The Social and Psychological Basis of Depression and Suicide

Question 1

What is subthreshold depressive symptoms?

Answer 1

Symptoms which fall below the criteria for major depression. Defined as at least one key symptom of depression but insufficient amount of other symptoms and/or functional impairment to meet criteria.

Question 2

What is Dysthymia?

Answer 2

subthreshold depressive symptoms which last for at least 2 years

Question 3

What is bipolar disorder?

Answer 3

Characterised by mania and depression

Question 4

What are the two key symptoms of depression?

Answer 4

• Persistent sadness or low mood and/or
• Marked loss of interest and pleasure.
  (one of these most days, most of the time for a minimum 2 weeks)

Question 5

What are the associated symptoms of depression?

Answer 5

• Disturbed sleep,
• Increased/decreased appetite and/or weight.
• Fatigue or loss of energy,
• Agitation or slowing of movements (catatonic)
• Poor concentration or indecisiveness,
• Feelings of worthlessness or guilt,
• Suicidal thoughts or acts

Question 6

What is Anhedonia?

Answer 6

Loss of interests or pleasure in hobbies and activities that were once enjoyed

Question 7

What is the negative cognitive triad?

Answer 7

Pessimistic and recurrently negative thoughts about oneself, the world and future.

Question 8

What are some of the biological/behavioural symptoms of depression?

Answer 8

• Lowered appetite, weightloss/gain,
• Insomnia, Early-morning awakening.
• Low energy,
• Loss of libido,
• Social withdrawal

Question 9

WHat are some possible ways of asking a patient about mood?

Answer 9

• During the last month have you often 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?

Question 10

What are some risk factors for depression?

Answer 10

• Genetic and family factors (3 fold increased risk of major depression if first degree relatives suffer),
• Early life experiences (poor parent-child relationship, marital discord/divorce, neglect, physical or sexual abuse, early childhood loss (esp loss of mother)),
• Stressful life events (failure at work/school, death of child, divorce, physical illness),
• Social support,
• Gender (more common in women - hormones, early life stress, additional responsibilities),
• Chronic Illness

Question 11

What are some links between depression and physical illness

Answer 11

• Depression can be risk factor for CV disease as it can cause dysregulation of systems responsible for cortisol and catecholamine secretion,
• Major depression associated with 2-4 fold increased risk of cardiac mortality in patients hospitalised for MIs.
• Insomnia, weight loss and fatigue can be presentation of depression,
• Drug treatments for other illness can have side effects of depression,
• Depressed patients are less likely to adhere to medical regimens and to make lifestyle changes

Question 12

What are some treatment options for depression?

Answer 12

• Pharmacological,
• Psychological (CBT),
• Physical activity,
• Electroconvulsive treatment

Question 13

What is cognitive behavioural therapy?

Answer 13

It is a short-term psychological treatment which identifies and challenges unhealthy modes of of thinking that cause depressed feelings and behaviours

Question 14

What can be offered for relapse prevention?

Answer 14

• Individual CBT,

- Mindfulness-based cognitive therapy

Question 15

What are the risk factors for suicide?

Answer 15

• Access to means to suicide,
• Stigma against seeking help,
• War/disaster,
• Discrimination, abuse/violence,
• Previous suicide attempts,
• Mental health disorders,
• Harmful use of alcohol,
• Financial loss,
• Chronic pain,
• Family history

Question 16

What should you do if a patients is assessed to be a suicide risk?

Answer 16

• Arrange additional support such as more frequent check-ins,
• Inquire about social support and awareness of sources of help,
• Referral to specialists.