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Population Health 102 > Lecture 15 and 16 > Flashcards

Lecture 15 and 16 Flashcards

1
Q

What is the relative importance of depression in the global burden of disease study (WHO)?

A

Depression was the third most important cause of disease burden worldwide in 2004
-depression was in “eight place in low income countries (more communicable problems), but at first place in middle and high income countries”

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2
Q

What percentage of youth suffer from a depressive disorder before the age of 18?

A

20-25% of young people suffer from depressive disorder before the age of 18
-75-80 of this is untreated

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3
Q

What is depression a major risk factor of?

A

Depression is a major risk factor for youth suicide

-NZ has a second highest youth suicide rate in OECD

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4
Q

What is the NICE guidelines for treating depression?

A

NICE guidelines recommend psychological therapies as first option for mild to moderate depression

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5
Q

What is access to psychological therapies?

A

Access to psychological therapies is limited

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6
Q

What are the risk factors for depression comparatively between genders?

A

Twice as common in women than in men

-prevalence changes through adolescence

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7
Q

What are the psychosocial difficulties risk factors for depression?

A

family discord and disruption, domestic violence and trauma

school difficulties including bullying

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8
Q

What are the 3x main categories for depression?

A
  1. psychsocial difficulties
  2. childhood abuse, especially sexual abuse
  3. school difficulties including bullying
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9
Q

What are the 4x groups which are at special risk of getting depression?

A
  1. Women
  2. Maori young people
  3. Transgender youth
  4. Youth in alternative education
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10
Q

What are the relative rate of depression of youth within NZ?

A

Maori = 16.2%
NZE = 11.7%
(OR 1.3, 95% Cl 1.11-1.52)

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11
Q

What are the relative rate of thoughts of suicide of youth within NZ?

A

Maori = 26%
NZE = 22.6%
(OR 1.18, 95% Cl 1.03-1.36)

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12
Q

What are the relative rate of suicide attempts of youth within NZ?

A

Maori = 11.5%
NZE = 5.7%
(OR 1.75, 95% Cl 1.42-2.15)

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13
Q

What proportion of young people have depression but get no treatment?

A

three quarters

3/4

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14
Q

What are some treatments for depression?

A 
three quarters of young people with depression get NO treatment
there are effective treatments available
1. talking therapies
-cognitive behavioural therapy (CBR)
Interpersonal therapy
2. Medication
-SSRIs and other antidepressants
Clinical guidelines recommend talking therapies as first option for mild to moderate depression
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15
Q

What is recommended as a first option to treat mild to moderate depression?

A

Talking therapies as a first option

-Clinical guidelines recommend talking therapies as first option for mild to moderate depression

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16
Q

What is CBT?

A

Cognitive Behavioural Therapy

an evidence-based psychological therapy for depression and anxiety

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17
Q

What are the 6x key elements to CBT?

A
  1. activity scheduling (doing things improves mood)
  2. Problem solving (active trouble shooting instead of passively experiencing distress
  3. relaxation (you cant be anxious at the same time as you’re relaxed
  4. Cognitive restructuring (changing you ‘unhelpful’ thoughts into helpful or more balanced way of thinking)
  5. Exposure for anxiety (facing your fears and worries gradually while staying calm and relaxed)
  6. Accessing help
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18
Q

What are the 5x main barriers to accessing treatment for depression in NZ?

A
  1. Not enough therapists: a. Worldwide and in NZ. b. developing countries particularly disadvantaged
  2. Therapists cluster in wealthier urban areas
  3. private practice is expensive
  4. training therapists is time consuming and expensive
  5. young people are not enthusiastic about seeing therapists
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19
Q

What are the 4x main types of Behavioural Intervention Technologies?

A
  1. Videoconferencing and phones
  2. Web-based interventions
  3. Mobile technologies
  4. Social media and gaming-using the power of engagement
20
Q

What is SPARX?

A

self-help online tool for young people who feel down, stressed or depressed
-is backed by evidence
laughed april 2014

21
Q

What are the 3x summaries of evidence about SPARX?

A

SPARX is as good as routine care on all measures
RCT
-routine care-on average 4x sessions of face-to-face counselling
SPARX better than usual care for those with more severe depression
Effective across ethnicity, gender and age groups
-power of narrative/story telling-chosen character who needs to overcome stems of gloom and restore the balance

22
Q

What 5x faculties supported SPARX?

A
  1. Developed by Dept of Psychological Medicine (UoA)
  2. Implemented by NIHI (UoA)
  3. Funded by PM’s Youth Mental Health Project and MoH
  4. Training module by Goodfellow Unit (UoA)
  5. Supported by Lifeline and Youthline (0508 4 SPARX)
23
Q

What are the 7 modules of CBT skills?

A
  1. HOPE - change how you think to feel better
  2. RELAXATION
  3. COMMUNICATION, ASSERTIVENESS, NEGOTIATION
  4. ACTIVITY SCHEDULING
  5. STRONG EMOTIONS, ANGER, MINDFULNESS
  6. PROBLEM SOLVING: STEPS. a. Identifying and challenging Gnats b. Identifying and growing SPARKS
24
Q

What are the 3x PhD studies to do with depression?

A
  1. AE youth (Dr Terry Fleming)
  2. Sexual Minority Youth (Dr Mathijs Lucassen)
  3. Maori youth (Dr Matt Shepherd)
25
Q

What is Youth in Alternative Education?

A

Whole classes of young people excluded form mainstream education
-Intervention immediately (n=20) vs. Delayed intervention (5 weeks later)(n=12)
Reduction in depression: SPARX(-14.7 point)
Waitlist (-1.1 points)
-p = 0.001

26
Q

What is the Project for Maori young people in regards to depression?

A
  1. Kaumatua
  2. Bi-cultural team
  3. Maori computer games developer
27
Q

What is the Design for Maori Maori young people in regards to depression?

A
  1. Focus groups Whanau, Tamariki, Kaumatua
  2. Advice from Maori mental health clinicians
  3. Used Maori symbols
  4. Used Maori actor as the Guide (telepresence)
28
Q

What were the elements of the RCT design and Open Trial when testing SPARX with Maori young people?

A

RCT design (Merry et al., 2012)
-attempter to recruit high numbers of Maori
-Included an analysis that showed no difference in effect for Maori (but underpowered)
Open Trial (Shepherd et al., 2014)
-Decrease was maintained at five month followup

29
Q

What were 3x elements of testing SPARX with Transgender young people?

A
  1. Development of RAINBOW SPARX
    - in collaboration with transgender young people (focus groups and expert advisory group)
  2. Open trial of Rainbow SPARX with sexual minority youth and comparisons to RCT
    - showed Rainbow SPARX effective and acceptable
  3. Post Rainbow SPARX interviews with sexual minority youth: well accepted - suggested improvements (increase ‘rainbow’ content further)
30
Q

What are 6x possible directions to treating depression? (where to from here)

A
  1. Monitoring up-take
  2. Move to touch screen technology
  3. Smart phones
  4. Maori version
  5. Release Rainbow SPARX
  6. Develop apps etc for other common mental health problems
  7. virtual interviewer- a sensor and webcam to scan your facial and body movements and tone of voice
31
Q

What is the Medical Model Definition?

A

Focused on the individual
Focused on impairment and loss of function
-Disability = impairment = loss of function
Views the ‘disables’ person as being dependant, and needing to be cured or cared for
Their ‘disables’ person must adapt (or be adapted) to live in society
-puts the focus on ‘fixing’ individuals - medical care and individual adaptation

32
Q

What is the Medical Model Assessment?

A

Focus on measuring impairment

  • classify types of impairment –e.g. hearing, vision, physical, mental health, intellectual, neurological etc.
  • measuring the degree of functional loss or the impact of that functional loss –e.g. severe, moderate, mild
  • usually used to establish fitness for work or reviewing claims for compensation
  • typically tools developed for older people or those living with chronic conditions
33
Q

What are the 5x questions from the OPCS survey in Britain?

A

what is wrong with you?
“What complaint causes your difficulty “
“invalid”

34
Q

What is the Social Model definition?

A

Impairment = loss of function
Focused on society
Focused on the way society disables people with impairments
Disability is caused by society - physical, organisational and attitudinal barrier to living a ‘normal’ life
Society can change to reduce disablement - puts the focus on ‘fixing’ society

35
Q

What is the Social Model assessment?

A

No widely used tool for assessing disability fro a social model perspective
Would need to include measures of: Impairment, physical environment, organisational environment, attitudinal environment etc.
There have been some recent moves towards establishing social model assessment

36
Q

What 4x things does the Social Model Assessment need to include measures of?

A
  1. Impairment
  2. Physical environment
  3. Organisational environment
  4. Attitudinal environment
37
Q

Why do models and definitions matter?

A 
Definitions = treatment
Definitions = identity and empowerment
Definitions = means to identify, classify and measure and these may link directly to entitlement to health resources
38
Q

What are the effects if disability on equality?

A

New Zealand Disability survey (2001)

  • 1/5 New Zealanders has an impairment
  • Survey of ‘disabled’ New Zealanders shows that in comparison to non-disabled kiwis “ disables people have”
    1. Lower levels of educational attainment
    2. Lower incomes
    3. A poorer general health status
    4. Less choice in housing
    5. Higher unemployment rates
    6. Poor access to support services and working arrangements that might allow them to move from a marginalised position in society
39
Q

What is the Material resources part of the Material/Structural explanation for disability and health?

A

Less likely to be employed and therefore income is limited
more reliant on welfare/benefits
less availability of suitable housing
Higher costs of living- greater power bills and transport cost

40
Q

What is the Structural resources part of the Material/Structural explanation for disability and health?

A

Access barrier to services, including health - physical barriers and non-physical barriers
Barrier to accessing information and education etc.

41
Q

What is the Cultural/Behavioural explanation for disability and health?

A

There is evidence to show that disabled people are more likely to have less healthy lifestyles
-smoking, physical activity, diet, substance abuse
But remember they often face situational constraints and experience higher levels of stress

42
Q

What is the Social Selection explanation for disability and health?

A

People with health problems or impairments are more likely to face barrier in life
-Directly- through direct discrimination
Indirectly - through living in a society that is not structures in a way that allows them to lead a ‘normal’ life

43
Q

What is the Historical Events explanation for disability and health?

A

Institutionalisation –> to de-institutionalisation (as institutions were shut down)
Medical model –> to social model
-Rehabilitation –> to participation/emancipation
Human rights, equal opportunities, civil rights movements

44
Q

What is the vicious cycle?

A

Middle: Material/structural, Natural/social selection, Historical events, Cultural/Behavioural
Ring:
Low income/Poverty –> Fewer choices, Poorer Housing and diet –> Increased risk of Ill health –> Disability and increased secondary health issues –> Fewer opportunities for employment and education –>

45
Q

What should be considered when rethinking disability?

A

Impairment-medical model?
Oppression-depressive thinking about why you can’t live a different life?
or maybe Diversity-dont recognise and celebrate the diversity?

46
Q

What are some initiatives developed by sparx?

A

send text reminders when mood scores are getting low
when you have been absent from the website for a period of time send text reminders to go back on
can link to youth health online from sparx
adaptation of CBT

47
Q

How has SPARX been able to reduce inequality?

A

wifi available anytime, anywhere
most people have smart phones-trying to get mobile app
accounting for gender differences - avatars of both boys and girls, and gender differing interactions (social vs shooting)
difficulty of the game play-simple for avid game players(lose interest)

Population Health 102 (14 decks)

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