Social and Psychological Bases of Depression and Suicide Flashcards
How many people worldwide suffer from depression ?
300 Million
Identify some main consequences of depression.
1) PERSONAL
- Great distress and suffering
2) SOCIAL
- Disrupted relationships
3) ECONOMIC
- Prevents people from working (e.g. job loss, absenteeism)
Define unipolar depression.
“a type that is not accompanied by episodes of mania or hypomania, such as major depressive disorder or dysthymic disorder. The term is sometimes used more specifically as a synonym of major depressive disorder”
Define subthreshold depressive symptoms.
Symptoms which fall below the criteria for major depression, and are defined as at least one key symptom of depression but with insufficient other symptoms and/or functional impairment to meet the criteria for full diagnosis.
AKA
Dysthymia, depressive symptoms that are subthreshold for depression but lasts at least 2 years.
Define bipolar disorder.
Manic-depressive illness. Characterised by severe highs (mania) and lows (depression).
Identify examples of affective disorders.
Major depression
Subthreshold depressive symptoms (AKA Dysthymia)
Bipolar Disorder
Identify the main features of major depression.
Loss of interest and enjoyment in ordinary things and experiences and low energy
Emotional, cognitive, physical, and behavioural symptoms
Low/Depressed mood
Identify a tool for the assessment of depression.
Assessment of depression is based on the criteria in DSM-IV. Assessment should include the number and severity of symptoms, duration of the current episode, and course of illness (also take into account degree of functional impairment and/or disability associated with the possible depression, and also ask about past and family history of mood disorders, and availability of social support)
• Principles for assessment: biopsychosocial
Identify key symptoms of depression.
Key symptoms:
• persistent sadness or low mood, unresponsive to circumstances (emotional)
• marked loss of interests or pleasure (in hobbies and activities that were once enjoyed) AKA ANHEDONIA (emotional)
➡At least one of these, most days, most of the time for at least 2 weeks.
If any of above present, ask about associated symptoms:
EMOTIONAL
• Irritability, tearfulness
BIOLOGICAL/BEHAVIORAL
• disturbed sleep (decreased or increased compared to usual)
• decreased or increased appetite and/or weight
• fatigue or loss of energy, or agitation
• Social withdrawal
• Loss of libido
COGNITIVE
• Negative view of the self, including:
-lowered self-esteem and self-confidence
-feelings of worthlessness or excessive or inappropriate guilt
-feelings of hopelessness and helplessness
-pessimistic and recurrently negatives thoughts about oneself, world, and future (negative cognitive triad)
• Mental slowing or rumination
• poor concentration or indecisiveness
• suicidal thoughts or acts
Identify the categories of people with a higher risk of depression.
People with a past history of depression or a chronic physical health problem with associated functional impairment
Identify questions to ask people who may have depression.
1) During the last month, have you often been bothered by feeling down, depressed or hopeless?
2) During the last month, have you often been bothered by having little interest or pleasure in doing things?
Identify risk factors for depression.
1) Genetic and family factors
- Family history of major depression (suggested by twin studies)
- Genetic factors influence overall risk of illness BUT also influence the sensitivity of individuals to the depressogenic effects of environmental adversity (gene-environment interaction, genes on their own do NOT cause depression)
2) Early life experiences
-Poor parent-child relationship
-Marital discord and divorce
-Neglect (especially parental)
-Physical abuse (esp. from a core tie) and sexual abuse (irrespective of any parental loss)
-Early childhood loss (early loss of motion somewhat increased risk of neglect and abuse)
(-Feelings of humiliation and entrapment)
3) Stressful life events (most depressions are preceded by a recent stressful event. Such events can influence the onset and course of depression):
– Failure at work, at school, loss of a job;
– Marital separation;
– Rejection by a loved one;
– Death of a child;
– Illness of a family member;
– Physical illness
4) Social Support
- availability of good-quality support from friends and family offers protection to the individual in dealing with stressors which may otherwise precipitate a depressive episode
- lack of intimate or confiding relationship can increase the risk of depression.
5) Gender
-Seems to be more common in woman (2:1 ratio), due to many factors:
∙ Women may express and report symptoms more than men
∙ Hormones
∙ Early life stress: e.g., sexual abuse (girls are more likely to be sexually abused)
∙ Additional stresses such as responsibilities both at home and work, single parenthood, caring for children and aging parents
Explain the relationship between depression and chronic illness.
• CHRONIC PHYSICAL CAN CAUSE, and EXACERBATE DEPRESSION
Although people with chronic illness generally function well psychologically, there is a significant minority who might be at risk for depression, especially through the pain, functional impairment and disability associated with chronic physical illness.
Examples: Documented for stroke, cancer, heart, HIV patients
Stats: (2-3x more common in chronic physical health patients. About 20% of chronic physical health patients have depression)
• DEPRESSION CAN EXACERBATE PAIN AND DISTRESS OF CHRONIC PHYSICAL ILLNESS AND ADVERSELY AFFECT OUTCOMES (AND INCREASE FUNCTIONAL IMPAIRMENT)
Including shortening life expectancy
• DEPRESSION CAN BE A RISK FACTOR IN DEVELOPMENT/WORSENING OF PHYSICAL ILLNESSES
Through:
– Adapting unhealthy behaviours (e.g., smoking, bad diet, lack exercise, poorer sleep, alcohol and substance abuse)
– Not adhering to medical regimens
– Direct effects on physiological mechanisms
Example: CV disease
Why can assessment of depression in chronically ill patients can be problematic ?
-Many signs of depression, such as fatigue, insomnia, or weight loss may also be an expression of the disease itself
– Drug treatments can also cause depression as a side effect, especially hypertensives, corticostreoids, and chemotherapy agents
Explain the relationship between depression and coronary heart disease (CHD).
DEPRESSION ➡ CHD
• Depression may contribute CHD by triggering dysregulation of neurohormonal systems responsible for cortisol and catecholamine secretion, and by resulting in inflammation and heart rate variability
- Major depression is associated with 2- to 4- fold increased risk for cardiac mortality among patients hospitalised for MI
- Depressed people without cardiac disease also have a significantly increased risk of cardiac mortality
• Depressed CHD patients are less likely to adhere to: – cardiac medication regimens
– Lifestyle risk factor interventions
– Cardiac rehabilitation programmes
• Depression may promote maladaptive health practices such as smoking
CHD ➡ Depression
• CHD may in turn cause/exacerbate depression through its manifestations (symptom burden, emotional distress, functional limitation)
Describe treatment of depression.
1) Pharmacological treatments
2) Psychological treatments
- CBT (short term psychological treatment, emphasizes the role of thinking in how we feel and what we do, encourages identifying and challenging unhealthy modes of thinking that cause depressed feelings and behaviour)
- Mindfulness-based cognitive therapy (for people who are currently well but have experienced three or more previous episodes of depression)
3) Physical activity (mild and moderate depression or persistent subthreshold depressive symptoms)
4) Electroconvulsive treatment (for severe and complex depression)
Identify the main NICE guideline for depression.
NICE CG90
Describe typical treatment for people with persistent subthreshold depressive symptoms or mild to moderate depression.
For people with persistent subthreshold depressive symptoms or mild to moderate depression, consider offering one or more of the following interventions, guided by the person’s preference:
– individual guided self-help based on the principles of cognitive behavioural therapy (CBT)
– computerised cognitive behavioural therapy (CCBT)
– a structured group physical activity programme
Describe typical prevention for people with depression who are considered to be at significant risk of relapse or who have residual symptoms.
People with depression who are considered to be at significant risk of relapse or who have residual symptoms, should be offered one of the following psychological interventions:
• individual CBT:
– for people who have relapsed despite antidepressant medication
– for people with a significant history of depression and residual symptoms
despite treatment
• Mindfulness-based Cognitive Therapy:
– for people who are currently well but have experienced three or more previous episodes of depression
What is the ratio of men to women who commit suicide ?
In high income countries, 3 times as many men die of suicide than women do, but in low- and middle-income countries, the ratio is at 1.5 men to each woman.
What age group is most at risk of suicide ?
Suicide rates are highest among aged 70 or older (men and women and worldwide)
How does suicide rank as a cause of death among 15-29 year olds ?
Second
Highest age range for suicide rate for men in the UK ?
45 to 49 years old
Identify the main risk factors for suicide.
1) Health System
• Health care access, access to means to suicide, media reporting
• Stigma against seeking help for suicidal beh/mental health issues/substance abuse
2) Community/Relationships
• War/disaster;
• discrimination; isolation; abuse/violence
3) Individual Factors • Previous suicide attempts • Mental disorders • Harmful use of alcohol • Financial loss • Chronic pain • Family hx of suicide
Identify examples of phrases to avoid in the context of suicide.
Commit suicide Cry for Help Successful or unsuccessful suicide attempt Suicide victim Suicide-prone Suicide-tourist
Identify examples of phrases to use in the context of suicide.
Take one's own life Person at risk of suicide Die by suicide Suicide attempt Completed suicide
Identify examples of myths about suicide.
- It is not true that people who talk of suicide do not do it.
- It is not true that talking openly about the topic of suicide puts ‘the idea in their head’
Describe NICE guidelines for addressing a person with risk of suicide.
Always ask people with depression directly about suicidal ideation and intent. If there is a risk of self- harm or suicide:
• assess whether the person has adequate social support and is aware of sources of help
• arrange help appropriate to the level of risk
• advise the person to seek further help if the situation deteriorates.
(also, address motivation for suicide and develop alternatives to suicide)
Identify conversation starters for people with risk of suicide.
How are ? (if answer fine, then how are you really ?)
You don’t seem yourself
I’ve had a terrible week, how was yours ?
Is everything okay at home/work/uni ?
Identify the steps to take if a patient is assessed to be at a suicidal risk.
– Additional support such as more frequent direct contacts with primary care staff or telephone contacts are particularly useful (e.g., setting up appointments)
– Inquire about social support and awareness of sources of help
– Referral to specialists
