2 - Depression Flashcards
1
Q
What are the different ways to approach depression prevention? Why would we want to do this?
A
- universal v. targeted
- prevention of first episode vs. relapse/recurrence
- early intervention: if all MDD cases in 13yr olds successfully treated, risk of MDD reduced by 10%
2
Q
Explain universal prevention programmes for depression and the problems with these
A
- target school-aged children
- aim: increase resilience, problem-solving etc.
- fewer adult studies
PROBLEMS
- paradox: most cases come from those at low/mod risk and only a minority at high risk (bc. no of high-risk people is small)
- mixed results: cog re-structuring more helpful than problem solving
- high cost + very large samples needed to see results
3
Q
Explain targeted prevention programmes for depression
A
- children with depressed parents
- adolescents with elevated depressive sx
- adults with high-risk status
- possibly more promising than universal programmes(?) BUT also easier to see results in targeted than universal due to higher mean depression scores at outset
- should work toward identifying effective targeted preventions, then transforming them into universal to have the biggest gains for the community
4
Q
Explain the benefits (5) of internet-based approaches and their development
A
BENEFITS
- cost-effective
- accessed any time
- programme fidelity can be maintained
- easy to monitor user progress/outcomes (automated)
- appealing/engaging for young people
- primarily CBT-based (also behavioural activation + IPT)
- designed for school/primary care settings
- few studies to date, but emerging promising evidence
5
Q
Explain the rationale behind recurrence prevention
A
- 50% who have 1 episode have at least 1 more; 80% who have 2 episodes have at least 1 more
- recurrence usually within 5yrs or initial episode
- average: 5-9 episodes
6
Q
Define remission, recurrence, relapse + recovery
A
- partial remission: no longer symptomatic, but more than minimal symptoms
- full remission: asymptomatic
- recovery: full remission, >8wks
- relapse: return of full symptom criteria for an episode during remission but before recovery (<8wks)
- recurrence: new episode after period of recovery
7
Q
What are the risk factors and possible protective factor for depression recurrence? (no, possibly and yes)
A
NO
- female (onset only)
- SES/marital status (onset only)
- 1st episode duration
POSSIBLY
- age of onset of first ep
- no. of episodes
- more severe first episode
- comorbidities (anx, behavioural dx)
YES
- fam hx. psychopathology
- negative cog style (onset too)
- high N (linked w more episodes)
- stressful life events (childhood + adulthood)
- protective factor: social support??
8
Q
Explain the scar theory of depression recurrence and the 4 key features of current scar models
A
ASSUMPTIONS
- no premorbid diff
- after MDD ep > ‘scar’ manifests and those with hx MDD differ from those without
- scar independently predicts future episodes
- PSYCHOSOCIAL SCAR: no evidence
- COG SCAR: low mood <> negative cognitions; some support in children (adults unclear)
- PERSONALITY SCAR: mixed results
- suggests that risk factors for depression recurrence are manifestations of underlying liability to depression in general?
UPDATED SCAR MODELS
- dimensional view of MDD and scar development: scars develop gradually over life-span, proportionally to severity + duration of dep sx experienced (along the full spectrum of low-high depression)
- individ diff in context, environment, history + biology: scars may only appear when certain contexts activate a person’s vulnerability
- diff b/w scars that develop following MDD and those that develop following what caused the MDD to develop (eg. stress): both stress and negative mood states can produce scars that increase vuln to MDD > these processes may also work together
- ‘scar’ may wax/wane depending on circumstances: scars are dynamic; biological evidence (epigenetics + neuronal mechanisms of learning > use it or lose it); emphasises resilience
9
Q
Explain why we need suicide prevention and how to go about it
A
- MDD and suicide independent but related factors
- 60% of suicides associated with mood dx
- suicide in Aus decreasing since 1997
- high: indigenous populations, young adult males, men >75yrs
- should focus on combo of risk + protective factors (individual, social, contextual, modifiable/not, distal/proximal)
- identify at-risk groups (eg. SES) NOT individuals
10
Q
Explain LIFE
A
- Living Is For Everyone
- Aus national suicide prevention
- universal, selective, indicated prevention model
- evaluation is central
ACTION AREAS
- increase knowledge/understanding of suicide prevention
- build resilience + capacity for self-help
- improve community strength, resilience + capacity in suicide prevention
- take coordinated approach to suicide prevention
- provide tailored suicide prevention activities
- implement standards in suicide prevention
11
Q
Explain depression in older adults and the effective treatments available
A
- impacts life expectancy
- not always offered treatment (“understandability” phenomenon)
- more physical problems
- lack mental plasticity (ageism)
- CBT: effective for older adults
12
Q
Explain the modifications to treatments that may be needed for older adults and why modifications are necessary
A
- CBT adaptations > least homogenous group, chronological age not the best marker for making the decision, life review necessary?
- cognitive impairment: repeat/summarise, present in multiple modalities, use folders/notebooks, offer memory training
- sensory impairment: recordings, bold print
- case conceptualisation: cohort beliefs, role investment, intergenerational links, physical health
- key cognitions: loss/transition points, attitudes to aging/ageism, health and anxiety
- client beliefs: too old to change, prejudice against younger therapist, passivity, dependence, stigma
- therapist beliefs: ageist assumptions
