Lecture 10: Depression Flashcards
Depression prevalence and impact
- Depression 12-month prevalence is about 6% of population
- Mood disorders (including depression) have a lifetime prevalence rate of 20% in NZ
- Rates higher than women
- Greater prevalence in industrialised countries than in developing countries
- Can occur at any age - but median is 30
Impacts of depression
- Depression is leading cause of disability worldwide and is a major contributor to overall global burden of disease
- > 300 million people of all ages suffer from depression
Major Depressive Disorder
DSM-5 diagnosis:
- Five or more following symptoms have been present during some 2 week period and represent a change from previous functioning:
= Depressed mood*
= Diminished interest or pleasure in all or almost all activities*
= Significant weight loss or reduction in appetite
= Insomenia or hypersomnia
= Psychomotor agitation or retardation
= Fatigue or loss of energy
= Feelings of worthlessness or guilt (feeling of regreat)
= Diminished ability to think, concentrate, indecisiveness
= Recurrent thoughts of death, suicidal ideation
* Must have one of other of these
- Children may have irritable rather than depressed mood
Persistent Depressive Disorder (Dysthymic Disorder)
DSM-5 diagnosis:
- Depressed mood for most of day or for more days than not for at least 2 years (or 1 year for children)
- Plus 2 (or more ) of following symptoms:
= poor appetite or overeating
= Insomnia or hypersomnia
= Low energy or fatigue
= Low self-esteem
= Poor concentration/difficulties making decisions
= Feelings of hopelessness
Why are rates increasing?
- There is less stigma associated with acknowledging depression
- Modern life is more stressful
- We have reinterpreted ordinary sadness as depression
Biological explanations/aetiology
- Genetic: family history 2-3 times more likely to experience depression
- Neuro-chemical explanations suggest lack of monoamines responsible for depression
= but simple serotonin hypothesis has been largely debated - Is depression a response to chemical imbalance or life events?
- Serotonin transporter gene not linked to depression
- Stressful life events alone predict likelihood of depression
Biological Intervention
- Anti-depressants prescribed to 1 in 9 in NZ adults (1 in 7 women)
- Tri-cyclic anti-depressants and more recent ‘Prozac’ - Selective Serotonin Reuptake Inhibitors and now ‘dual action’ anti-depressants Serotonin and Norepinephrine reuptake inhibitors
- Some claim are no more effective than placebos - except for severe depression = other disagree
Study of 1829 NZ antidepressant users: (Read et al., 2014)
- 62% reported sexual difficulties
- 60% reported feeling ‘numb’
- 52% feeling ‘not like myself’
- 39% feelings of suicidality
- 42% reported reduction in positive feelings
- 55% reported withdrawal effects
Positive experiences (54%)
Negative (16%)
Mixed (28%)
Psychodynamic explanations
- Early experience of loss, rejection by caregiver
- Ambivalent feelings towards caregiver
- Negative feelings conflict with need for care and love
- Anger turned inward (defence mechanism of introjection)
- Leads to self hatred
Psychodynamic intervention
- Explore early experiences
- Help client to identify habitual defences
- Develop insight
- Has a broader focus than just symptoms of depression - looks at quality of relationships etc.
Humanistic (client-centred) explanations
- Limited experience of UPR
- Lacked the env. needed to develop awareness of organismic (real) self
- Discrepancy between real and ideal self
Humanistic interventions
- Provide a facilitating env. with empathy, UPR, genuineness
- Allows client to explore their own feelings without judgement
- Provides opportunity for them to discover who they are and what they need
- Tends not to be focused specifically on depression but rather dev. of an authentic, self actualised client
Behavioural explanations
- Seligman: Learned helplessness - repeated experience of lack of control over aversive stimulus produces helpless response
- Treatments aimed at shifting inactive behavioural patterns combined with CBT
Behavioural interventions
- Pleasant Activity scheduling
- Mood activity schedule to identify depression lifting activities (score depression on 0-100%)
Cognitive explanations
- Beck negative cognitive triad = negative beliefs about self, others, world
Cognitive interpretations
Challenging negative beliefs
- Use thought records to challenge negative beliefs
- Keep a record of depressed thoughts and associated events
- Monitor associated feelings and behaviours
- Challenge depressed thoughts through socratic questioning or experiment
- Replace with rational/helpful thoughts
Family therapy explanations
- Individual psychological problems seen as a function of family difficulties
- Focus on problems in family structure, roles, communication etc.
Family therapy interventions
- Family therapy for family with child suffering from depression
- Couple therapy for relationship problems resulting in depression for one or
both partners - Mother-infant therapy to improve attachment
ACT explanations
- Depression involves fusing with thoughts about the past and worries about the future and ruminating on these
ACT interventions
- Notice thoughts.
- Use mindfulness to defuse
from thoughts and bring self back to
present. - Increase self compassion and acceptance
Maori model explanations
- Effects of colonisation, historical trauma
- Loss of connection to culture, iwi and whenua (land)
Maori model interventions
- Reconnection with culture.
- Adaptations of other models to be suitable for Maori
Suicide statistics
- New Zealand has the highest rate of male youth suicide and third highest rate of female youth suicide amongst 27 high income
countries (Patton, 2012) - Suicide is one of the leading causes of death for young people under the age of 25 in NZ
- Gender paradox: Women are more likely to attempt suicide than men, men are more likely to complete
- Study of reasons New Zealand youth give for suicide inescapable difficulties, constant pressure, emotional distress, a cry for help
Suicide risk assessment
- An important consideration in the treatment of depressive disorders
- Some issues to consider in a suicide risk assessment:
= Mental health problem (especially mood disorders)
= Active or passive intention
= Chosen method
= Access to method
= Previous history
= Alcohol or drug use
What to do if you think someone is
suicidal
- Take them seriously
- Listen to them without judging
- Do not leave them alone
- Do not agree to secrecy
- Speak with a responsible adult/professional
- Call 111 if you think there is immediate risk
- Phone or take them to your local hospital
- Youthline
- Lifeline
