DEPRESSION AND THE RISK OF SUICIDE Cruse Colin Murray Parkes

Transcription

1 DEPRESSION AND THE RISK OF SUICIDE Cruse 2015 Colin Murray Parkes

2 Depression Is Depression or Grief? How frequent is Major Depression after Bereavement? What Causes Depression? What Helps? Assessing the Risk of Suicide

3 Depression Is Depression or Grief? How frequent is Major Depression after Bereavement? What Causes Depression? What Helps? Assessing the Risk of Suicide

4 Distinguish Normal Grief from Clinical Depression Depressed feel helpless and hopeless all the time, grief fluctuates much more Depressed often slow in thought and actions or agitated and distraught, grief restless but less extreme

5 Continued Depressed wake very early feeling at their worst, grievers may find it hard to go to sleep. Depressed often blame themselves unreasonably for many things Depressed very poor appetite and severe weight loss, grievers may lose weight at first but soon regain it and may then put on too much

6 Good Question:- Has there been any time in the last two weeks when you have not been deeply unhappy?

7 Depression Is Depression a normal feature of Grief? How frequent is Major Depression after Bereavement? What Causes Depression? What Helps? Assessing the Risk of Suicide

8 Prevalence of Major Depression First Year after Bereavement 45% Acutely bereaved spouses at some time during first year (Bornstein 1973) After First Year 17% bereaved spouses (Bornstein 1973) 14% elderly bereaved spouses 25 moths after bereavement (Zisook 1994)

9 Depression Is Depression a normal feature of Grief? How frequent is Major Depression after Bereavement? What Causes Depression? What Helps? Assessing the risk of suicide.

10 Theories of Depression and their Implications Genetic Theory (Numerous papers) Stress Theory (ditto) Learning Theory (Seligman, Beck) Attachment Theory (Bowlby, Parkes) Psychoanalytic Theory (Freud) Sociological Theories All of the above.

11 Genetic Factors Incidence of Major Depression higher in Identical Twins than Fraternal Twins, even when brought up apart. Genes can only account for a predisposition to Depression.

12 Stress Theory Reid, IC & Stewart, CA (2001) Based largely on studies of animals, recent research shows that uncontrollable stress influences neuronal growth in the brain, vulnerability and plasticity. Major stressors over which the animal has no control can disrupt both activities of individual cells and neuronal networks. Anti-depressants reverse these effects.

13 Problems with Stress Theory Stress is too vague a term to be a satisfactory explanation. Much of what we call stress is beneficial! All mental processes are accompanied by physical changes in the brain. It is unclear whether these cause depression or result from it.

14 Seligman, MEP (1975) Learning Theory Formulated theory of Learned Helplessness- the cause of depression is the belief that action is futile. The central goal of therapy is the patient s regaining his belief that he can control events important to him.

15 The Cognitive Triad (Beck, 1967) The self comes to seem worthless The world pointless The future completely hopeless.

16 Attachment Theory Bowlby,J. & Parkes, C.M. (1970) The pang of grief is best understood as a reflection of the innate need to search for and find a loved person who is now lost. In the relatively uncommon circumstance of loss by death the search is frustrated and the consequence is helplessness.

17 Attachment Theory (Continued) Parkes research found high rates of anxiety & depression among bereaved psychiatric patients who report insecure attachments to parents in childhood.

18 Disorganised/Disoriented Attachment Family Rejection/Violence, Danger &/or Depression Child Unhappy, Tearful, Wishes self dead Adult lacks trust in self & others, at End of Tether Turns in, may harm self Bereavement - Anxiety/Panic, Depression, Alcohol Problems

19 Psychoanalytic Theory In melancholia the relation to the object is complicated by ambivalence. This hinders the work of mourning. Freud, S. (1917) Mourning and Melancholia, Ambivalence Approach/Avoidance Learned Helplessness Conflicted Grief sometimes leads to Depression.

20 Marital Conflicts and Emotional Reaction 2-4 years after Death of Spouse (Parkes & Weiss 1983) Marital Conflict High Low n Depressed 45% 19% Anxiety (Some or Great)82% 52% Feelings of Guilt re Loss 63% 33% Yearns for Spouse 63% 29%

21 Sociological Theory Anomie, Depression and Suicide (Durkheim) Higher rates of Depression in bereaved with few social supports (Stroebe) Loneliness in Bereavement in Old Age (Parkes)

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23 Depression Is Depression a normal feature of Grief? How frequent is Major Depression after Bereavement? What Causes Depression? What Helps? Assessing the risk of suicide.

24 What Helps? Social/Family Support Therapies that Reduce Helplessness Physical Methods of Treatment

25 Social and Family Support Kissane et al. Families with Low cohesiveness and expressiveness have high rates of depression after bereavement. Random Allocations study showed good response to treatment by Family-Focussed Grief Therapy provided that they are not hostile and highly conflicted.

26 Therapies that Reduce Helplessness Cognitive Behaviour Therapies (CBT) Supportive Psychotherapies.

27 Mary

28 Physical Methods of Treatment Anti-depressants Electro-convulsive Therapy (ECT)

29 Depression Is Depression a normal feature of Grief? How frequent is Major Depression after Bereavement? What Causes Depression? What Helps? Assessing the risk of suicide.

30 Is there a Risk of Suicide? Depression is the most frequent precursor of Suicide. Always assess the risk. Never be afraid to ask: Has it been so bad that you wanted to kill yourself?

31 What to do if risk of Suicide? Ask how they plan to do it? Assess immediacy of risk. Discuss with Supervisor and/or Psychiatrist even if client asks you not to. Refer on for Treatment of the Depression. Monitor success of referral.

32 Depression is infectious. Get support.

33 Thank you For your Attention

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