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General Introduction toDepression

Public Health Detailers TrainingNYC Department of Health and Mental Hygiene

Sandra Ramos, PhD

Deputy Director, Office of Program DevelopmentJudy Stein, LMSW, MS

Co-Director, NYC DOHMH Depression Initiative


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Outline

What is depression

Symptoms

Causes

Types

Risk Factors

Women

Elderly

Young Adults


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Outline

Racial/Ethnic Disparities

Psychosocial/Environmental Factors

Burden Detailing Messages


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What Is Depression?

A very common, highly treatable, medicalillness.

Affects physical, mental and emotionalwell-being.

Affects basic, everyday activities like eating

and sleeping.

Affects how people think about things andfeel about themselves.


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What is Depression?

In contrast to the normal emotionalexperiences of sadness, loss, or passing moodstates, clinical depression is persistent andcan interfere significantly with an individual's

ability to function.

People with depressive illness cannot just pullthemselves together and get over it.

Depression often takes on a life of its own without treatment, symptoms can last monthsor even years.


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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


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Loss of energy or feeling tired all the time

Having an increase or decrease in appetiteor weight

Having problems concentrating, thinking,remembering or making decisions

Feeling worthless or guilty

Having thoughts of death or suicide


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People with Major Depression experience atleast five of these symptoms all day, nearlyevery day, for at least 2 weeks.

The symptoms cause clinically significantdistress or impairment in social, occupational,or other important areas of functioning.


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Causes of Depression

Causes not known, but current theories include:

Genetic

Runs in families

However, depression can also occur inpeople who have no family history.

Environmental

A serious loss, difficult relationship,

financial problem, or any stressful(unwelcome or even desired) change in lifepatterns can trigger a depressive episode.


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Personality Characteristics low self-esteem, pessimistic world view, low

stress tolerance Whether this represents a psychological

predisposition or an early form of the illnessis not clear.

Biological Continues to be studied extensively Current thinking explores problems in brain

functioning in the following areas: Limbicsystem, neurotransmitters and neurons,hormones and the endocrine system


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Combination

a combination of genetic, psychological,

environmental, and/ or biological factorsmay contribute to the onset of adepressive disorder.


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Forms of Depression

Major Depression

At least 5 of the 9 symptoms ofdepression present including either loss of

interest/pleasure or depressed mood;symptoms interfere with daily functioning

Minor Depression

Fewer symptoms than major depressionwith significant disability; shorterduration than chronic depression


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Forms of Depression

Bipolar Disorder

Cycling mood changes with severe highs(mania) and severe lows (depression)

Dysthymia

Low grade chronic symptoms ofdepression that last for a minimum of 2years


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Depression and Suicide

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

More than 90% of those who commit suicidehave a diagnosable psychiatric illness at thetime of death, usually depression, alcohol

abuse or both


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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 twiceas often as men. This may result from agreater likelihood to discuss depression or toseek help.


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Depression in Women

Depression is the second leading cause ofdisease-related disability among women

1 in 4 women will suffer from a Major

Depressive Episode during the course of theirlives 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 increasedrisk for major depression Pregnancy and new motherhood may

increase the risk of depressive episodes


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Depression in Older Adults

Of the nearly 35 million Americans age 65 and older, anestimated 2 million have a depressive illness (major depressivedisorder, dysthymic disorder, or bipolar disorder).

Symptoms of clinical depression can be triggered by otherchronic illnesses common in later life, such as Alzheimersdisease, Parkinsons disease, heart disease, cancer andarthritis.

Depression is one of the most common conditions associatedwith suicide in older adults.

Individuals age 65 and older have highest rates of suicide

High suicide rate among older people (85 and older) is largelyaccounted for by White men.


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Depression in Young Adults

10% of college students have beendiagnosed with depression, including 13%of college women.

Lifetime prevalence for MDE highest amongyoung adults age 18-25 (10%)

Suicide is the third leading cause of deathfor those aged 15-24


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Additional Risk Factors forDepression

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


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Depression in Racial/EthnicMinorities

Mental health needs of minority racial/ethnic groups remain largely unmet .

Certain groups have higher rates of major

depression Native Americans

Women (middle aged, separated or divorced,low-income)

Mexican- American and white individuals Have significantly earlier onset of major

depressive disorder compared with AfricanAmericans.


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Depression in Racial/EthnicMinorities

Latinos with self reported depression are lesslikely to:

receive any treatment for depression

fill an antidepressant prescription receive adequate course of psychotherapy

African American and Latinos are more likelythan Whites to be under-diagnosed and under-

treated Minorities are less likely than Whites to receive

treatments that adhere to treatment guidelines


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Explanatory Factors

Lack of insurance coverage

Poor access to appropriate screening and early

detection Tendency to attribute mental health problems

to religious and other cultural belief systems

Lack of access to receptive and culturally

compatible providers


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Psychosocial/EnvironmentalFactors

Psychosocial health has been associatedwith mental health in general and withdepression in particular

Neighborhood social disorganization is

associated with depressive symptoms, Living in socio-economically deprived areas

is associated with depression. A recentstudy found 29 % - 58% were more likely to report part 6

month depression 36% - 64 % were more likely to report lifetime

depression


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Depression Burden

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

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

Increased use of general medical services aswell as costlier health services, such asEmergency Room and Inpatient.


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Depression Burden

Patients who are depressed are more likely to engage inbehaviors that contribute to poor health, such assmoking, limited or no exercise, poor eating habits andare likely to have greater difficulty managing their co-morbid conditions.

Depressive disorders are projected to become theleading cause of disability and the second leadingcontributor to the global burden of disease by 2020

US workers with depression cost employers an estimated$44 billion per year.


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Detailing Messages

Primary care physicians can effectively detectand manage depression.

Routinely screen for depression using a simple2-question tool (PHQ2)

Depression can be treated! Medication and

psychotherapy, alone or in combination, canhelp most patients.


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Detailing Messages

Primary care physicians can effectively detectand manage depression.


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Detection of Depression: Why Screenand Manage in primary care?

Primary care is the 1st line of defense = To findpeople who may be depressed or at risk fordepression who dont know it

Screening for depression in the primary care settingimproves detection rates US Preventative Service Task Force (USPSTF)

recommends screening adults for depressionin clinical practices that have systems in placefor accurate diagnosis, effective treatment,

and follow-up.

Only 50% of those referred to specialty mentalhealth practitioners complete more than one visit


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Detailing Messages

Routinely screen for depression using a simple

2-question tool (PHQ2)


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Depression Screening: PHQ2

A physician can simply and quickly screen fordepression by asking 2 questions (PHQ2):

During the past 2 weeks, have you been bothered

by:

1. little interest or pleasure in doing things?

2. feeling down, depressed, or hopeless?

The PHQ-2 is a valid and practical tool fordepression screening in busy medical settings.


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Detailing Messages

Depression can be treated! Medication andpsychotherapy, alone or in combination, can

help most patients.


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Detailing Messages

More than 80% of people with clinical depression can besuccessfully treated.

Antidepressants are the 1st line treatment for moderate to

severe depression

About half of the moderate to severe episodes of depressionwill improve with antidepressant treatment

A combination of pharmacotherapy and psychotherapy mayimprove treatment response , reduce risk of relapse, enhancequality of life, and increase adherence to pharmacotherapy.

dmh depression 01

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