Social and Psychological Bases of Depression and suicide Flashcards
What are the 2 key factors of depression?
- Persistent sadness or low mood
- Marked loss of interests or pleasure
More than just feeling sad/down
What is dysthymia?
Subthreshold depression over the course of 2 years
What is bipolar disorder (manic-depressive illness) characterised by?
Severe highs (mania) and lows (depression)
What is the term given to the way depression should be assessed?
Biopsychosocial
- Not just symptom count, take into ccount degree of functional impairment and/or disability associated with the depressionand duration of episode
What are the 2 KEY symptoms associated with depression?
- Persistent sadness or low mood and/or
- Marked loss of intrests or pleasure
- At least one of these, most days, most of the time for at least 2 weeks
What are the associated symptoms one should ask the patient about if they present one of the key symptoms?
- Disturbed sleep (decreased or increasded compared to usual)
- Decreased or increased apetite and/or weight
- Fatigue or loss of energy
- Agitation or slowing of movements
- Poor concentration or indecisiveness
- Feelings of worthlessness or excessive inapropriate guilt
- Suicidal thoughts or acts
What is anhedonia?
Loss of intrest or pleasure in hobbies and activities that were once enjoyed
What are some cognitive symptoms related to depression?
- Negative view of self (inferior, incompetant, hopelessness)
- Poor concentration and reduced attention, difficulty making decisions
- Mental slowing or rumination
- Suicidal ideation may be present
What is the negative cognitive triad?
Negative thoughts about oneself, world and future
Name some biological/behavioral symptoms associated with depression?
- Lowered appetite, weight loss, sometimes weight gain
- Insomnia, early-morning awakening, feeling worse in the morning
- Low energy, fatigue
- Loss of libido
- Social withdrawal
What sort of questions should you ask to bring up the topic of depression (particularly in patients with a history)?
- During the last month, have you been bothered by feeling down, depressed or hopeless
- During the last month, have you often been bothered by having little interest or pleasure in doing things
What are the vulnrability factors which can lead to depression?
- Genetic and family factors
- Early life experiences
- Stressful life events
- Social support
- Gender
What is the increase in chances of depression in a first-degree relative of a depressed person?
3-fold increase
What are the chances of depression in a twin?
Concordance for lifetime major depression in:
- Monozygotic twins = 46%
- Dizygotic twins = 20%
What early-life experiences can increase chances of depression?
- Poor parent-child relationship
- Marital discord and divorce
- Neglect
- Physical and sexual abuse
- Loss of family member
What are most depressions preceded by?
Stressful event (i.e unemployment, divorce, death, illness)
What factor cacn significantly reduce chances of depresion?
- Availability of good-quality support from friends and family
- Intimate or confiding relationship
- Both provide protection from stressors which otherwise may lead to a depressive episode
What may lead to an increased prevelance of depression in women?
- Express and report symptoms more than men
- Hormones
- Early life stress (sexual abuse)
- Home, work stress, single parenthood, caring for children and/or aging parents
What is the increased risk of chronic illness for depression?
- 2-3x more likely
- 20% of people with chronic illness
What can make assessment of depression in chronically ill patients problematic?
- Many signs of depression such as fatigue, insomnia weight loss associated with disease itself
- Drug treatments may cause depression
What is the increase in cardiac mortality among patients who are hospitilised for an MI who have major depression?
2-4x (depression also increases risk of cardiac disease)
What are the factors which lead to an increased risk of cardiac mortality for those who are depressed?
Less likely to adhere to:
- Medication
- Lifestyle risk factor interventions
- Cardiac rehabilitation programmes
How can depression lead to increased risk of CV disorders?
- Beahvioural factors e.g physical inactivity, med non-adherence, smoking
- Dysregulation of neurohormonal systems responsible for cortisol and catecholamine secretion
What are effective non-interventional treatment which can be used to treat mild or moderate depression?
- Physical activity
- Individual guided self-help based on the principles of cognitive behavioral therapy
- Computerised cognitive behavioural therapy
What does cognitive behavioural therapy involve?
- Short-term psychological treatment
- Emphasises the role of thinking in how we feel and what we do
- Identifying and challenging unhealthy modes of thinking that cause depressed feelings and behaviour
- Can be delivered one-to-one or in group settings
What are the psychological interventions for relapse prevention?
- Individual CBT (for those who have relapsed despite medication/treatment or a significant history and residual symptoms despite treatment)
- Mindfulness-based cognitive therapy (currently well but have experienced 3 or more previous episodes of depression)
In what age group are suicides most common?
70 or older
What is the gender gap in suicides?
- High income countries: Men 3x higher
- Low income countries: Women 1.5x higher
What is the second leading cause of death among 15-29 year olds globally?
Suicide
WHat are the main kinds of factors which lead to suicide?
- Health system (access, stigma for mental health)
- Community/relationships (war/disaster, discrimination)
- Individual factors (FH, abuse, unemployment, mental disorders, chronic pain)
What are some myths about suicide?
- People who talk about it do not do it
- Talking openly about the topic puts the idea in the head
What is needed 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
- Inquire about social support and awareness of sources of help
- Referral to specialists
- ASK directly
