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Psychology of Human Growth and Development
Depression
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cognitive development part 2
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Development of emotions
Depression
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The Development of emotions

part 2

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

 

  1. Emotional

 

v      sad depressed mood

v      completely without hope and initiative

v      may have crying spells

v      may contemplate suicide

 

  1. 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

 

  1. 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

 

  1. 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.. 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

 

  • failure at school

 

  • failure at work

 

  • loss of loved one

 

  • 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.

 

 

 

 

 

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