8 The social and psychological bases of depression and suicide Flashcards
How many people suffer form dperession globally?
300 million
Examples of affective disorders
- Major depression
- unipolar depression - Dysthymia
- persisten subthreshold depressive symtpoms that have lasted for at least 2 years - Bipolar disorder
- aka manic-depressive illness
- characterised by severe highs (mania) and lows (depression)
Major depression referes to a wide range of issues characterised by?
- Loss of interest and enjoymeny in ordinary things and expereicnes and low energy
- Emotional, cognitive, physical, and behavioural symtpoms
- Low/ depressed mood
What should assessents for depression include?
- number and severity of symptoms
- duration of current episode
- course of illness
Key symptoms of depression? (NICE guidelines CG90)
- Persistent sadness or low mood
- Marked loss of interest or pleasure
-at least one of these, most days, most of the time for at least 2 weeks
If any of the key symptoms of depression are present, ask about associated symptoms. What are they? (NICE guidelines CG90)
- Disturbed sleep (decreased or increased compared to usual)
- Decreased or increased appetite and/ or weight
- Fatigue or loss of energy
- Agitation or slowing of movements
- Poor concentration or indecisiveness
- Feelings of worthlessness or excessive or inappropriate guilt
- Suicidal thoughts or acts
Definition of anhedonia?
loss of interest or pleasure in hobbies and activites that were once enjoyed
Emotional symptoms of depression?
- Anhedonia
- persistent sandess or low mood, unresponsiveness to circumstances
- irritability, tearfulness
Cognitive symptoms of depression?
- 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) - Poor concentration and reduced attention, difficulty making decisions
- Mental slowing or rumination
- Suicidal ideation may be present
BIological/ behavioural symptoms of depression?
- Lowered appetite, wieght loss/gain
- Insomia, early-morning awakening, feeling worse in the morning
- Low energy, fatigue
- Loss of libido
- Social withdrawal
RIsk factors for depression?
- Genetic and family factors
- Early life experiences
- Stressful life events
- Social support
- Gender
What is the increased risk for major depression in 1st degree relatives of individuals with major dperession vs. general population?
3-fold increase
Early life experiences as risk factor for depression?
- Poor parent-child relationship
- Marital discord and divorce
- Neglect
- Physical and sexual abuse
- Early childhood loss
Stressful life events as risk factor for depression?
- failure at work, school, loss of a job
- Marital seperation
- Rejection by a loved one
- Death of a child
- Illness of a family member
- Physical illness
Social support as risk factor for depression?
- availabilty of good-quality support from friends and family offer protection to the individual in dealing wih stressors
- lack of intimate or confiding relationship can increase risk of depression
Depression and gender?
-more common in women (2:1)
- women may express and report symptoms more than men
- hormones
- early life stress e.g. sexual abuse
- additional stresses e.g. responsibilities both at home and work, single parenthood, caring for children and aging parents
Depression and chronic illness?
- depression 2-3 times more common in patients with a chronic physical health problem than healty people
- 20% of people with chronic helath problem suffer
How is depression linked to chronic illness?
- adapting unhealthy behaviours (e.g. smoking, bad diet, lack of exercise, poorer sleep, alcohol and substance abuse)
- not adhering to medical regiments
- direct effects on physioogical mechanisms
Treatment options for depression
- Pharmacological treatments
- Physiological treatments
- Physical activity (mild and moderate depression or persistent subthreshold depressive symptoms)
- Electoconvulsive treatment (for severe and complex depression)
- Stepped care model
Pharmacological treatment for depression?
Antidepressants
Low-intensity psychosocial interventions?
- individual guided self-help base on the principles of cognitive behavioural therapy (CBT)
- computerised cognitive behavioural therapy (CCBT)
- strucutres group physical activity programme
What is cognitive behavioural therapy (CBT)?
- short-term psychological treatment
- emphasises the role of thinking in how we feel and what we do
- indentifying and challenging unhealthy modes of thinking that cause depressed feelings and behaviour
Psycholoigcal interventions for relapse prevention?
- Individual CBT
- for people who have relasped despite antidepressant medication
- for people with a significatn history of depression and residual symptoms despite treatment - Mindfullness-based cognitive therapy
- for people who are currently well but have experiences 3 or more previous episodes of depression
Suicidal behaviour?
- 804,000 deaths in 2012
- High income countries: 3 times as many men die
- Low/middle income countries: 1.5 men to women
- Highest rates in 70 or older
- 2nd leading cause of death in 15-29 year olds
Health system and suicide?
- health care access, access to means to suicide, media reporting
- stigma against seeking healp for suicidal beh/ mental health issues/ substance abuse
Community/ relationships and suicde?
- war/ disaster
- discrimination; isolation; abuse/ violence
Indiviudal factors and suicide?
- previous suicide attempts
- etnal disorders
- harmful use of alcohol
- financial loss
- chronic pain
- family hx of suicide
What to do when a patient is assessed to be a suicidal risk?
- Additional support - more frequent direct contacts with primary care staff or telephone contacts
- Inquire about social support and awareness of sources of help
- Referral to specialists
