-hostility scores, and a significant increase in energy-vigor scores after treatment (P < 0.05). There was no significant difference in POMS scores between the two groups before treatment (P > 0.05), and the experimental group showed significant decreases in tension-anxiety, depression-dejection, disorient-confusion scores after treatment compared with the control group (P < 0.05). This indicates that suggestive therapy significantly improved the patients’ mood states (Table 2).
Table 2 Changes in patients’ mood state before and after treatment.
Changes in sleep quality before and after treatment in two groups
Compared with the control group before treatment, the sleep quality, sleep time, sleep efficiency, and PSQI total score of the treatment group patients significantly decreased (P < 0.05). After treatment, the sleep quality, sleep time, sleep efficiency, sleep disorders, and PSQI total score of the experimental group patients significantly decreased (P < 0.05). There was no significant difference in POMS scores between the two groups before treatment (P > 0.05). After treatment, the sleep efficiency, sleep disorders, hypnotic, and PSQI total score of the experimental group significantly increased (P < 0.05). These findings suggest that the suggestive therapy significantly improved the sleep quality of the patients (Table 3).
Table 3 Changes in sleep quality before and after treatment in patients.
Depression is a severe mood disorder. Its clinical features include persistent feelings of sadness and cognitive impairment, which can be accompanied by physical symptoms such as loss of appetite, sexual dysfunction, and sleep disturbances. Depression not only causes mental losses in patients[17], but also imposes a heavy economic burden on them. To reduce the adverse effects of depression on patients and society, it is necessary to look for reliable and effective treatment options[18]. Antidepressant therapy is the basic treatment for depression with various options, including escitalopram, which is commonly used[19]. However, the use of escitalopram alone does not meet the treatment needs of some patients with moderate-to-severe depression[20,21]. Patients are at a risk of relapse after drug discontinuation and may even develop treatment-resistant depression.
Suggestion therapy is one of the methods of psychotherapy[22]. It is a therapeutic method that allows patients to accept the attitudes and opinions of the suggester in a non-confrontational manner and gradually change their own mentality and behavior[23]. This method plays an important role in transforming the patients’ mentality and relieving depression and anxiety. Psychological suggestion therapy helps patients adjust their psychological state, establish a positive and optimistic attitude, promotes early recovery, and effectively adjusts their anxiety and depression through language psychological suggestions, emotional transfer, and other means. In this study, 102 female patients aged 35-49 years treated at our hospital between October 2022 and October 2023 were selected. The group treated with psychological suggestion therapy as an adjunct to escitalopram showed a significant decrease in SDS and SAS scores compared to the group treated with escitalopram alone, indicating that the suggested therapy as an adjunct to escitalopram treatment significantly reduced depressive and anxiety symptoms in patients.
Mood state is an emotional state awakened by external environment influences[24]. A positive mood state is characterized by subjective energy and happiness, which gives individuals a positive and optimistic attitude towards reality, boosts self-confidence, enhances work efficiency, and positively affects both physical and mental health[25,26]. By contrast, a negative mood state manifests as feelings of depression, tension, fear, and suppression, leading to reduced initiative, decreased efficiency, and negative effects on physical and mental health[27]. Mood state is a dynamic process, and cultivating a positive mood state is of great significance for improving the symptoms of depression disorders[25]. This study showed that the experimental group had lower tension-anxiety, depression-dejection, and disorient-confusion scores than the control group, suggesting that suggestion therapy with escitalopram treatment significantly improved the mood state of middle-aged female patients with depression.
Sleep disorders are a common symptom in middle-aged women entering the menopausal stage and are mutually causal and influential with many common physiological and psychological symptoms of menopause, forming a vicious circle[28,29]. Owing to various physiological, psychological, and social influences, middle-aged women tend to have poor sleep quality, long sleep latency, and higher use of hypnotic drugs[30,31]. Our results showed that sleep quality, sleep duration, sleep efficiency, sleep disorders, and the PSQI total score significantly decreased in the experimental group. After treatment, the experimental group’s sleep efficiency, sleep disorders, and PSQI total score significantly increased compared to that of the control group, suggesting that suggestion therapy combined with escitalopram significantly improved the sleep quality of middle-aged women with depression.
CONCLUSION
Suggestion therapy in combination with escitalopram can help middle-aged women with depressive disorders change their mood states, reduce psychological stress, alleviate depressive and anxiety symptoms, and improve sleep quality. It is more effective than escitalopram monotherapy, thereby enhancing their quality of life. In this study, there was no significant difference in age and educational level between the two groups of patients, but further research should be conducted on the influence of individual differences and the social support system of patients on the therapeutic effect. However, this study still has limitations, such as a small sample size and limited case distribution area. Patients were not followed-up for long-term outcomes, and improvements in the above-mentioned limitations are needed for further verification of the accuracy of the results.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Psychiatry
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B, Grade C
Novelty: Grade B, Grade B
Creativity or Innovation: Grade B, Grade C
Scientific Significance: Grade C, Grade C
P-Reviewer: Pino O; Taylor BL S-Editor: Wei YF L-Editor: A P-Editor: Yu HG
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