General Introduction to Depression by yec10699


									General Introduction to

Public Health Detailers’ Training
NYC Department of Health and Mental Hygiene

Sandra Ramos, PhD
Deputy Director, Office of Program Development
Judy Stein, LMSW, MS
Co-Director, NYC DOHMH Depression Initiative
   What is depression
   Symptoms
   Causes
   Types
   Risk Factors
     Women
     Elderly
     Young Adults

   Racial/Ethnic Disparities
   Psychosocial/Environmental Factors
   Burden
   Detailing Messages
What Is Depression?
 A very common, highly treatable, medical

 Affects physical, mental and emotional

 Affects basic, everyday activities like eating
  and sleeping.

 Affects how people think about things and
  feel about themselves.
What is Depression?
   In contrast to the normal emotional
    experiences of sadness, loss, or passing mood
    states, clinical depression is persistent and
    can interfere significantly with an individual's
    ability to function.

   People with depressive illness cannot just “pull
    themselves together” and “get over it.”

   Depression often takes on a life of its own –
    without treatment, symptoms can last months
    or even years.
Symptoms of Depression
 Feeling sad, blue, or down in the dumps

 Loss of interest in things you usually enjoy

 Feeling slowed down or restless

 Having trouble sleeping or sleeping too much
Symptoms of Depression
 Loss of energy or feeling tired all the time

 Having an increase or decrease in appetite
  or weight

 Having problems concentrating, thinking,
  remembering or making decisions

 Feeling worthless or guilty

 Having thoughts of death or suicide
Symptoms of Depression

 People with Major Depression experience at
  least five of these symptoms all day, nearly
  every day, for at least 2 weeks.

 The symptoms cause clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning.
Causes of Depression
Causes not known, but current theories include:
 Genetic
     • Runs in families
     • However, depression can also occur in
        people who have no family history.
 Environmental
     • A serious loss, difficult relationship,
        financial problem, or any stressful
        (unwelcome or even desired) change in life
        patterns can trigger a depressive episode.
Causes of Depression
 Personality Characteristics
   low self-esteem, pessimistic world view, low
     stress tolerance
   Whether this represents a psychological
     predisposition or an early form of the illness
     is not clear.

 Biological
   Continues to be studied extensively
   Current thinking explores problems in brain
     functioning in the following areas: Limbic
     system, neurotransmitters and neurons,
     hormones and the endocrine system
Causes of Depression

 Combination
     a combination of genetic, psychological,
      environmental, and/ or biological factors
      may contribute to the onset of a
      depressive disorder.
Forms of Depression
 Major Depression
     At least 5 of the 9 symptoms of
       depression present including either loss of
       interest/pleasure or depressed mood;
       symptoms interfere with daily functioning

 Minor Depression
      Fewer symptoms than major depression
       with significant disability; shorter
       duration than chronic depression
Forms of Depression
 Bipolar Disorder
      Cycling mood changes with severe highs
       (mania) and severe lows (depression)

 Dysthymia
     Low grade chronic symptoms of
       depression that last for a minimum of 2
Depression and Suicide

 Of those with MDD, close to 50% report
  feelings of wanting to die, 33% consider
  suicide and 8.8% report a suicide attempt.

 More than 90% of those who commit suicide
  have a diagnosable psychiatric illness at the
  time of death, usually depression, alcohol
  abuse or both
Who is at risk for Depression?
Anyone is potentially at risk for a depressive
illness. Yet, these groups are believed to be at
higher risk:
 Older adults
 Young adults
 Women, pregnant and post partum women
     Note: women report depression about twice
       as often as men. This may result from a
       greater likelihood to discuss depression or to
       seek help.
Depression in Women
 Depression is the second leading cause of
  disease-related disability among women

 1 in 4 women will suffer from a Major
  Depressive Episode during the course of their
  lives as compared to 1 in 10 men.
  • Women may be more likely to discuss
      depression or to seek help.

 Women of childbearing age are at increased
  risk for major depression
  • Pregnancy and new motherhood may
     increase the risk of depressive episodes
Depression in Older Adults
   Of the nearly 35 million Americans age 65 and older, an
    estimated 2 million have a depressive illness (major depressive
    disorder, dysthymic disorder, or bipolar disorder).

   Symptoms of clinical depression can be triggered by other
    chronic illnesses common in later life, such as Alzheimer’s
    disease, Parkinson’s disease, heart disease, cancer and

   Depression is one of the most common conditions associated
    with suicide in older adults.

   Individuals age 65 and older have highest rates of suicide

   High suicide rate among older people (85 and older) is largely
    accounted for by White men.
Depression in Young Adults

 10% of college students have been
  diagnosed with depression, including 13%
  of college women.

 Lifetime prevalence for MDE highest among
  young adults age 18-25 (10%)

 Suicide is the third leading cause of death
  for those aged 15-24
Additional Risk Factors for
 Family or personal history of depression

 Current substance abuse problem

 A major life stressor or change in life events;
  i.e.: loss of a loved one or a job

 Chronic disease
Depression in Racial/Ethnic
 Mental health needs of minority racial/
  ethnic groups remain largely unmet .
 Certain groups have higher rates of major
   Native Americans
   Women (middle aged, separated or divorced,
 Mexican- American and white individuals
   Have significantly earlier onset of major
    depressive disorder compared with African
Depression in Racial/Ethnic
 Latinos with self reported depression are less
  likely to:
   receive any treatment for depression
   fill an antidepressant prescription
   receive adequate course of psychotherapy
 African American and Latinos are more likely
  than Whites to be under-diagnosed and under-
 Minorities are less likely than Whites to receive
  treatments that adhere to treatment guidelines
Explanatory Factors

 Lack of insurance coverage
 Poor access to appropriate screening and early
 Tendency to attribute mental health problems
  to religious and other cultural belief systems
 Lack of access to receptive and culturally
  compatible providers
 Psychosocial health has been associated
  with mental health in general and with
  depression in particular
 Neighborhood social disorganization is
  associated with depressive symptoms,
 Living in socio-economically deprived areas
  is associated with depression. A recent
  study found
   29 % - 58% were more likely to report part 6
    month depression
   36% - 64 % were more likely to report lifetime
Depression Burden

Untreated depression causes distress, disability,
and, most tragically suicide.

Depressive disorders are associated with
increased prevalence of chronic diseases (e.g.
asthma, diabetes)

Increased use of general medical services as
well as costlier health services, such as
Emergency Room and Inpatient.
Depression Burden
 Patients who are depressed are more likely to engage in
  behaviors that contribute to poor health, such as
  smoking, limited or no exercise, poor eating habits and
  are likely to have greater difficulty managing their co-
  morbid conditions.

    Depressive disorders are projected to become the
    leading cause of disability and the second leading
    contributor to the global burden of disease by 2020

 US workers with depression cost employers an estimated
  $44 billion per year.
Detailing Messages
 Primary care physicians can effectively detect
  and manage depression.

 Routinely screen for depression using a simple
  2-question tool (PHQ2)

 Depression can be treated! Medication and
  psychotherapy, alone or in combination, can
  help most patients.
Detailing Messages

 Primary care physicians can effectively detect
  and manage depression.
Detection of Depression: Why Screen
and Manage in primary care?
 Primary care is the 1st line of defense = To find
  people who may be depressed or at risk for
  depression who don’t know it

 Screening for depression in the primary care setting
  improves detection rates
     • US Preventative Service Task Force (USPSTF)
       recommends screening adults for depression
       in clinical practices that have systems in place
       for accurate diagnosis, effective treatment,
       and follow-up.

 Only 50% of those referred to specialty mental
  health practitioners complete more than one visit
Detailing Messages

 Routinely screen for depression using a simple
  2-question tool (PHQ2)
Depression Screening: PHQ2

 A physician can simply and quickly screen for
  depression by asking 2 questions (PHQ2):

During the past 2 weeks, have you been bothered

     1. little interest or pleasure in doing things?
     2. feeling down, depressed, or hopeless?

 The PHQ-2 is a valid and practical tool for
  depression screening in busy medical settings.
Detailing Messages

 Depression can be treated! Medication and
  psychotherapy, alone or in combination, can
  help most patients.
 Detailing Messages
 More than 80% of people with clinical depression can be
  successfully treated.

 Antidepressants are the 1st line treatment for moderate to
  severe depression

 About half of the moderate to severe episodes of depression
  will improve with antidepressant treatment

 A combination of pharmacotherapy and psychotherapy may
  improve treatment response , reduce risk of relapse, enhance
  quality of life, and increase adherence to pharmacotherapy.

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