Depression (George Hales)

How to measure depression

With diagnostic tools: summarises emotions, behaviours, distress that typically occur together

What are the four D's

• distress

• dysfunction

• danger

• deviance from norms

DSM-5 definition of depression

Clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.

DSM-5 approach

• Committee of experts define the diagnosis

• Diagnostic categories are made up of’criteria’

• Criteria are symptom clusters that are grouped together based on intuition to bring reliability and to produce validity

• Every diagnosis has one or several criteria which contains one or several possible symptoms

What is the rule that is needed to meet a specific criteria

A number of symptoms must be present to meet a number of specifc criteria

Defining mental illness based on logical rules has

high reliability, but limited validity

DSM-5 major depression criteria (core symptoms)

• feeling of sadness or low mood

• loss of interest in usual activity

How long do core symptoms have to last

at least two weeks

What are the other common symptoms of depression

• change in appetite, losing or gaining weight

• sleeping too much or not sleeping well

• fatigue and low energy most days

• feeling worthless, guilty, and hopeless

• inability to focus/concentrate that may interfere with daily tasks

• movements that are unusually slow or agitated (a change noticeable to others)

• thinking about death and dying; suicide

How many symptoms should at least be present

five symptoms

WHO - “Globally, the total number of people with depression was estimated to exceed…

300 million in 2015”

Prevalence varies by country and gender, from a … among males in the Western Pacific Region to … among females in the African Region

• 2.6% among males

• 5.9% among females

Depression was the … most common reason for consulting a doctor or GP (Singleton et al., 2001)

third

Prevalence estimates of adolescent depression symptoms by region what is the percentage in the Middle East (Shorey et al., 2022)

64%

Prevalence estimates of adolescent depression symptoms by region what is the percentage in Africa (Shorey et al., 2022)

45%

Prevalence estimates of adolescent depression symptoms by region what is the percentage in Asia (Shorey et al., 2022)

40%

Prevalence estimates of adolescent depression symptoms by region what is the percentage in North America (Shorey et al., 2022)

20%

Prevalence estimates of adolescent depression symptoms by region what is the percentage in Europe (Shorey et al., 2022)

16%

Prevalence estimates of adolescent depression symptoms by region what is the percentage in South America (Shorey et al., 2022)

15%

Prevalence estimates of adolescent depression symptoms by region what is the percentage in Oceania (Shorey et al., 2022)

14%

The number of incident cases of depression worldwide increased of … (Liu et al., 2019)

50% from 172 million in 1990 to 258 million in 2017

Prevalence of elevated depression symptoms among adolescents increased from … (Shorey et al., 2022)

24% in 2001-10 to 37% in 2011-20

• estimated higher for females (32%) compared to males (24%)

Despite efforts to raise public awareness about mental health problems to reduce/prevent distress, prevalence has

increased

What is the polygenetic risk scores studies (Halldorsdottir et al., 2019)

estimates the effects of many genetic variants

• strongly associated with depression diagnosis, severity of symptoms, and age of onset

What is the study by Mandelli et al., 2015?

• reviewed and meta-analysed studies that evaluated childhood traumas 

• depression must have been assessed by clinical or structured interview, or self-report questionnaires

What did Mandelli et al., 2015 find?

Emotional abuse strongest association with depression (OR = 2.78) followed by neglect (OR = 2.75) and sexual abuse (OR = 2.42)

• significant associations also found for domestic violence (OR = 2.06) ad physical abuse (OR = 1.98)

What did Kraaij et al., 2002 do?

• meta analysis of 25 studies of specific types of negative life events and depression in old age

• grouped negative life events into categories:

  • severe illness of self or significant others

  • sudden unexpected events

  • negative events in relationships

  • daily hassles

  • abuse

Total number of negative life events and the total number of daily hassles had strongest relationship with

depression

• abuse, negative events in relationships, and severe illness all associated with depression

• sudden unexpected events not related to depression

Not all individuals who experience negative life events will develop depression because

resilience is a common response to negative life events (Masten, 2001)

Most influential theory ‘negative Triad Theory’ (Beck, 1967) states that depression arises from:

• negative schemas

• results in information processing biases (e.g. over sensitive to criticism)

• dysfunctional attitudes leading to absolute negative beliefs

Psychological risk factors: the cognitive model

Gender differences in depression, (Salk et al., 2017)

women are twice as likely as men to have depression, not due to men under-reporting depression (Parker & Brotichie, 2010).

Gender differences in depression possible factors (Salk et al., 2017)

• girls are more likely to be abused

• women more likely to be exposed to chronic stress (e.g. caregiving)

• women tend to provide more social support to others facing stress (dubbed the ‘cost of caring’)

• social roles

Treatment for depression

antidepressants in combination with CBT

Cognitive behavioural therapy

schemas and coping strategies

• i.e challenge dysfunctional thoughts and replace with rational beliefs

What did Lopez-Lopez et al., 2019 state

CBT yields larger decrease in depression scores to TAU

Psychoanalysis

depression a response to loss

• symbolic loss, e.g. losing a job

What did Zimmerman et al., 2014 state

more use of psychoanalytic techniques and greater number of sessions associated with better outcomes compared to CBT

Acceptance and commitment therapy

aims to increase psychological flexibility

What did Ruiz (2012) state

initial studies indicated ACT outcomes were comparable to CBT