15-09-23 – The social and psychological bases of depression and suicide Flashcards
Learning outcomes
- Identify the symptoms of major depression
- Discuss the role of risk factors associated with major depression
- Discuss the relationship between depression and chronic illness
- Identify psychological approaches to treatment of depression
- Identify the risk factors associated with suicidal behaviour
- Understand the principles of suicidal risk assessment
What are 3 effects depression has on an individual?
- 3 effects depression has on an individual:
1) Causes great distress and suffering for the individual with depression
2) Disrupted relationships
3) Economic and societal consequences: – Prevents people from working (e.g., job loss, absenteeism)
What is an old term for major depression?
What are subthreshold depressive symptoms?
What are they defined as?
- An old term for major depression is unipolar depression
- Subthreshold depressive symptoms are symptoms which fall below the criteria for major depression
- They are defined as at least one key symptom of depression but with insufficient other symptoms and or functional impairment to meet the criteria
Affective disorders of depression.
What is Dysthymia?
What is another name for bipolar disorder?
What is it characterized by?
- Affective disorders of depression
- Dysthymia: symptoms that are subthreshold for depression but lasts at least 2 years
- Bipolar disorder is also called manic-depressive illness
- It is characterised by severe highs (mania) and lows (depression)
What are 3 signs of major depression?
- 3 signs of major depression:
1) Loss of interest and enjoyment in ordinary things and experiences
2) Low/depressed mood
3) Emotional, cognitive, physical, and behavioural symptoms
Describe NICE guidelines CG90 Appendix: Assessing depression and its severity (p 50)
- NICE guidelines CG90 Appendix: Assessing depression and its severity (p 50)
- As set out in the introduction to this guideline, the assessment of depression is based on the criteria in DSM-IV.
- Assessment should include the number and severity of symptoms, duration of the current episode, and course of illness
Describe NICE guidelines CG90 Appendix: Assessing depression and its severity
- NICE guidelines CG90 Appendix: Assessing depression and its severity
- Principles for assessment: biopsychosocial
- ‘When assessing a person who may have depression, conduct a comprehensive assessment that does not rely simply on a symptom count.
- Take into account both the degree of functional impairment and/or disability associated with the possible depression and the duration of the episode.’
NICE guidelines CG90 Appendix: Assessing depression and its severity.
What are 3 key symptoms of depression?
What are 7 associated symptoms we should ask about if any key symptoms are present?
What should we ask about after this?
- NICE guidelines CG90 Appendix: Assessing depression and its severity
- 3 key symptoms of depression:
1) Persistent sadness or low mood; and/or
2) Marked loss of interests or pleasure.
3) At least one of these, most days, most of the time for at least 2 weeks. - 7 associated symptoms we should ask about if any key symptoms are present:
1) Disturbed sleep (decreased or increased compared to usual)
2) Decreased or increased appetite and/or weight
3) Fatigue or loss of energy
4) Agitation or slowing of movements
5) Poor concentration or indecisiveness
6) Feelings of worthlessness or excessive or inappropriate guilt
7) Suicidal thoughts or acts - Then ask about duration and associated disability, past and family history of mood disorders, and availability of social support
What are 4emotional symptoms that can be associated with depression?
- 4 Emotional symptoms that can be associated with depression:
1) Anhedonia
* Loss of interest or pleasure in hobbies and activities that were once enjoyed
2) Persistent sadness or low mood, unresponsive to circumstances
3) Irritability
4) Tearfulness
What are 4 cognitive symptoms associated with depression?
- 4 cognitive symptoms associated with depression:
1) Negative view of the self:
* Lowered self-esteem and self-confidence
* Feelings of guilt and worthlessness
* Feelings of hopelessness and helplessness
* Pessimistic and recurrently negative thoughts about oneself, world, and future
* ‘negative cognitive triad’
2) Poor concentration and reduced attention, difficulty making decisions
3) Mental slowing or rumination
4) Suicidal ideation may be present
What are 5 biological/behavioural symptoms associated with depression?
- 5 biological/behavioural symptoms associated with depression:
1) Lowered appetite, weight loss, sometimes weight gain
2) Insomnia, early-morning awakening, feeling worse in the morning
3) Low energy, fatigue
4) Loss of libido
5) Social withdrawal
Describe NICE Guidelines 90: Case identification and recognition
- NICE Guidelines 90: Case identification and recognition:
- “Be alert to possible depression (particularly in people with a problem with associated functional impairment) and questions, specifically:
1) “During the last often been bothered depressed or hopeless?”
2) “During the last month, have you often been bothered by having little interest or pleasure in doing things?”
What is the cause of depression?
What are 5 risk factors of depression?
- Depression has no single cause
- It results from a combination of factors
- 5 risk factors of depression:
1) Genetic and family factors
* (Fava & Kendler, 2000) - “About 3-fold increased risk for major depression in the first-degree relatives (parents, siblings, off- spring) of individuals with major depression versus the general population”
* Not everyone who experience stressful life events experience depression
* Not everyone who has a depression experience depression themselves
* (Fava & Kendler, 2000) It appears that genetic factors influence overall risk of illness BUT also influence the sensitivity of individuals to the depressogenic effects of
environmental adversity
* Gene-by-environment interaction
* Genes on their own do not cause depression
2) Gender
* Major depression seem to be more common in women.
* Many factors may contribute to this:
1) Women may express and report symptoms more than men
2) Hormones
3) Early life stress: e.g., sexual abuse – girls more likely to be sexually abused)
4) Additional stresses such as responsibilities both at home and work, single parenthood, caring for children and aging parents
3) Early life experiences
* (Fava & Kendler, 2000): We know that early life experiences such as:
1) Poor parent-child relationship
2) Marital discord and divorce
3) Neglect
4) Physical and sexual abuse
* Can increase a person’s vulnerability to depression in later life
4) Stressful life events
* (Brown & Harris (1978): Studies showed The rate of depression was almost 3 times higher among women who, before age 11, had lost their mother and who also experienced a severe recent loss
- Brown (2002) mentions that: Subsequent work showed that a child’s experience of
1) Marked parental neglect
2) Physical abuse from a core tie
3) Sexual abuse from anyone irrespective of any parental loss was critical
4) Early loss of mother - Somewhat increased the risk of such neglect and abuse.
- Most depressions are preceded by a recent stressful event:
1) Failure at work, at school,
2) Marital separation;
3) Death of a child;
4) Illness of a family member;
5) Physical illness - Although people with chronic illness generally function well psychologically, there is a significant minority who might be at risk for depression
- Documented for stroke, cancer, heart, HIV patients
- “Depression is approximately two to three times more common in patients with a chronic physical health problem than in health and occurs in about 20% of people with a chronic physical health problem”
- Depression can exacerbate pain and reduce life expectancy
- Depression also acts as a big risk factor for the development of physical illnesses, such as CVS disease, with the functional impairment expected to be greater in someone that has depression than someone without
5) Social support
* Availability of good- quality support from friends and family offers protection to the individual in dealing with stressors which may otherwise precipitate a depressive episode
* Lack of intimate or confiding relationship can increase the risk of depression.
Why can Assessment of depression in chronically ill patients can be problematic?
- Assessment of depression in chronically ill patients can be problematic:
1) As many signs of depression, such as fatigue, insomnia, or weight loss may also be an expression of the disease itself
2) Drug treatments can also cause depression as a side effect, especially hypertensives, corticostreoids, and chemotherapy agents
How are Depression and Coronary Heart Disease (CHD) linked?
- Major depression is associated with 2- to 4- fold increased risk for cardiac mortality among patients hospitalised for MI. (cf, Penninx et al, 2001)
- Depressed people without cardiac disease also have a significantly increased risk of cardiac mortality (Penninx et al, 2001) Penninx, BW, et al.
- Depressed CHD patients are less likely to adhere to:
1) Cardiac medication regimens;
2) Lifestyle risk factor interventions;
3) Cardiac rehabilitation programmes - E.g., in the 1st few weeks after coronary angiography, older depressed patients adhered to a prophylactic aspirin regimen less than non-depressed patients (Carney et al., 1995)
- Depression may promote maladaptive health practices such as smoking
- Depression may contribute CHD by triggering dysregulation of neurohormonal systems responsible for cortisol and catecholamine secretion (See Carney et al., 2002- required reading)
Describe the relationship between depression and cardiovascular disorders by Elderon & Whooley (2013) (in picture)
What is Cognitive Behavioural therapy (CBT)?
What does this treatment emphasise and identify?
How is CBT delivered? Describe the CBT flow chart (in picture)
- Cognitive Behavioural therapy (CBT) is a short-term psychological treatment
- This treatment emphasises the role of thinking in how we feel and what we do
- CBT involves identifying and challenging unhealth modes of thinking that cause depressed feelings and behaviour
- CBT can be delivered one-to-one or in group settings
- CBT flow chart (in picture) 0 thoughts (cognitions, emotion (affect), and behaviour all affect each other
O’Connor and Nock: The Psychology of suicidal behaviour (2014) p.77 (in picture)
Conversation starters for talking about suicide (in picture)
