Depression and Its Social Impact

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Questions and Answers

What percentage of adults experience depression at any one point in time?

10%

5% (correct)

Which statement best describes the relationship between depression and socio-cultural factors?

Depression is purely a biological disorder.

Socio-cultural context is irrelevant to understanding depression.

Only emotional symptoms influence the perception of depression.

Depression should be seen as a socio-cultural construct. (correct)

What is the lifetime prevalence range of depression according to the information provided?

2% - 21% (correct)

1% - 5%

10% - 30%

15% - 25%

What caution should be taken regarding diagnostic systems for psychological disorders?

They may hinder understanding due to over-medicalization. Signup and view all the answers

According to the information, what percentage of individuals with one major depressive episode may experience recurrence?

50% Signup and view all the answers

Which physiological symptom is associated with depression?

Marked loss of libido Signup and view all the answers

What cognitive aspect is commonly associated with a negative cognitive triad?

Sense of worthlessness Signup and view all the answers

Which emotion is NOT typically associated with depressive disorders?

Joy Signup and view all the answers

What behavioral symptom might a person showing signs of depression exhibit?

Lowered activity levels Signup and view all the answers

Which of the following is considered a social-interpersonal symptom of depression?

Disengagement from friends Signup and view all the answers

What type of therapy focuses primarily on changing negative thought patterns?

Cognitive Behavioral Therapy (CBT) Signup and view all the answers

Which treatment approach utilizes direct electrical stimulation to affect brain activity?

Electroconvulsive Therapy (ECT) Signup and view all the answers

Which of the following symptoms signifies a cognitive-motivational issue in depressive disorders?

Negative rumination Signup and view all the answers

What impact does inadequate care in childhood have on self-perception?

It builds a model of self as inadequate and unlovable. Signup and view all the answers

How do negative internal working models from childhood affect adults during stressful times?

They may generalize to a negative life outlook. Signup and view all the answers

According to the theory of causal attribution, depression is more likely if the attribution is perceived as which of the following?

Internal, stable, and global. Signup and view all the answers

What is the primary focus of the cognitive-behavioral approach to emotional difficulties?

Addressing thinking and behavior issues. Signup and view all the answers

Which of the following is NOT listed as a method for clinical assessment?

Patient self-reporting only. Signup and view all the answers

What classifications are considered when assessing depression?

Onset, severity, features, duration, and course. Signup and view all the answers

Which assessment tool is specifically designed to evaluate symptoms of depression?

Patient Health Questionnaire (PHQ-9). Signup and view all the answers

What additional factor is recognized in the evolved formulation of the cognitive-behavioral approach?

Social context in understanding difficulties. Signup and view all the answers

What is the primary focus of Interpersonal Therapy (IPT)?

Improving current interpersonal relationships Signup and view all the answers

Which of the following aspects is NOT a key feature of Cognitive Behavioral Therapy (CBT)?

Analysis of childhood traumas Signup and view all the answers

Who originally developed Interpersonal Therapy?

Gerald Klerman Signup and view all the answers

What does 'collaborative empiricism' in CBT involve?

Shared exploration of thought patterns Signup and view all the answers

According to the theoretical background of IPT, which factor is linked to psychiatric problems?

Insecure attachment to caregivers Signup and view all the answers

What is a common misconception about the aims of IPT?

Focusing solely on current interpersonal problems is sufficient Signup and view all the answers

What critical element is emphasized in the therapeutic relationship of CBT?

The dynamics of the relationship Signup and view all the answers

Which principle is emphasized during the intervention phase in CBT?

Engagement in both talking and doing Signup and view all the answers

What is NOT one of the interpersonal problems that IPT addresses?

Personality disorders Signup and view all the answers

What is the primary goal of the first phase of IPT?

Exploring difficulties and setting goals Signup and view all the answers

During which phase of IPT are solutions to problems actively worked on?

Phase 2 Signup and view all the answers

What does Behavioral Activation aim to reduce?

Avoidance and unhelpful behaviors Signup and view all the answers

What role does functional analysis play in Behavioral Activation?

It evaluates behaviors before, during, and after activities. Signup and view all the answers

Which of the following describes an outcome of successful Behavioral Activation?

Enhanced engagement in enjoyable activities Signup and view all the answers

Which aspect of depression does Behavioral Activation specifically address?

Reducing rewarding behaviors and activities Signup and view all the answers

Which classification system is produced by the American Psychiatric Association?

Diagnostic & Statistical Manual of Mental Disorders (DSM) Signup and view all the answers

What is a common depressive disorder listed in the DSM-5-TR?

Premenstrual Dysphoric Disorder Signup and view all the answers

Which of the following is NOT listed as a mood disorder in the ICD-11?

Disruptive Mood Dysregulation Disorder Signup and view all the answers

Which factor is NOT considered a broad determinant of depression?

Economic Status Signup and view all the answers

Which model relates closely to the understanding of interpersonal relationships in depression?

Interpersonal Model Signup and view all the answers

What neurotransmitter is primarily associated with depression according to biological theories?

Serotonin Signup and view all the answers

Seasonal Affective Disorder (SAD) is categorized as which type of disorder?

Other Syndromes with Depression Signup and view all the answers

Which of the following is considered a potential cause of depression?

Drug or alcohol use Signup and view all the answers

What type of disorder is characterized by depressive symptoms occurring after childbirth?

Post-natal Depression Signup and view all the answers

Which DSM-5-TR disorder is specifically designated for individuals experiencing significant mood instability?

Bipolar Type I Disorder Signup and view all the answers

Study Notes

Course Information

Course: Year 3: PS3112 Clinical Psychology
Date: 1 October 2024
Speaker: Dr Aftab Laher
Topic: Psychological Understanding and Treatment of Depression

Additional Information

Dr Aftab Laher is a Consultant Clinical Psychologist.
He is an Accredited Cognitive Behavioural Psychotherapist.
He is an Honorary Lecturer in Clinical Psychology.
He is in the School of Psychology at the University of Leicester.

Looking After Yourself (and Others)

The presentation advises students to step out or do what feels safe if they are experiencing distress.
Students can speak with the presenter or contact the Student Wellbeing Service at 0116 223 1780 or [email protected]

Aims

Explore the nature of "depression".
Provide an overview of classification and clinical diagnosis.
Examine the causes and theories of depression.
Consider the clinical assessment of depression.
Summarize the psychological treatment approaches to depression.
Focus on CBT for adults.
Critically examine how depression has been conceptualized, categorized, and treated.

Nature of Depression

Quotations are provided from various sources describing depression.
J.K. Rowling describes depression as the absence of hope and a deadened feeling, different from sadness.
Dorothy Rowe describes depression as a prison.
An anonymous source describes depression as walking down a dark hallway, not knowing when the light will turn on.

Depression as a Clinical Syndrome

Depression is a clinical syndrome distinct from sadness, characterized by a non-transient depressed mood.
Key themes include pervasive feelings of loss, emptiness, entrapment, worthlessness, and hopelessness.
Impairment in daily functioning.
Clinical presentation can be "masked" or vary.
Symptoms include physiological, emotional, cognitive-motivational, behavioral, and social/interpersonal components.
Recognizing depression as a societal construct is important.

Epidemiology of Depression

280 million people worldwide experience depression (WHO, 2023).
The lifetime prevalence is estimated at 2%-21%. (Gutiérrez-Rojas et al., 2020).
Prevalence in community samples reached 32% during the COVID-19 pandemic (Dettman et al., 2022).
A significant portion of primary care patients experience recovery from depression (35-60%) with some experiencing chronic illness. (Steinert et al., 2014).
The risk of recurrence is over 50% with one major episode.

Overview of Classification & Diagnosis

The WHO's International Classification of Diseases and the DSM system produced by the APA are two major systems for classifying and diagnosing psychological disorders.
Specific ICD and DSM subtypes of depressive and bipolar disorders are listed.

Caution Regarding Diagnostic Systems

Diagnostic systems can be helpful but also hinder the understanding of psychological disorders.
There's debate on how diagnostic categories are developed and applied.
Systems may promote "over-pathologizing" or "over-medicalizing" psychological disorders,
Socio-cultural context is frequently disregarded.

ICD-11 and DSM-5-TR

Specific depressive and bipolar disorders from ICD-11 and DSM-5-TR are presented in lists.

Major Depressive Disorder

Diagnostic criteria are outlined in a table from the DSM-5, including symptoms (e.g., depressed mood or loss of interest, nearly daily for 2 weeks, etc.).
Diagnostic criteria for recurrent MDD are also listed in the table

Other Syndromes with Depression

Other conditions associated with depression listed include; Seasonal affective disorder (SAD), psychotic depression, post-natal depression, and adjustment disorders (reactive depression).

Causes & Theories of Depression

The presentation outlines various factors contributing to depression, including:
- Lifestyle.
- Life history.
- Personality.
- Other illnesses.
- Socio-cultural context.
- Genetics/ biomedical factors.
- Life events/ stress/ big changes.
- Conditioning/ learning.
- Cognitive style/ outlook/ meaning-making.
- Drugs/ alcohol

Depression Often Associated With

A list of factors often correlated with depression is presented, encompassing bereavement, relationship difficulties, work problems, family problems, isolation, and role change/ loss of personal identity.

Theoretical Approaches

Biological, behavioural, personality, psychodynamic, attachment, cognitive, and interpersonal models are discussed as potential explanations for depression.

Biological Factors

Moderate heritability is seen through twin and family.
Neurotransmitter imbalances/ dysregulation (serotonin, norepinephrine, cortisol, and dopamine) are potential contributing factors.
Other brain and neuropsychological abnormalities can also play a role.

Behavioural Factors

Learned Helplessness (classical conditioning).
Reduction in positive reinforcement/ increase in negative reinforcement (operant conditioning).
Social learning.
Formation of "vicious cycles" of depression-sustaining behaviours.

Psychodynamic Approach

Freud's concepts of mourning and melancholia are compared, differentiating them.
Both conditions involve pain.
Loss is a key element.

Later Developments (Neo-Freudian)

Object Relations Theory, an updated psychodynamic approach is shown
Depressive vulnerability originates from caregiver interactions.
Depression often arises from losing close relationships.

Attachment Theory

John Bowlby and Mary Ainsworth's influence on attachment theory is noted.
An attachment theory model of self and other is presented.
Children with inadequate care may develop negative self-images and negative views of others.

Cognitive Models

The theory of causal attribution (re-formulated learned helplessness).
Attribution of depression to internal, stable, global factors is highlighted – factors like these.
Beck's cognitive-behavioral approach, emphasizing thinking and behavior.
Evolved formulation- acknowledging socio-cultural context.

Assessment

Comprehensive clinical assessments are vital.
Clinical interviews, observations, and psychometric questionnaires (e.g. PHQ-9, BDI-II, HADS) are highlighted as valuable tools
Information from other sources is important when obtained with patient consent.

Classification of Depression

Onset (sudden/ gradual).
Severity (mild/moderate/severe).
Features (melancholic, catatonic, etc.).
Duration.
Course/ recurrence (longitudinal, seasonal, rapid cycling, etc.).
Aspects to consider when classifying depression.

Core Dimensions

Physiological, emotional, cognitive-motivational, behavioral, and social/interpersonal domains are core aspects to consider when analyzing depression.
Listing of specific examples of these dimensions and descriptions is presented.

Treatment

Talking therapies, including CBT, IPT, and others are presented as ways to approach treatment
Brain stimulation approaches are also mentioned.

CBT

CBT is an evidence-based therapy aimed at identifying unhelpful thoughts and behaviors.
The therapy method employs techniques like cognitive restructuring, behavioural activation, and others.
Brief CBT models, online approaches, and approaches for cognitive impairment are listed.

Aims of CBT

To change unhelpful thoughts, beliefs, behaviours, and patterns of interacting with the environment while addressing adverse systemic and environmental variables.
Involves cognitive reframing (using 'talking' and 'writing' to challenge negative thinking).
Behaviour changes, activity planning, and 'experiments' are incorporated
Social and environmental context modifications are encouraged.

CBT Model Core Aspects

Reciprocal interactions between biological/psychological, and social/environmental systems are key aspects in the model
Prominence in cognition, especially subjective meaning/appraisal, is vital within the CBT approach.

IPT

A short-term therapy focusing on current interpersonal relationships and needs.
The onset and fluctuations of depression are understood through the lens of interpersonal issues.
Methods to deal with interpersonal problems effectively.

IPT – Core Aspects

Difficulties in interpersonal roles, transitions, loss, and deficits are central areas of interest for IPT.

IPT– How it Works

Three phases are involved:
- Phase 1 (2-4 sessions): Understanding the issues, agreeing on diagnosis, and collaboratively planning goals.
- Phase 2 (4-8 sessions): Actionable steps are used to solve problems and achieve goals.
- Phase 3 (2-3 sessions): Preparing for the end of therapy and maintaining gains.

Behavioural Activation

A therapy method used to reduce depression rooted in behavioral therapy.
Focuses on increasing engaging and rewarding behaviours to confront the cycle of inactivity and disengagement, improving motivation and energy.

Summary

Depression is more complex than sadness. It is a pervasive condition requiring several factors.
Multiple factors influence individuals and depression is often multi-factorial.
Several types of therapy can be effective, including CBT and IPT.
Medication and biological interventions may be necessary for severe or persistent cases.

Additional Points

A website for the speaker's contact information is included.

Studying That Suits You

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Description

This quiz explores key concepts related to depression, including its prevalence among adults and the influence of socio-cultural factors. You will also learn about the implications of diagnostic systems and the rates of recurrence in individuals with major depressive episodes.