Importance Of Diagnosing Depression by Rabia06

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									Importance Of Diagnosing
•Up to 15% of individuals with severe depression
                 die by suicide
 •Fourfold increase in death of individuals with
            depression over age 55.
 •In general, serious depression predicts more
            pain and physical illness
 •Age of onset decreasing for those born more
      Importance Of Diagnosing

• Depression is the most common mental
  health disorder in the United States
• Each year it affects 17 million people
• About 20% of people will experience a
  depressive illness at some point in their

• As many as 1 in 33 children may have depression (5%)
• In teens the number may be as high as 1 in 8 (10% -
     – Depression in adults often has its’ origin in
•   70% to 80% of depressed adolescents do not receive
•   Equal gender distribution of MDD in childhood. In
    adolescence MDD occurs twice as frequently in girls
      Symptoms Of Depression

Not everyone who is depressed experiences
  every symptom. Some people experience
  a few symptoms, some many.
The severity of symptoms varies person to
person and also varies over time.
          Overview of Symptoms

–   Persistent sad, anxious, or "empty" mood.
–   Feelings of hopelessness, pessimism.
–   Feelings of guilt, worthlessness, helplessness.
–   Loss of interest or pleasure in hobbies, people and activities that
    were once enjoyed, including sex.
–   Decreased energy, fatigue, being "slowed down."
–   Difficulty concentrating, remembering, making decisions.
–   Insomnia, early-morning awakening, or oversleeping.
–   Appetite and/or weight loss or overeating and weight gain.
–   Thoughts of death or suicide/suicide attempts.
–   Restlessness, irritability.
–   Chronic pain, illness, digestive disorders
              Types of depression:
               Major Depression
• Manifested by a combination of symptoms that
    interfere with the ability to work, study, sleep,
    eat, and enjoy once pleasurable activities. Such
    a disabling episode of depression may occur
    only once but more commonly occurs several
    times in a lifetime.
•   50%-60% of people suffering from MDD can be
    expected to have a 2nd episode;
•   Those with 2 have 70% chance of a third, those
    with 3 have 90% chance of having a fourth
MDD – Associated features
• In general MDD predicts more pain and physical illness
• “Affluenza” : higher rate of depression in adolescents
    from high income families
•   Age of onset decreasing for those born more recently
•   Once a young person has experienced a major
    depression, he or she is at risk of developing another
    depression within the next five years
•   Suicide is the third leading cause of death for 15-24 year
A less severe type of depression, involves long-
  term, chronic symptoms that do not disable, but
  keep one from functioning well or from feeling
  good. Many people with dysthymia also
  experience major depressive episodes at
  some time in their lives.
Early diagnosis and treatment of dysthymia is
  crucial since it serves as a major pathway to
  recurrent depression in children
• Evidence indicates that depression runs in families
   – Not everybody with the genetic makeup that causes
     vulnerability to mood disorders will have the illness.
     Apparently additional factors, possibly stresses at
     home, work, or school, are involved in its onset.
• Biochemical abnormalities in mood regulating
  neurotransmitters may cause depression (endogenous
• Sometimes the onset of depression is associated with
  acute or chronic physical illness (reactive depression)
• Negative life events such as the loss of a loved one, a
  break-up, family conflict, divorce, a move, abuse,
  bullying at school a major financial upheaval or other
  loss may cause depression (reactive depression)
• Certain personality traits such as low self-esteem,
  shyness, anxiety, and perfectionism may increase the
  likelihood of developing depression
    – People who have low self-esteem, who consistently
      view themselves and the world with pessimism or
      who are readily overwhelmed by stress, are prone to

  In summary, a combination of genetic,
psychological, and environmental factors is
involved in the onset of a depressive
disorder. Later episodes of illness typically
are precipitated by only mild stresses, or
none at all.
Symptoms in Children specifically

• Change in school performance such as frequent
    complaints from teachers, loss of usual work effort, loss
    of usual interest in nonacademic school activities
•   Diminished socialization such as decreased group
    participation, social withdrawal, decreased friendliness
•   Change in attitude toward school such as decreased
    enjoyment in school activities or refusal to attend school
•   Somatic complaints such as non-migraine headaches,
    abdominal pain, and muscles aches or pains
•   Loss of energy
•   Unusual change in appetite and/or weight
• Dysphoric mood statements or appearance of sadness,
    loneliness, unhappiness, hopelessness and/or pessimism
•   Mood swings, irritability, hypersensitivity and negativity
•   Feelings of being worthless, useless, dumb, stupid, ugly
•   Desire to run away or leave home
•   Suicidal thoughts or attempts
•   Aggressive behavior such as excessive fighting or
    sudden angry outbursts, disrespect towards authority,
    belligerence, difficulty getting along with others
•   Sleep disturbances such as insomnia, restless sleep and
    difficulty waking
Reasons for under-diagnosis in

• Differing manifestation of depressive symptoms
    in childhood- e.g. Irritability and duration
•   Children not always able to accurately express
    how they feel
•   Co-morbid disorders can mask affective
•   Clinicians often view mood disorders as adult
Parental Depression

• Children with at least one depressed parent are
    approximately three times more likely to have a lifetime
    episode of MDD than children of nondepressed parents.
•   The lifetime risk for MDD in children of depressed
    parents has been estimated to range from 15% to 60%
•   Offspring of depressed parents are not only at risk for
    affective disorders, but they also are at increased risk for
    general psychopathology, including anxiety and
    disruptive disorders
Depressed Mothers’ Interactions
with kids
• Mother appears withdrawn, uninterested
• Mother does not provide adequate stimulation
    for child (touch, play, affection)
•   Tends to interpret child’s facial expressions as
•   Alternates between hostile, over-involved and
    unresponsive inattentive.
•   Mothers perceive children as hard to parent

• Depressed parents tend to be more irritable and
   – Children are more likely to develop behavioral problems when
     their parents rely heavily on yelling and criticism when dealing
     with poor behavior
• Depressed parents tend to focus on the negative and
  ignore the positive
   – Child is prone to “give up” on trying to improve if efforts at
     behaving are ignored
• Child of depressed parent learns that the way to get
  parent out of depressed mood is to misbehave
Cognitive Styles and Temperment

• Children who have negative attributional styles
    for interpreting and coping with stress and
    negative life events tend to become hopeless
    and dysphoric and appear to be at higher risk of
    developing MDD
•   It appears that a negative cognitive style
    becomes more fixed during adolescence
    emphasizing the need for early intervention.
Finding Help…
•   The process of finding a therapist can be highly
    anxiety producing - cut yourself some slack.
•   A sweet personality is no guarantee of ethical or
    effective skills,
•   One size does not fit all! A therapist who is just
    perfect for one person may not be a good fit for the
•   Word of mouth is a good starting place. Get referrals.
•   Before interviewing a therapist, be familiar with the
    various options available
•   Ask yourself…….. “What do I hope to gain from
    therapy? Can this therapist help me do that?”
•   Interview perspective therapists…. Many of them.
•   Trust your instinct - Ask yourself “Am I comfortable
    with THIS therapist?”
•   Ask about membership in professional organizations,
    specialization and licensure, and how long they have
    been in practice
•   Ask what it is that the therapist does that is supposed
    to be helpful. How is this different from how other
    therapists work? What should you expect?
The Helping Professionals:
Who They Are – What They Do
Helping professionals work in many settings, such
  as schools, mental health centers, clinics,
  employee assistance programs, private and
  group practice, hospitals, nursing homes,
  residential centers, partial care organizations,
  family or social service agencies, and university
  medical centers or teaching hospitals. The
  promotion and enhancement of healthy,
  satisfying lifestyles are the goals of all helping
  professional regardless of where services are
  provided. (SEE HANDOUT)

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