Transcript Anxiety and Depression in the Spina Bifida Community

Anxiety and Depression in
the Spina Bifida
Community
By: Lauren Bendik, MSW
About Me


Professional

B.A. in Psychology from University of the Pacific, 2012

M.S.W. (Master’s in Social Work) with a mental health
concentration and PPS credential from University of Southern
California, 2015

Experience working with children/families in various capacities

Interest in the connection between physical disability and mental
health; passionate about bringing attention to it.
Personal

From Los Angeles, CA

Born with Spina Bifida- L5S1, leg braces, shunt

Experience with anxiety disorder and depression
My Editorial

“‘Do you provide any mental health services geared for people with physical
disabilities?’ was a question I recently asked several mental health service providers in
Los Angeles. The response I heard most often was “What do you mean? Our services
are physically accessible”. This is an example of how, in the public conscience,
physical health and mental health are frequently viewed as separate issues. Inclusion
by current mental health services is beneficial but there is a need for mental health
services that are specifically geared towards people with physical disabilities. Like
other marginalized populations, they have their own concerns and needs that cannot
be met simply through inclusion. Studies indicate that people with physical disabilities
exhibit higher rates of depression and anxiety than the general population and are atrisk for experiencing rejection, isolation, and discrimination. According to the 2010
Census Bureau, there are 41.5 million U.S. adults living with a physical disability and
around 7 million of these adults report being “frequently depressed or anxious” while
5.9 million say they have trouble coping with stress...The need for mental health
services for adults with physical disabilities is expected to grow in the future. Children
with physical disabilities are increasingly being mainstreamed into general education
classes that include peers without physical disabilities who do not always understand
or attempt to initiate friendships with them. Social rejection can lead to low selfesteem and isolation. In addition, medical advances have allowed all people with
physical disabilities, congenital or acquired, to live into old age when they previously
did not. As the demand grows, it is important to develop specialized mental health
services for adults with physical disabilities.” (Bendik, 2014)
Anxiety

Anxiety Disorders (and Depression) are “social and emotional
consequences” of inadequate responses to stress (Mulligan,
2014). They are considered internalizing disorders.

Anxiety

Anxiety or Anxiety Disorder?


Stressor, intensity/length, impairment
Major types of anxiety disorders

Generalized Anxiety Disorder (GAD)

Panic Disorder

Specific Phobia

Social Anxiety Disorder

Agoraphobia

others: separation anxiety, selective mutism
Anxiety (cont.)

All anxiety disorders include these symptoms:
 Rigid/distorted
 Obsessive
thinking
thoughts
 Physical:
dizziness, sweating, trembling, trouble breathing,
detached from reality (dissociation)

Depersonalization Disorder
Depression


Symptoms

Difficulty concentrating and remembering details

Fatigue and decreased energy

Feelings of guilt, helplessness, and worthlessness

Insomnia or excessive sleeping; irritability/restlessness

Loss of interest in activities or hobbies that were once pleasurable

Overeating or appetite loss

Persistent aches, headaches, cramps, or digestive problems

Persistent sadness, anxiousness, or feelings of “emptiness”

Thoughts of suicide, suicide attempt
Special Considerations for people with Spina Bifida

Underlying medical condition
Mental Health Indicators: Risk or
Protective Factors

Social Ecological Theory
Disability and Mental Health

Children and adults with Spina Bifida (and other
disabilities) are at an increased risk of experiencing
symptoms of anxiety and depression (CDC).

A Rhode Island study showed that 29.8% of people with severe
disabilities suffered from frequent depression, compared to 14.6%
of people with moderate disabilities and 4.2% of people with no
disabilities. Thus, compared with the no disabilities group, people
with severe disabilities were 7 times more likely to report
frequent depression (defined as 15+ days a month).
Disability and Mental Health (cont.)

Congenital v.s. Acquired Disability

Jon Bateman (2013): “those who acquire disability bring
with them the self-awareness, social networks and cultural
identity that they had before they were injured. This is
something many people born with disabilities have difficulty
accessing because they’re already excluded from
mainstream society due to their conditions…..”Instead of
seeing themselves as a person above and beyond their
disability they can sometimes see a lack of distinction
between themselves and their physical circumstance. This
also happens regularly in schools and in the everyday
interactions of many people born with disabilities while
those who acquire disabilities are usually able to
successfully avoid this kind of “learned helplessness”
especially if their injury occurs in adulthood.”
Psychosocial Theories-Community/Interpersonal

Culture

Stigma
 There
is a stigma attached to people with disabilities, perpetuating
the idea that they are less valuable members of society than people
without disabilities. Children begin to prescribe to this stigma during
late elementary school, giving rise to the rejection and isolation that
inhibits the development of social competence (Salmon, 2013).
Psychosocial Theories-Community

Health

Incontinence
 https://www.youtube.com/watch?v=PEM_LWNNouA

Sexuality/reproductive ability

Chronic pain, latex allergy, shunt malfunction, pressure sores,
tethered cord, frequent surgery
Psychosocial Theories-Community

Productivity/Employment status

In 2014, 17.1% of people with disabilities in the U.S. were
employed (33% of them were part-time); 64.6% of people without
disabilities were employed (Bureau of Labor Stats, 2015).

Unemployment contributes to financial hardship, reduction of
social network, and psychological distress (Claussen,1999).

Causality Dilemma: depression leads to unemployment or vise
versa?
Psychosocial Theories-Interpersonal

Peer Relations/Social Support

Schools: Structural Inclusion v.s. social inclusion

80% of children with SB are taught in mainstream classrooms.

People with physical disabilities tend to have fewer friends and
less social acceptance from peers; less “positive peer
experiences” (Essner & Holmbeck, 2010).

Reduced opportunity to participate in social activities.

Physical play

Children who do not learn how to build and maintain friendships
turn into adults who lack interpersonal skills (Essner & Holmbeck,
2010).

Dating and marriage
Psychosocial Theories-Interpersonal

Family Dynamics

The way in which family members interact and live together.

Cohesive families, or those that have strong emotional bonds,
foster open communication and a positive attitude which is shown
to increase children’s social skills and general resiliency (Bennett
& Hay, 2007).


Low levels of family cohesion and high levels of conflict are associated
with anxiety, general fearfulness, and social avoidance.

Divorce
Restrictive parenting practices (i.e. limit time with peers)
contribute to low social competence, and thus, low self-esteem.
Cognitive Theories- Individual

Adverse early life experiences (Beck,1967)

Schemas
 Ex:
Negative Core Belief of “I’m no Good”

A minor negative event occurs, which activates our belief and
reinforces idea that the world is dangerous or terrible

Produces automatic negative thought (ex: “I always fail”)

Anxiety
 Cognitive
Distortions
 arbitrary
inference, personalization, catastrophizing,
overgeneralizing

Distorted thinking can be identified and treated in as early as 3rd
grade.
Prevention Strategies

Involvement in the SB community

Relationships and Social Support


Family, neighbors, friends, community/religious affiliations
Positive Self-Talk and Attitude

Parent’s attitudes directly relate to children’s attitudes

Build self-awareness
Prevention Strategies (Cont.)

Increasing independent living skills

Self-care: bladder and bowel management,
transferring, transportation, skin care,
appointment setting, medication, self-advocacy

Catheter Training

request a FREE copy of the Medikidz Explain Clean
Intermittent Catheterization comic book at
[email protected].
http://www.wellspect.u
s/For-users/Bladdermanagement/Yourchild-andcatheterization
Intervention Strategies

Tips for Parents

Peer Support/Group counseling

Talk Therapy
 Cognitive

Behavioral Therapy (CBT)
teaches people to evaluate their thinking about common difficulties,
helping them to change their thought patterns and the way they react
to certain situations. Helpful in improving core beliefs and reducing
cognitive distortions.
Intervention Strategies (cont.)

Relaxation Techniques

Medication




Children
Treat symptom or cause?
Anti-depressants
Most effective when combined with talk/behavioral therapy
Resources

SpinaBifidaAssociation.org

Spina Bifida/Hydrocephalus books and information for children:
http://www.sbhao.on.ca/programs-services/youth/kids-resources

National Alliance on Mental Illness Information Helpline – Trained
volunteers can provide information, referrals, and support for those
suffering from anxiety disorders/depression in the U.S. Call 1 (800) 950NAMI (6264), Monday through Friday, 10 am-6 pm, Eastern time. (NAMI)
http://www.nami.org/Find-Support/NAMI-HelpLine

Treatment.adaa.org - Search for treatment providers in the U.S. and find
advice on selecting the right doctor or therapist. (Anxiety Disorders
Association of America)

Podcasts for parents of children with anxiety disorders:
http://www.adaa.org/living-with-anxiety/children/podcasts-childrenteens

Anxiety info/self-help website for parents, children, teens, and adults:
https://www.anxietybc.com

Mental health apps: http://www.adaa.org/finding-help/mobile-apps

MindShift, T2 Mood tracker, Pacifica, Headspace, Panic Relief, Live OCD Free
Questions or Comments?
Thank You!
Lauren Bendik, MSW
E-mail: [email protected]
Works Cited

American Association on Health and Disability, 2008.

Beck, A. T. (1967). Depression: Clinical, Experimental, and Theoretical Aspects. New York: Harper & Row.
(Republished as Depressions: Causes and Treatment. Philadelphia: University or Pennsylvania Press, 1972.)

Kellie S. Bennett & David A. Hay (2007) The role of family in the development of social skills in children with physical
disabilities, International Journal of Disability, Development and Education, 54:4, 381-397, DOI:
10.1080/10349120701654555.

Bureau of Labor Stats, 2015.

Center for Disease Control, 2013.

Christopher Mulligan notes; 2014.

Coster & Haltiwanger, 2004; Rodriguez, Smith-Canter, & Voytecki, 2007

Claussen, 1999

Drake

Duquette, Marie-Michele, Carbonneau, Helene, & Jourdan, Collette (2015). Young people with disabilities: The
influence on leisure experiences on family dynamics. Annals of Leisure Research, DOI:
10.1080/11745398.2015.1122537

Holmbeck et al, 2003; Holmbeck et al, 2010; Essner and Holmbeck, 2010.

Honey A, Emerson E, Llewellyn G, Kariuki M. 2010. Mental Health and Disability. In: JH Stone, M Blouin, editors.
International Encyclopedia of Rehabilitation. Available online:
http://cirrie.buffalo.edu/encyclopedia/en/article/305/

Lépine, J. P., & Briley, M. (2011). The increasing burden of depression. Neuropsychiatric Disease Treatment, 7, 3-7.

North Carolina booklet

Oddson, B.E., Clancy, C.A., & McGrath, P.J. (2006). The role of pain in reduced qualify of life and depressive
symptomology in children with Spina Bifida. Clinical Journal of Pain, 22 (9),784-9.