Transcript Wyoming Behavioral Institute

Wyoming Behavioral Institute
Women and Depression
Nadine Dexter, WBI Director of Clinical Services
Statewide Videoconference
Nov. 13, 2006
What is depression?
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Symptoms of depression include:
 Persistent sad, anxious or “empty” mood
 Loss of interest or pleasure in activities, including sex
 Restlessness, irritability or excessive crying
 Feelings of guilt, worthlessness, hopelessness,
pessimism
 Sleeping too much or too little; early-morning
awakening
What is depression?
Appetite and/or weight loss or overeating and
weight gain
 Decreased energy, fatigue, feeling “slowed
down”
 Thoughts of death or suicide, suicide attempts
 Difficulty concentrating, remembering or
making decisions
 Persistent physical symptoms that do not
respond to treatment, such as headaches,
digestive disorders and chronic pain
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What is depression?

Major depression – “Unipolar” or clinical
depression includes some or all of the symptoms
for at least 2 weeks but frequently for several
months or longer:
 Episodes can occur once, twice or several times
in a lifetime
 Affects twice as many women as men,
regardless of racial and ethnic background or
economic status
The “Blues” vs. Depression
Depression
The Blues
Essential
distinction:
Duration:
An illness
A normal reaction to life
situations
Persists
Temporary
Symptoms:
Multiple: Moods,
Thoughts, Bodily
Functions
Single: Moods
Suicide Potential:
Can result in suicide
Rarely produces suicidal
thoughts
Treatment:
Requires specific medical
psychiatric treatment
Requires a good listener +
time to heal
Grief vs. Depression
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Grief
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Recognizable loss
Open anger
Crying
Vivid dreams
Episodic difficulty
with sleeping
Responds to warmth
Pleasure varies
Others sympathetic
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Depression
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If loss, seen as punishment
Consistent sadness
Anger not turned outward
No crying or uncontrollable
crying
Few dreams
Severe insomnia, early morning
wakening
Unresponsive unless pressured
Restricts pleasure persistently
Others irritated, not accepting
Major Depressive Disorder
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Major depressive disorder is the leading cause of
disability in the U.S. for people ages 15-44
Major depressive disorder affects 14.8 million
American adults (6.7% of the U.S. population 18
and older)
Median age at onset is 32
Major depressive disorder is more prevalent in
women than in men
Types of Depressive Illness
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Dysthymia – Same symptoms are milder
and last at least 2 years
People with dysthymia are frequently lacking in
zest and enthusiasm for life, living a joyless and
fatigued existence that seems almost a natural
outgrowth of their personalities
 They can also experience major depressive
episodes
 Effects twice as many women as men,
regardless of racial and ethnic background or
economic status
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Types of Depressive Illness
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Manic-depression – “Bipolar disorder” is not
nearly as common as other types of depressive
illness and involves disruptive cycles of
depressive symptoms that alternate with mania
 During manic episodes, people may become
overly active, talkative, euphoric, irritable,
spend money irresponsibly and get involved in
sexual misadventures
 Men and women are equally vulnerable to
bipolar disorder
Types of Depressive Illness
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Seasonal affective disorder – May be an
effect of seasonal light variation
Most difficult months are January and February
 Women and younger persons are at greater risk
 Identifiable because there is full remission of
depression in summer months
 Symptoms occur at least two years
consecutively
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Impact of Depression
Major depression is the leading cause of
disability worldwide
 For women in market economies,
depression is the leading cause of years of
healthy life lost
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Causes of Depression
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Genetic factors
Risk higher for bipolar disorder
 Not everyone with a family history develops
the illness
 Depression can occur in people who have had
no family members with the illness
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Causes of Depression
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Biochemical factors
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Individuals with major depressive illness typically have
dysregulation of certain brain chemicals, called
neurotransmitters
Sleep patterns, which are biochemically influenced, are
typically different in people with depressive disorders
Depression can be induced or alleviated with certain
medications
Some hormones have mood altering properties
Causes of Depression
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Environmental and other stressors
Significant loss
 Difficult relationship
 Financial problems
 Major change in life pattern
 Acute or chronic physical illness
 Substance abuse disorder (occurs in about 1/3
of people with any type of depressive disorder)
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Causes of Depression
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Other psychological and social factors
Pessimistic thinking
 Low self esteem
 Sense of having little control over life events
 Tendency to worry excessively
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Research findings
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Adolescence
Between the ages of 11 and 13 there is a
precipitous rise in the depression rates for girls
 By age 15, females are twice as likely to have
experienced a major depressive episode as
males
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Research findings
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Adulthood
For both men and women, rates of major
depression are highest among the separated and
divorced and lowest among the married,
although always higher for women
 Rates of depression are highest among
unhappily married women
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Research findings
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Reproductive events
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Menstrual cycle, pregnancy, post pregnancy, infertility,
menopause, and sometimes the decision not to have
children are reproductive events sometimes resulting in
depression
Hormones have an effect on the brain chemistry that
controls emotions and mood
Women who experience major depression after
childbirth very often have had prior depressive episodes
even though they may not have been diagnosed and
treated
Research findings
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Reproductive events
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Pregnancy seldom contributes to depression and having
an abortion does not appear to lead to a higher
incidence of depression
Women with infertility problems may be subject to a
higher rate of depressive illness
Motherhood may be a time of heightened risk for
depression because of the stress and demands it poses
Menopause is not associated with an increased risk of
depression
Research findings
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Victimization
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Women molested as children are more likely to have
clinical depression at some time in their lives
Women who are raped as adolescents or adults have a
higher incidence of depression
Women who experience physical abuse and sexual
harassment on the job may also experience higher rates
of depression
Poverty
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Low economic status brings with it many stresses,
including isolation, uncertainty, frequent negative
events, and poor access to helpful resources
Research findings
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Later adulthood
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Studies do not support the belief that women are particularly
vulnerable to depression when their children leave home and
they are confronted with “empty nest syndrome”
More elderly women than men suffer from depressive illness
Widowhood is a risk factor for depression
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About 1/3 of widows/widowers meet criteria for major depressive
episodes in the first month after the death, and ½ remain clinically
depressed 1 year later
Depression should not be dismissed as a normal consequence
of the physical, social and economic problems of later life
Rurality and Mental Health
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Stressful life events that are unique to rural
environments have been linked to feelings of
depression and worthlessness in many rural
communities
High levels of stress may be the result of access to
limited resources required to meet both personal
and interpersonal needs
Non-metropolitan poverty rates continue to be
higher than those in metropolitan regions across
many demographic groups
Depression and Stress
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The most commonly studied psychological
disorder in rural areas is depression
Depressed persons report clinically and
significantly worse mental and physical
functioning than non-depressed persons
Additional factors associated with depression
among rural women include: isolation, weather
problems, and a lack of social, educational and
child care resources
Community dissatisfaction is the strongest
predictor of depression
Identifying Depression
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Psychological complaints account for more than 40% of all
patient visits to rural family practice practitioners
Rural family practice practitioners detect 50% less
depression in their patients than do their urban counterparts
Even when mental health professionals are available near
physician offices, only 5% of depressed patients receive
mental health care
More than two thirds of the unidentified depression cases
initially seen by family practitioners in rural primary care
settings meet the criteria for major depression five months
later
Identifying Depression
Rural women are unlikely to discuss the
symptoms of depression with their primary
care providers
 Rural women frequently present in primary
care settings with psychosomatic symptoms
such as headaches, backaches, insomnia,
fatigue, and abdominal pain
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Suicide
More than 90 percent of people who kill
themselves have a diagnosable mental
disorder, most commonly a depressive disorder
or a substance abuse disorder
 Four times as many men as women die by
suicide
 Women attempt suicide two to three times as
often as men
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The cost of poor mental health
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Mental and substance-use conditions are the leading
combined cause of disability and death among
American women and the second highest among
men, yet millions go untreated
According to the Institute of Medicine, failure to
deliver effective care to people with mental health
and substance use problems results in significant
costs to the nation's economy, including considerable
costs to employers because of employee absenteeism,
impaired work performance, days of disability, and
on-the-job accidents
Leading sources of disease burden in
established market economies, 1990
All causes
.
Total DALYs
(millions)
98.7
Percent of
Total
.
1
Ischemic heart disease 8.9
9.0
2
6.7
Unipolar major
depression
Cardiovascular disease 5.0
6.8
4
Alcohol use
4.7
4.7
5
Road traffic accidents
4.3
4.4
3
5.0
What is the impact of untreated
mental illness?
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The burden of mental illness on health and productivity
in the United States is profoundly underestimated
Data developed by the World Health Organization, the
World Bank, and Harvard University, ranks mental
illness, including suicide, second in the burden of
disease in established market economies
Mental illness emerged from the Global Burden of
Disease study as a surprisingly significant contributor to
the burden of disease
Breaking the Cycle
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As individuals move into adulthood, developmental
goals focus on productivity and intimacy including
pursuit of education, work, leisure, creativity, and
personal relationships
Good mental health enables individuals to cope with
adversity while pursuing these goals
Untreated, mental disorders can lead to lost
productivity, unsuccessful relationships, and significant
distress and dysfunction
Mental illness in adults can have a significant and
continuing effect on children in their care
Why people go without treatment
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Cost or insurance issues were the most commonly
reported reasons for not getting needed treatment
among adults with serious mental illness who did not
receive treatment (51.4 %)
Other commonly reported reasons were:
 not feeling a need for treatment (at the time) or
thinking the problem could be handled without
treatment (32.7%)
 not knowing where to go for services (28.1%),
Why people go without treatment
stigma associated with receiving treatment
(26.9%)
 did not have time (16%)
 treatment would not help (11.1 %)
 fear of being committed or having to take
medicine (10.5 %)
 reasons relating to access barriers other than
cost (4.1%)
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Regional variations in treatment
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Adults in the West had the lowest rate of
treatment for mental health problems in 2003
(11.9%) compared with:
13.7% for those in the Northeast
 14.3% for those in the Midwest
 13.1% for those in the South
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The rate of outpatient treatment in the West
decreased from 8.3 % in 2002 to 6.6 % in 2003
Wyomingites’ Mental Distress
Wyomingites’ Mental Distress
Central
Northeast
Northwest
Southwest
Southeast
65+
ages 55-64
ages 45-54
ages 35-44
ages 25-34
ages 18-24
Females
Males
0.00%
2.00%
4.00%
6.00%
8.00%
% reporting mental health was not good for 14 or more of last 30 days
10.00%
12.00%
14.00%
Wyomingites’ Mental Distress
Female
16
45-54
NE
25-34
55-64
14
12
18-24
SW
65+
NW
SE
Male
10
8
6
4
2
0
8+ days poor mental health in past 30 days
Central
Who gets treatment?
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In 2003, adults with family income of
<$20,000 were more likely to have received
treatment for mental health problems
(15.4%) than those with incomes of:
$20,000 to $49,999 (12.2%)
 $50,000 to $74,999 (13.3%)
 $75,000 or more (13%)
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Who gets treatment?
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Adults in families receiving government
assistance were more likely to receive treatment
for mental health problems in 2003 (19.3%) than
adults in unassisted families (12.3%)
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Adults in assisted families were more likely than
those in unassisted families to receive inpatient
treatment, outpatient treatment, or prescription
medication
Is there a solution?
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Research has contributed to our ability to recognize,
diagnose, and treat these conditions effectively in terms
of symptom control and behavior management
Medication and other therapies can be independent,
combined, or sequenced depending on the individual’s
diagnosis and personal preference
A new recovery perspective is supported by evidence on
rehabilitation and treatment as well as by the personal
experiences of consumers
The Good News
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More than half of adults who received
treatment for mental health problems in
2003 (57.5%) reported treatment improved
their ability to manage daily activities "a
great deal" or "a lot"
Treatment for Depression
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Seek medical examination to rule out any physical
illnesses that may cause depressive symptoms
Ask for physician or pharmacist review of
medications – some medications can cause the
same symptoms as depression
Seek psychological examination, and if
recommended:
 Take medication
 Participate in psychotherapy
Treatment for Depression
Find support groups
 Exercise
 For SAD sufferers, phototherapy or bright
light therapy can help
 Antidepressant drugs may prove effective in
reducing symptoms
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Preventing Depressive Episodes
Eat a balanced diet
 Get regular exercise (for SAD sufferers,
being outdoors on sunny days can be
therapeutic)
 Maintain a regular sleep pattern
 Avoid drugs and alcohol
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Preventing Depressive Episodes
Take medication as prescribed
 Continue to take medications for at least 7
to 15 months after symptoms improve
 Continue with cognitive-behavioral therapy
even after medications have been stopped
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Continuing counseling for 2 years after
medications stop lower rates of relapse
Wyoming Behavioral Institute
 Free,
confidential 24 hour toll free
assessment hotline:
1-800-457-9312