Depression

Question 1

Learning objectives:

Answer 1

1. Describe the features of depression
2. Identify the social impact of depression
3. Summarise the epidemiology of depression
4. Outline key psychological theories of depression
5. Discuss and apply these theories in the context of an overall diathesis-stress model

Question 2

1. Describe the features of depression

Has emotional, motivational, behavioural, physical and cognitive symptoms.

Emotional symptoms

Answer 2

Emotional symptoms;

• restricted to negative ones
• sadness, misery, dejection, feeling discouraged
• often cry
• difficulty experiencing positive emotions
• loss of sense of humour
• find it hard to display positive facial expressions
• Anxiety is commonly experienced alongside depression.

Question 3

1. Describe the features of depression

Has emotional, motivational, behavioural, physical and cognitive symptoms.

Motivational symptoms

Answer 3

Motivational deficits;

• deficits and loss of interest in normal daily activities or hobbies
• lack of initiative, or spontaneity
• not really caring anymore or getting pleasure from things they previously enjoyed
• social withdrawal
• loss of appetite and sexual desire.

Question 4

1. Describe the features of depression

Has emotional, motivational, behavioural, physical and cognitive symptoms.

Behavioural symptoms

Answer 4

Behavioural symptoms;

• slowed speech and behaviour
• physically inactive
• stay in bed for a long time
• decreased energy and fatigue
• specific postures and movements

Question 5

1. Describe the features of depression

Has emotional, motivational, behavioural, physical and cognitive symptoms.

Physical symptoms

Answer 5

Physical symptoms;

• sleep disturbance, such as insomnia or oversleeping
• headaches
• indigestion and constipation
• dizzy spells
• general pain

Question 6

1. Describe the features of depression

Has emotional, motivational, behavioural, physical and cognitive symptoms.

Cognitive symptoms

Answer 6

Cognitive symptoms;

• negative views of themselves, the world around them, and the future (Beck) – generally pessimistic thinking
• impaired ability to concentrate or make decisions
• feelings of worthlessness, shame and guilt
• dysfunctional beliefs, like people would be better off if they were dead - leads to suicidal thoughts

Question 7

1. Describe the features of depression

Major depressive disorder

Answer 7

• -> Major depression
• characterised by relatively extended periods of clinical depression, with a significant impairment in social and occupational functioning (also called unipolar depression)

DSM 5 diagnostic criteria for major depressive disorder;

• the presence of a single major depressive episode, not attributable to normal/ expection reactions to bereavement etc (without previous manic/ hypomanic episodes and symptoms are not accounted for by other disorders)
• symptoms must cause clinically significant distress, or impairment in social occupational or other forms of functioning

Need five or more depressive symptoms during the same two-week period and must have dysfunctional symptoms e.g. feelings of worthlessness

Question 8

3. Summarise the epidemiology of depression

Why do rates differ between countries?

Answer 8

There are several reasons for international variations in prevalence of depression

• stigmatisation mean that in non-western societies people might be unwilling to report symptoms
• there are higher levels of somatization (expression of psychological distress in physical terms) in non-western countries vs in western countries it tends to be described in more emotional terms
• unlike many other conditions depression cannot be observed or measured directly - there’s always an element of subjectivity in the way symptoms are measured or recorded
• lifetime prevalence rates will always be affected by recall problems and recall failure and prevalence rate decrease with increasing age

Question 9

3. Summarise the epidemiology of depression

Onset and gender difference

Answer 9

> median age of onset of major depression has decreased to 27 years in the US
women are almost twice as vulnerable to periods of major depression than men, however, depression is the single largest cause of death in men under the age of 45 in the UK, suggesting that there are differences in the way depression is conceptualised, coped with or treated in men

Question 10

2. Identify the social impact of depression

Answer 10

Massive impact on the student population

In 2013, depression was the second leading cause of years lived with disability worldwide

Women consistently across countries have lifetime risk of major depression, roughly twice that of men

Suicide

• 1 death every 2 hours in the UK
• In 2014, suicide was the leading cause of death for men under 50 years of age in England and Wales, and for women aged 20–34.
• Depression is the leading cause of death for men in the UK under 45, suggesting that there are differences in the way depression is conceptualised, coped with or treated in men

Question 11

Biological theories of depression… (Brief)

Answer 11

> Genetic factors
- 1st degree relatives of major depression sufferers are 2/3x more likely to develop major depressive symptoms

> Neurochemical factors
Depression/ mood disorders are reliably associated with abnormalities in (namely low of) brain neurotransmitters  serotonin, norepinephrine and dopamine. Drugs that treat depression tend to elevate levels of serotonin and norepinepherine in the brain, dopamine in low levels could also contribute (reward systems)
- interactions between the different neurotransmitters might be more important than just the activity of them, suggesting that depression is associated more with an imbalance in neurotransmitters than a deficit in activity
- evidenced in the fact that low levels of serotonin and high levels of norepinephrine results in mania

Question 12

Biological theories of depression… (Brief)

Answer 12

> Genetic factors
- 1st degree relatives of major depression sufferers are 2/3x more likely to develop major depressive symptoms

> Neurochemical factors
Depression/ mood disorders are reliably associated with abnormalities in (namely low of) brain neurotransmitters  serotonin, norepinephrine and dopamine. Drugs that treat depression tend to elevate levels of serotonin and norepinepherine in the brain, dopamine in low levels could also contribute (reward systems)
- interactions between the different neurotransmitters might be more important than just the activity of them, suggesting that depression is associated more with an imbalance in neurotransmitters than a deficit in activity
- evidenced in the fact that low levels of serotonin and high levels of norepinephrine results in mania

> Brain abnormalities
Studies have identified or dysfunction, or abnormalities in a number of brain areas that appear to be associated with depression –> prefrontal cortex, anterior cingulate cortex, the hippocampus and amygdala.
- It must be remembered that these brain abnormalities might be the result of imbalances of neurotransmitters, rather than the cause of depression

> Neuroendocrine factors
Depression is regularly associated with problems in the regulation of body cortisol levels, which is a stress hormone - hippocampal abnormalities mean that due to a lack of inhibitory control cortisol levels rise - causing enlargement of the adrenal glands, lowering the frequency of serotonin transmitters in the brain – low levels cause deficit symptoms

Question 13

4. Outline key psychological theories of depression

Name the psychological theories of depression

Answer 13

• psychodynamic
• behavioural
• negative cognitions and schemas
• learned helplessness and attribution –> hopelessness
• rumination

Question 14

4. Outline key psychological theories of depression
5. Discuss and apply these theories in the context of an overall diathesis-stress model

Psychodynamic

Answer 14

FREUD
> argues that depression is a response to loss (loved one)
- first stage of response is introjection, regress to the oral stage of development, integrate identities
- direct their feelings onto themselves (anger and guilt) - develop self-hatred which develops into low self-esteem which contribute to feelings of depression and hopelessness

• argues depression has a functional role to play, returning the person to a period in their lives where they were dependent on others - utilise the support that this will offer.

HOWEVER, not everyone who experiences depression has lost a loved one

> Freud proposed an additional concept of symbolic loss in which other kinds of losses (a job) are viewed as equivalent to losing a loved one

• losses cause the individual to regress to the oral stage, and might trigger memories of inadequate parenting or support during childhood
• poor parenting is actually a significant risk factor for depression, and particularly a kind of parenting style known as a effectionless control - characterised by high levels of overprotection combined with a lack of warmth and care.

Criticisms of psychodynamic theory;

(1) evidence consistent with this view also backs up many other theories of depression - doesn’t help to differentiate which one is true
(2) many individuals who experience and poor parenting don’t go on to experience depression.
(3) key aspects of the theory are difficult to test, difficulty is compounded by the Freudian belief that mental processes, often are thought to operate on an unconscious level

In the context of stress diathesis…
- poor parenting predisposes them to depression when a stressful event (a loss) occurs, this triggers them to regress to the oral stage and utilise support, depression is functional in dealing with the loss

Question 15

4. Outline key psychological theories of depression
5. Discuss and apply these theories in the context of an overall diathesis-stress model

Behavioural

Answer 15

Behaviourists say depression results from a lack of
reinforcement for positive behaviours
- extinction of positive behaviours and to a “behavioural vacuum”, in which the person becomes inactive, and withdrawn.

> Behavioural theory makes sense in the context of loss - person has lost an important source of reward and reinforcement for positive social and occupational behaviours.

Introducing rewards into the lives of a depressive helps to alleviate their mood

Interpersonal theories of depression

• losses likely result in a reduction of reinforcement from the individual lost or job etc
• leads to a vicious cycle that can establish depression as a chronic condition as…
• often people with depression can be very outwardly negative, lacking in initiative, demanding of support or socially withdrawn
• elicit negative reactions from others
• unlikely to lead to the development of alternative sources of reinforcement

Criticisms of behavioural theories;

• research on reinforcement and depression is retrospective in nature, due to the negative cognitions in depression they might underestimate the extent of actual rewards in their life
• reductionist, ignores nature and biological causes
• environmentally deterministic
• we need to understand whether excessive reassurance seeking and seeking negative feedback are dispositional factors that create a risk for depression or whether depressive symptoms themselves create these characteristics

In the context of the stress diathesis model…
low self esteem and reassurance seeking are vital here, they need reinforcement from the object or person lost, when this ceases they are at risk of developing depressive symptoms

Question 16

4. Outline key psychological theories of depression
5. Discuss and apply these theories in the context of an overall diathesis-stress model

Negative cognitions and schemas

Answer 16

Beck (1960/80s) - cognitive theory

• depression may be caused by biases and thinking and processing information
• claims that depressives have developed a broad negative schema which predisposes them to a negative cognitive triad in which they view themselves, the world and the future in a negative way (stable personality characteristic)
• develops as a result of adverse childhood experiences
• in later life is triggered by a stressful experience that reactivates the schema and gives rise to bias thinking

The triad generates selves for self-fulfilling prophecies

Evidence to support negative cognitions and schemas –

• in an emotional stroop procedure, depressed individuals are slower at naming the colour of negative words and positive words, suggesting that their attention is drawn towards the meaning of negative words
• depressed individuals exhibit memory biases in which they are able to recall more negative words than positive words in memory tests and remember more negative than positive information and autobiographical memories about themselves
• they have interpretational bias that would lead them to interpreting ambiguous events. More negatively to judge events more negatively

In the context of a stress diathesis model…
Beck says the triad develops as a result of adverse childhood experiences that may predispose the individual to biases in thinking and processing and the negative triad, when stressful life experiences arise the schemas is activated and depressive symptoms can occur

Question 17

4. Outline key psychological theories of depression
5. Discuss and apply these theories in the context of an overall diathesis-stress model

Learned helplessness and attribution –> hopelessness

Answer 17

> Learned helplessness and attribution

Seligman (1975) proposed that depression is linked to negative life experiences, and the individual learns to become hopeless and depressed.

• perceived lack of control over these events leads them to become pessimistic and believe that negative life events will happen to them no matter what they do.
• derived this hypothesis from animal learning experiments (dogs and electric shocks, those who couldn’t avoid before didn’t learn to avoid after)

Learned helplessness can be applied to battered women’s syndrome
Walker (2000) suggested a pattern of repeated partner abuse led battered women to believe that they are powerless and changing their situation

Criticisms of learned helplessness theories;

• many people with depression, see themselves as responsible for their failures and losses, somebody who believes they are helpless shouldn’t blame themselves for these events.
• in battered women passivity might not be the result of learned helplessness but it might be an adaptive response to abuse.

Development of attribution theories, arguing that people learn to become helpless, because they possess certain attributional styles that generate pessimistic thinking,

> Hopelessness theory
The helplessness account of depression has been further refined to account for the fact that attributional style appears to interact with a number of other factors to cause depression
- people become depressed when they attribute negative life events to factors that they cannot control, they attribute them to stable, global and internal factors

Hopelessness theory is very similar to attributional and learned helplessness accounts, BUT it also predicts the other factors like low self-esteem might be involved as vulnerability factors in depression. So, they might have a negative attributional style, then experience negative life effects events. This is coupled with low self-esteem to produces depression.

Criticism;
- there is some evidence that the negative attributional style disappears during remission or recovery, suggesting it’s not a stable dispositional personality factor but rather a feature of depression  hard to say what comes first, and the negative attributional style, or the symptoms of depression… causal factor or resultant of disorder?

In the context of the stress diathesis model…
negative life experiences trigger depression as the person is predisposed via learned helplessness to believe they have no control over what happens to them, with hopelessness this is coupled with attributional styles that exacerbate depression symptoms

Question 18

4. Outline key psychological theories of depression
5. Discuss and apply these theories in the context of an overall diathesis-stress model

Rumination

Answer 18

Depressed individuals tend to ruminate (tendency to repetitively dwell on the experience of depression or its causes, in either a repetitive, or brooding fashion), which increases the risk of depression, and the probability of relapse following recovery.

Rumination appears to be driven by meta-cognitive beliefs that rumination is a necessary process to help resolve the condition (much like rumination drives worrying in GAD), it is seen as functional.

In the context of the stress diathesis model…
Rumination occurs when the individual is already depressed, but meta-cognitive beliefs about the function of rumination serve to reinforce the behaviour, which in combination with stressful life events increases chances of relapse and worsens pre-existing symptoms