depression
Normal occurrence
- Almost everyone gets depressed
at times
- Depression is a normal response
to many of life’s stressors.
Depression is abnormal when
- It is out of proportion to the
event.
- Continues past the point at which
most people begin to recover.
Symptoms
- A single individual seldom shows
all the aspects of depression but the diagnosis is typically made it at least
a few signs are evident particularly and when they are intense
- Emotional
v sad depressed mood
v completely without hope and initiative
v may have crying spells
v may contemplate suicide
- Cognitive
v Negative thoughts\
v Low self-esteem
v Feel inadequate
v Blame themselves for their failures
v Feel hopeless about the future
v Pessimistic that they can do anything to improve their life
v complaints or evidence of difficulty in concentrating e.g.: slowed thinking and indecisiveness
v paying attention is an exhaustive effort
- Motivational
v Very low in depressives
v Tends to be passive
v Difficulty initiating activities
v loss of interest and pleasure in usual activities
v utterly dejected
v may be apprehensive, anxious and despondent much of the time
v When confronted with a problem the ideas for its solutions don’t occur to them
v May neglect personal hygiene and appearance
v May make numerous hypochondrial complaints that have no physical basis
- Physical
v difficulties sleeping (insomnia) or a desire to sleep a great deal of the time
v poor appetite and weight loss or increased appetite and weight gain
v fatigue
v loss of energy
v shift in activity level, becoming either lethargic (psychomotor retardation) or agitated.
- difference
between depression in teens and adults
- There are specific clinical symptoms that differentiate the experience
of depression in adolescents from that of adults:
- significant impairments in interpersonal relationships and academic functioning
- the extremes of helplessness, despair, lack of pleasure, hypersomia,
and changes in weight as compared with adults
- Depression among adolescents is observable as reports of excessive boredom,
substance abuse, family problems, insubordination, symptoms of conduct disorder, and eating disorders
- stages of depression are
often followed by stages of improved functioning, which reflect the more episodic
nature of adolescent depressive disorders
·
Major depressive disorder
o
Symptoms:
§ Experience severe periods of depression lasting several weeks or more.
§ Accompanied by some or all of the following symptoms.
·
Difficulty concentrating
·
Loss of pleasure
·
Slowed speech
·
Slowed movement
·
Vegetative signs: e.g.: sleepiness,
loss of appetite.
·
Weight changes
·
Dysthymia
Less severe form of depression but lasts much longer.
o
Symptoms
§ Same as above but less severe
·
Adjustment disorder with depressed mood
o
Brought on by stress
Relatively
brief
·
Masked depression
o
Depression is often masked in
early adolescence.because symptoms can be mistakenly interpreted as a natural part of adolescence
o
Symptoms include:
§ Fatigue:
§ Poor concentration
§ Hypochondriasis (excessive concern with illness or health)
·
Prevalence
o
Feelings of sadness, loneliness
and despair become common by mid-adolescence.
§ Roughly one out of 12 teens suffers significant depression before the age of 18.
§ Nearly half of all adolescents report experiencing some of the symptoms that characterize
depression.
o
Prevalence of major depressive
disorder is lower
§ The onset of major depressive disorders (MDD) appears most likely between the ages of 13 and 19
§ 10% of all adolescents report this.. ¾ are women.
·
Gender differences
o
Throughout childhood and preadolescence, depression
rates between the sexes tend to be fairly equal.
§ Rates of female to male depression rapidly soar during adolescence to a 2:1 ratio
§ at about the age of 14, female adolescents begin experiencing depressive disorders at twice the rate
of male adolescents.
§ One out of every 4 girls is likely to experience moderate to severe symptoms of depression
o
Explanation for sex-differences
§ biological factors
·
Hormonal influences
·
the significant increase in estrogen and progesterone
hormones for girls that boys do not experience
·
The differences in types of hormone secretions
between male and female adolescents have also been suggested as a potential factor.
·
Arguments for the role of hormones in the
onset of depression in female adolescents suggest that dysregulation of the estrogen
and progesterone hormones leads to depression, and because boys do not experience a surge of these hormones during puberty,
they are less vulnerable to depression during this time
·
Relationships between steroids, birth control,
premenstrual syndrome, and their connections to depressive mood may further the argument for the potential role of hormones
in depression among young girls
·
but Preliminary investigations of the relationship
between depression in adolescent girls and hormones, however, have not consistently found correlations between the two.
·
the
development of secondary sex characteristics associated with puberty
·
girls are more likely to be dissatisfied with
their bodies starting at this time. This finding is important because further research studies have suggested that body dissatisfaction
leads to more depressive symptoms in girls than in boys.
§
social
role expectations
§
Social
Development
§
The social development tasks of early adolescence
can be uniquely stressful for young women.
§
Navigating the underlying social milieu of
female friendships, exploring one's sexuality, and establishing autonomy from parents are all new developmental transitions
taking place at this time.
§
It has been hypothesized that stresses from
the developmental transitions during this period are related to increases in depression among female adolescents.
§
Research has also noted significant drops in self-esteem related to various social development factors and a shift in focus from a desire to achieve
to a preoccupation with being well liked by other young girls (Eder, 1985). In the midst of all these challenges, female adolescents are also fighting to establish or
maintain a sense of self because a majority of the ideas and interests they previously identified with are no longer readily
accepted by their peers (Pipher, 1994).
§
Social
Role Expectations
·
Identification with culturally
defined gender roles
·
Young girls coming into adolescence often
find increased pressures on them from peers, parents, teachers, and society as a whole to become more "feminine." Specific
changes in personality and behavior often occur at this age in order to meet these pressures.
·
Female gender role includes
more socially undesirable characteristics than does the male gender role.
·
The pressures on them to make such changes
at this age are significant. Media images and commercials challenge female adolescents to look their best, which often means
looking similar to others.
·
Peer
group
o
Many changes in female adolescents' peer relations
typically occur at this time
·
there
have been no empirical studies concluding that any of these factors are solely responsible,
·
the most likely model is that a combination
of these factors leads to a unique set of problems and characteristics that put female adolescents at higher risk for experiencing
depression.
precipitating factors
- realization
that illness or ageing is depleting one’s resources
·
Treatment
o
Approximately half of the teenagers with untreated
depression may attempt suicide, which remains the third leading cause of death in this age group.
- Cognitive-behavioral treatment
- Cognitive distortions,
- helping them uncover connections between their thoughts and current depressives
- symptomatology. Teaching relaxation and coping skills
- Interpersonal treatment approaches,
originally designed for adults with depression,
- Modeling, teaching, and practicing social skills
- Role-plays help female adolescents
transfer new social approaches to other environments should support the development of the skills and self-confidence
o
Medication
o
the biological aspects of depression that
can be treated with medication.
o
Biological markers for depression in adults
have been identified and antidepressants have provided many adults with significant relief from depressive symptomatology,
but studies have not found similar biological correlates in adolescents who are depressed
o
only attempt psychopharmacological treatment
for adolescent depression when other psychological interventions have failed because such treatments have not proved to be
particularly efficacious.
depression in the elderly
·
Prevalence
o
Mood disorders are less common
in older adults than in younger adults
o
Estimated to account for nearly
half of the admissions of older adults in acute psychiatric care
o
Gender differences
§ None
§ Women have more periods of depression than men for most of their lives except when they
reach old age
·
Differences between depression in older versus younger adults
o
Symptoms are similar to those
of depressed in other age groups with some differences
§ Feelings of guilt were found less often in the elderly
§ Somatic complaints were common in the elderly
§ Thoughts of suicide were less common in elderly.
§ Age attributions / old-age explanation
·
Causes of depression in the elderly
o
Maladaptive personality traits
o
Inadequate coping skills
o
Health
o
Genetic predisposition
o
Life stressors
·
Correlates of depression in the elderly
o
Health
§ Many aged in poor physical health are depressed
§ Physical illness and depression are linked
o
Life events that can cause depression
§ Each older person brings to late life a developmental history that makes his / her reactions
to common problems unique.
§ Two factors to determine how effectively they will respond to new life events.
·
Coping skills
·
Personality
·
Treatment of depression in the elderly
o
Substantial evidence that depressed older adults can be helped by psychological intervention
§ E.g.: Gallagher
and Thompson (1982)
§ Compared different treatments
§ Behavioural, cognitive and brief psychodynamic therapies were helpful in older depressed
individuals.
§ E.g.: Thompson et al (1987)
§ 70% of elderly patients were judged either completely cured or markedly improved.
§ Compared favorably with therapy in younger depressed group
§ But older adults are less likely than younger to recover unless they are treated.
suicide
·
Prevalence
o
Suicide ranks 8th
as a cause of death among adults in general but 3rd in those aged between 15 – 24. After accidents and homicides.
o
Gender
differences
§ Female adolescents have a 12-fold increase in suicide risk and are twice as likely as their male peers
to attempt suicide
·
Risk factors
o
Several factors put people in
general at high risk for suicide
§ Serious physical illness
§ Feelings of hopelessness
§ Social isolation
§ Loss of loved one
§ Dire financial circumstances
·
Warning signs
o
Depression
§ More than 90% of adolescents who die by suicide have been diagnosed with at least one psychiatric disorder,
typically major depression
o
Sudden changes in behavior.
o
Experiencing a humiliating event
o
Feelings of guilt or hopelessness
o
An inability to concentrate
o
Talk of suicide
o Giving away one’s most important possession.
·
Prevention
o
Primary
prevention
§ consists of efforts to remedy the conditions that may lead to suicide before it occurs.
o
Secondary
prevention
§ involves dealing directly with a suicidal crisis or problem;
§
its goal is to prevent a condition that already
exists from progressing to a more serious problem
§ Brief, crisis-oriented, giving adolescent skills that they can apply to their on-going
relationships.
§ Highly structured programs that train adolescents
in skills they can apply at home an din school
§ Teach adolescents to attribute their successes to their own efforts
§ Help them identify problem areas and generate alternative solutions.
§ Teach them conflict management
§ Family therapy
o
Tertiary
prevention
§ involves the provision of services to suicide survivors after the suicide has occurred.
suicide in the elderly
·
Prevalence
o
About 3 times that for the rate of younger people
o
in the older adult population, 80% of the
suicide intents would result in an attempt.
o
Gender differences
§ Men
·
Throughout their lifespan men
have higher suicide rates than women but most notable in their old age
·
Suicide rates for men rise from
youth and increase in a linear fashion with age.
·
Risk for taking their lives
peaks from 80 to 84
§ Women
·
Risk for taking their lives
peaks before they reach 50 and declines steadily thereafter
·
Warning Risk factors
o
Physical frailty / illness
o
Widowhood / recent death of a loved one
o
Mental disorders / depression
o
Social isolation / Communication
·
Intervention / treatment
o
Communication:
1. Try to reduce the intense psychological pain and suffering
2. Persuade the person to regard his problem in less desperate terms.
3. Help them to see options other than their continued suffering.
4. encourage the person to pullback from the self-destructive act.
