The Social and Psychological Bases of Depression and Suicide Flashcards
What are Subthreshshold Depressive Symptoms?
At least one key symptom of depression but with insufficient other symptoms and/or functional impairment to meet the criteria (of depression)
What is Dysthymia?
Symptoms that are sub threshold for depression but lasts for at least 2 years
What is Bipolar Disorder?
Characterised by severe highs (mania) and lows (depression)
What is the assessment of major depression based on?
The criteria in the DSM.IV. It should include the number and severity of symptoms, duration of the current episode and the course of illness
What NICE guideline covers assessment of depression?
CG90
What are the biophysychosocial principles of assessment of depression?
Don’t assess purely on symptom count, take the degree of functional and/or disability associated with possible depression and the duration of the current episode
What are the key symptoms of depression?
- Persistent sadness or low mood
* Marked loss of interest/pleasure
In relation to the key symptoms, what are the requirements for a diagnosis of depression?
At least one key symptom, most days, most of the time for at least 2 weeks.
What are the associated symptoms of depression?
- Disturbed sleep
- Decreased or increased appetite and/or weight
- Fatigue or loss of energy
- Agitation or slowing of movements
- Poor concentration or indecisiveness
- Feelings of worthlessness or excessive inappropriate guilt
- Suicidal thoughts or acts
Aside from key and associated symptoms of depression, what should you also ask the patient about?
- Duration
- Associated disability
- Past history of mood disorders
- Family history of mood disorders
- Availability of social support
What are the emotional symptoms of depression?
- Anhedonia- loss of interest or pleasure in hobbies and activities that were once enjoyed
- Persistent sadness or low mood, unresponsive to circumstances
- Irritability, tearfulness
What are the cognitive symptoms of depression?
• Negative view of the self
- lowered self esteem and self confidence
- feelings of guilt and worthlessness
- feelings of hopelessness and helplessness
- pessimistic and negative thoughts about oneself, world and the future (negative cognitive triad)
• Poor concentration and reduced attention, difficulty making decisions
• Mental slowing or rumination
• Suicidal ideation may be present
What are the biological/behavioural symptoms of depression?
- Lowered appetite, weight loss, sometimes gain
- Insomnia, early morning awakening, feeling worse in the morning
- Low energy, fatigue
- Loss of libido
- Social withdrawal
What are risk factors of depression?
- Gender
- Genetic and family factors
- Early life experiences
- Stressful life events
- Social support
Describe genetics as a risk factor
- Approx. 3 fold increase risk for major depression in the first degree relative (parents, siblings, offspring) of individuals with major depression versus that of the general population
- Twin studies suggest a genetic component: major lifetime depression concordance is 46% for monozygotic twins compared to 20% for dizygotic twins
How can early life experiences increase risk of depression?
• Certain experiences can increase risk such as:
- Poor parent-child relationship
- Marital discord and divorce
- Neglect
- Physical and sexual abuse
- Early child hood loss
• The rate of depression was almost 3 times higher in women who had lost their mother before the age of 11 and who also experienced a recent loss (early loss of mother could also increase risk of neglect and abuse)
What are most episodes of depression preceded by?
A recent stressful event such as: • Failure at work or school • Marital separation • Rejection by a loved one • Death of a child • Illness of a family member • Physical illness
How can social support influence depression?
Availability of a good social support network offers the individual protection in dealing with stressors which may A lack of intimate or confounding relationships may increase the risk of depression
Gene by environment interaction relating to depression
Genetic factors influence the overall risk of illness and also the sensitivity of of individuals to the depressogenic effects of environmental adversity
Gender and depression
Major depression seems more common in women, this could be because:
• Women may express and report symptoms more often than men
• Hormones
• Early life stressors e.g. more likely to experience sexual abuse
• Additional stresses such as responsibilities both at home and at work, single parenthood, caring for children and ageing parents
Chronic illness and depression
• Depression is 2-3 times more likely in patients with a chronic illness than those with good physical health
• occurs in 20% of people with a chronic illness
• A chronic illness can both cause and exacerbate depression due to
- pain
- functional impairment and disability
• Depression can exacerbate pain and distress associated with chronic illness
Why can assessment of depression in the chronically ill 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, corticosteroids and chemotherapy agents
Depression and coronary heart disease
- Major depression is associated with a 2 to 4 fold increased risk for cardiac mortality among patients hospitalised for MI
- Depressed people without cardiac disease also have significantly increased risk of cardiac mortality
How may depression affect specifically patients with CHD?
• Depressed CHD patients are less likely to adhere to:
- Cardiac medication regimens
- Lifestyle rise factor interventions
- Cardiac rehabilitation programmes
• May promote maladaptive health practices e.g. smoking
• May contribute to CHD by triggering dysregulation of neuro-hormonal symptoms responsible for cortisol and catecholamine secretion
What are the different categories of treatment for depression?
- Pharmacological
- Psychological
- Physical activity (in mild/sub-threshold depression)
- Electroconvulsive treatment (severe/ complex depression)
For people with mild to moderate depression or persistent sub threshold depressive symptoms, what interventions can be considered?
- Individual guided self help based on the person’s principles of cognitive behavioural therapy (CBT)
- Computerised cognitive behavioural therapy (CCBT)
- A structured group physical activity programme
What is cognitive behavioural therapy?
- 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
What interventions should be considered to help prevent relapse?
• Individual CBT:
- for people who have relapsed despite antidepressant medication
- for people with significant history of depression and residual symptoms despite treatment
• Mindfulness- based cognitive therapy
- for people who are currently well but have experienced 3 or more episodes of depression
What are the health system related risk factors for suicide?
- Health care access
- access to means of suicide
- media reporting
- Stigma against seeking help for suicidal behaviours/ mental health issues/ substance abuse
What are the community/relationship related risk factors for suicide?
- War/disaster
* Discrimination; isolation; abuse/violence
What are the individual related risk factors for suicde?
- Previous suicide attempts
- Mental disorders
- Harmful use of alcohol
- Financial loss
- Chronic pain
- Family history of suicide
What should you do if the patient is assessed as a suicide risk?
- Offer additional support e.g. more frequent direct contacts with primary care staff or telephone contacts
- Inquire about social support and awareness of sources of help
- Refer to specialists
If there is a risk of the patient self harming what should you do?
- Assess if the have adequate social support and is aware of the sources of help
- Arrange help appropriate to the level of risk
- Advise the person to seek further help if they deteriorate
