Chapter 10: Depressive Disorders and Suicidal Behavior
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111 Terms
What is anhedonia?
Losing interest or enjoyment in activities
How are symptoms of depression in school-aged children more likely to present when compared to adults?
Externalizing behaviors: irritability, disruptive behaviors, and temper tantrums
How long must symptoms be present in order to be diagnosed with Major Depressive Disorder (MDD)?
At least 2 weeks
How often must symptoms be present throughout the day in order to be diagnosed with MDD?
Most of the day on most days
How many symptoms are needed in order to be diagnosed with MDD?
At least 5
What must at least one of the symptoms be in order to be diagnosed with MDD?
Depressed mood (or irritability in children)
OR
Anhedonia, loss of interest or pleasure
What is important to look for when considering a diagnosis of MDD, especially in children?
Significant changes in behavior
Is MDD more common in males or females? How does this change in childhood vs. adolescence?
MDD is more common in females than in males
→ Childhood: 2:1
→ Adolescence: 3:1
How are rates of depression affected in adolescence?
Rates of depression double during adolescence
In what areas might depression cause impairment in a child’s life?
At school, with family, and in their social life
What disorder has the highest rates of comorbidity with MDD?
Anxiety disorders
What other disorders are also commonly comorbid with MDD?
Persistent Depressive Disorder
Conduct Disorders
ADHD
Substance-Use Disorder
If you have been diagnosed with MDD, how likely are you to have at least one other comorbid disorder?
Having at least one comorbid disorder occurs in about 90% of cases
How many people with MDD have at least 2 or more comorbid disorders?
About 50%
Comorbid disorders with MDD almost always…
Come before the onset of MDD
Is MDD or comorbid disorders more likely to persist?
Comorbid disorders are more likely to persist over time
Having comorbid disorders alongside MDD increases risk in what 3 areas?
Increases the risk of recurrent depressive episodes
Increases the risk of severity and longevity of depressive symptoms
Increases the risk of suicidal ideation
How common is MDD in childhood and adolescence?
A range of about 2% to 8%
What is the most common age of onset for MDD?
Between 13-15 years old
Is the onset of MDD sudden or gradual?
Onset of MDD can be sudden or gradual (ex. depressive syndromes)
When is MDD most difficult to diagnose?
In children younger than 7 years old
What is the course of MDD?
MDD occurs in episodes: symptoms of an episode will eventually recede, but there are usually recurrent depressive episodes later in life
When depressive episodes first occur earlier on in childhood, what is true about recovery and risk?
Recovery: younger children usually recover quicker from depressive episodes
Risk: the earlier the first depressive episode, the higher risk of having recurrent episodes later in life
When the onset of MDD occurs in youth, how likely are children to have had a recurrent depressive episode within 1 year, 2 years, and 5 years?
→ 25% of youth will have a recurrent episode within 1 year
→ 40% of youth will have a recurrent episode within 2 years
→ 70% of youth will have a recurrent episode within 5 years
What did Persistent Depressive Disorder (PDD) used to be called?
Dysthymia
How does the severity of symptoms compare between PDD and MDD?
Symptoms of PDD are less severe but more chronic than in MDD
How long must symptoms be present in order to be diagnosed with PDD?
At least 1 year, for most of the day, on most days
Can someone have both MDD and PDD?
Yes, this is referred to as “double depression”
What is Disruptive Mood Dysregulation Disorder (DMDD) characterized by?
Having a persistent irritable/angry mood and severe temper outbursts
In order to be diagnosed with DMDD, how often must a child be having severe temper outbursts?
At least 3 times a week
In order to be diagnosed with DMDD, how long must persistent irritable/angry mood be present?
At least one year, occurring on most days, for most of the day
Between what ages is DMDD most commonly diagnosed?
Between 6 - 10 years old
How might the symptoms of DMDD change as a child gets older? How would this impact diagnoses and treatment?
As the child gets older, symptoms of irritability tend to change to symptoms of sadness
→ The child’s diagnosis and treatment plan would change
Is DMDD more common in males or females?
DMDD is more common in males
What are some ways that depression may cause impairment in intellectual and academic functioning?
Difficulty concentrating
Speed of informational processing slows
Brain fog
Stop coming to class
Decrease in academic performance
Does a decrease in academic performance in children with depression represent a low IQ?
No!
What kinds of cognitive biases and distortions are a hallmark characteristic of depression?
Automatic negative thoughts
What are automatic negative thoughts?
Self-critical thoughts reflecting feelings of worthlessness and hopelessness
What are the 8 types of cognitive distortions?
Arbitrary inference
Dichotomous “all or nothing” reasoning
Discounting the positive
Emotional reasoning
Minimization/magnification
Overgeneralization
Personification
Selective abstraction
How do arbitrary inferences distort one’s thinking?
Drawing conclusions about something without having all the facts
What is an example of an arbitrary inference?
Thinking “my friends must hate me” because they haven’t texted you yet today
How does dichotomous “all or nothing” reasoning distort one’s thinking?
Viewing things as either black or white and overlooking the possibility that things may lie on a spectrum
What is an example of dichotomous “all or nothing” reasoning?
After failing one test, thinking “I failed this test so I am a complete failure”
How does discounting the positive distort one’s thinking?
Identifying only negatives in positive situations or events, or turning positive results into negative ones
What is an example of discounting the positive?
After doing well on a test, thinking “I just got lucky”
How does emotional reasoning distort one’s thinking?
Using one’s feelings about something to rationalize one’s thoughts, assuming that something is true simply because it feels true
What is an example of emotional reasoning?
Thinking “I feel so nervous, I’m definitely going to bomb this interview”
How does minimization/magnification distort one’s thinking?
Over-emphasizing the negative situational attributes while downplaying the positive ones
What is an example of minimization/magnification?
After classmates compliment your presentation, thinking “I’m definitely going to fail because I mispronounced that one word”
How does overgeneralization distort one’s thinking?
Drawing overly broad conclusions from standalone events; using singular cases to draw conclusions about all other events
What is an example of overgeneralization?
After going on one bad date, thinking “I’ll never be able to find a relationship”
How does personalization distort one’s thinking?
Feeling personally to blame for things that are beyond your control
What is an example of personalization?
After a friend had to cancel a lunch date for a personal emergency, thinking “they canceled because they don’t want to hang out with me”
How does selective abstraction distort one’s thinking?
Using a single or small negative attribute to draw conclusions regarding a whole scenario
What is an example of selective abstraction?
After receiving multiple compliments on a project, only being able to focus on the one criticism they got
What are the 3 main cognitive characteristics associated with depression?
Attributions
Depressive rumination style
Hopelessness
What are attributions?
How one explains the causes of events
What are the 2 spectrums that help explain different attribution types?
Internal (my fault) vs. external (their fault)
Stable (always) vs. unstable (sometimes)
What type of attributions would someone with depression have in response to their failures? How do these attribution types reinforce depression?
Internal and stable attributions
→ Lead to developing feelings of hopelessness
How would someone who has depression respond to their failures with internal/stable attribution types such as failing a test?
“I’m a total failure and I will never be able to do anything right”
What type of attributions would someone with depression have in response to their successes? How do these attribution types reinforce depression?
External and unstable attributions
→ Discredits their efforts and reinforces feelings of low self-esteem
How would someone who has depression respond to their successes with external/unstable attribution types such as getting a good grade on a test?
“The teacher must have made the test super easy and I got lucky”
What is a depressive rumination style?
After experiencing a negative event, one will continue to repeatedly focus on and think about the negatives of the situation (ex. how bad it feels, why it happened, etc.)
How does a depressive rumination style reinforce depression?
It’s a passive thought process that doesn’t actually change anything and only makes someone feel worse
Why are feelings of hopelessness in depression such a red flag?
They can lead to suicidal ideation
How is self-esteem affected with depression?
Develops extremely low self-esteem, especially in adolescence
Does self-esteem stay the same with depression?
No, self-esteem fluctuates based on stressors!
→ One can be feeling okay one day and have slightly higher self-esteem…
→ And the next day they can go through a stressful experience and have much lower self-esteem…
How are social interactions affected by depression?
Leads to high withdrawal from social interactions, reinforcing feelings of loneliness and isolation
Does social withdrawal reflect a deficit in social skills for people with depression?
No! Depressive symptoms interfere with functioning
How much more predisposed is someone to developing depression if their parents have a history of depression?
30% heritability rate
What are 2 ways that family dynamics can interact with children with depression?
Family might not even be aware that their child is depressed due to social withdrawal and not wanting to tell anyone what’s wrong
→ Child’s depression goes untreated
Family may struggle to effectively comfort their child because they don’t fully understand the severity of depression
→ Child feels more alone
Do the majority of people who have depression die by suicide?
No! But those who do almost (if not) always have depression…
What are the 5 main stages included in the range of suicidal behavior from least to most severe? How many people continue on to each step?
Less and less people continue on to each suicidal behavior
Suicidal ideation
Makes a suicide plan
Attempts suicide
Attempts suicide and requires medical intervention
Dies by suicide
Why do people die by suicide? Explain Thomas Joiner’s theory.
Thomas Joiner’s theory: everyone who dies by suicide feels three things at the time of their death
Failed sense of belongingness
Perceived burdensomeness
Hopelessness (that 1. and 2. will never change)
What are some examples of how perceived burdensomeness (from Thomas Joiner’s theory) presents in children?
“No one will miss me”
“It wouldn’t matter if I died”
“People would be better off without me”
What is the gender paradox of suicidal behavior between males and females?
Males are more likely to die by suicide…
While females are more likely to attempt suicide
How much more likely are males to die by suicide?
3-4 times more likely
How much more likely are females to attempt suicide?
2-3 times more likely
What is the most common means for males to use when engaging in suicidal behavior?
Firearms (higher lethality)
What is the most common means for females to use when engaging in suicidal behavior?
Overdose or cutting (lower lethality)
What are 4 reasons that explain the gender paradox of suicidal behavior?
Males are less likely to reach out for help
Males are more likely to use more lethal means
Males are less likely to receive treatment
Females are more likely to have more protective factors
What is the average age range for first suicide attempts?
Around ages 13-15
When does the rate of suicide attempts double?
During adolescence
What is the most dangerous common myth about suicide prevention?
Why is this not true?
What evidence-based suicide prevention program proves this myth wrong?
“Asking someone if they’re considering suicide will increase the likelihood that they will attempt suicide by ‘putting the thought in their head'”
→ The opposite of this myth is true! By asking someone if they’re thinking about suicide it decreases the risk that they will attempt suicide!
→ QPR Suicide Prevention Training!
Question: “Are you thinking about suicide?”
Persuade: To get help
Refer: To mental health professionals
What is another common myth about suicide prevention?
Why is this not true and what is a corrective emotional experience?
What interview project proves this myth wrong?
“If you prevent one suicide attempt, the person will just come up with another plan and try again”
→ The opposite of this myth is true! Preventing one suicide attempt acts as a corrective emotional experience and decreases the risk that someone will attempt suicide again!
→ The Golden Gate Survivors Interviews: the first thing that survivors felt after jumping was immediate regret
What is the main assumption that informs the behavioral theory of depression?
Depression is maintained by behavior: when anhedonia causes someone to stop doing things they enjoy and withdraw socially, they will feel worse because they are not receiving any positive reinforcements from engaging in rewarding activities
How does the behavioral theory of depression inform treatment?
Behavioral treatment aims to increase someone’s participation in pleasant and rewarding activities in order to increase reinforcement and decrease feelings of depression
What “homework” are people given when receiving behavioral treatment for their depression?
Activity scheduling (“behavioral activation”): Do an activity they used to enjoy for at least 5 minutes every day
→ Will provide more positive reinforcement and help them feel better
What is the main assumption that informs the cognitive theory of depression?
Depression is maintained by our thought processes: how we think about things in our lives influences the way that we feel about them and further influences our mood
What are the 4 main depressogenic cognitions that maintain depression according to cognitive theory?
Hopelessness theory
Negative attributional style
Negative cognitive triad
Negative cognitive schemas
What is the main idea of hopelessness theory?
Feeling hopeless leads to the development of learned helplessness
→ “What’s the point in trying?”
What are the negative attributional styles associated with depression and what do they lead to?
Internal, stable, and global attributions
→ Over time, leads to hopelessness
What is the negative cognitive triad?
How we view:
Ourselves
The world
Our future
Hopeless: “I’ll always be like this…”
What are negative cognitive schemas?
How we comprehend information from the outside world and how we use it to control the way we see ourselves
What causes depression?
There are multiple pathways that lead to the development of depression, including:
Heritability
Family experiences
Life stress
What is the heritability rate for depression?
About 30% - 40%
How much more likely are you to develop depression if you have a parent with depression?
About 3 times more likely
How can family experiences influence the development of depression?
Punitive or unsupportive responses to the child
Parents with depression struggle to support their child to their best capabilities
How does life stress influence the development of depression?
Life stress often comes before the onset of a depressive episode
Can only major life stress result in a depressive episode?
Can positive change result in a depressive episode?
Major and non-major life events can lead to a depressive episode
→ Any change is stress! Not just bad change!