Contents. Dedication... Acknowledgements... Preface... Introduction...

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1 Contents Dedication... Acknowledgements... Preface... Introduction... xiii xiv xv xvi 1 Causes of depression... 1 Epidemiology of depression... 1 Gender and depression... 2 What is depression?... 3 Causes of depression... 3 Recognizing the symptoms of depression... 4 Depression as normal... 4 Different types of depression... 5 Major depression... 5 Typical symptoms... 5 Commonsymptoms... 5 Dysthymia... 6 Commonsymptoms... 6 Manic depression or bipolar disorder... 6 Mania... 7 Seasonal affective disorder... 8 Postnatal depression... 9 Anxiety Physical causes linked to depression Beliefs about depression Cultural beliefs about depression Lay beliefs and depression... 12

2 vi Contents Sociological beliefs Conclusion Reflection and discussion Why is it important to consider cultural beliefs about depression? Give some causes of depression Recognize some of the symptoms of depression Name some of the different types of depression Discuss the importance of recognizing the signs and symptoms of depression and how this influences patientcare References Depression in children and young people Introduction Incidence of mental disorder in children Causes of depression in young people Physical conditions Diagnosing depression in children Associated risk factors Treatment of depression in children and young people Drugtreatment Therapies Substance misuse in young people Cannabis or marijuana Self-harm and suicide Self-harming behaviour Suicide in young people Risk factors associated with suicide Conclusion Reflection and discussion What factors need to be considered when suspecting depression in children? What other factors need to be considered? Discuss appropriate treatments for depressed children and young people. Reflect on the impact of substance abuse in children and young people and the impact upon their mental health. Give examples of self-harming behaviour Describe the risk factors associated with suicide References... 32

3 Contents vii 3 Depression throughout the adult female life cycle Introduction Premenstrual syndrome and premenstrual dysphoric disorder Diagnosis of premenstrual syndrome and premenstrual dysphoric disorder Depression in pregnancy Anxiety and depression during pregnancy Postpartum depression Trans-cultural studies Predicting risk of postnatal depression Puerperal psychosis Depression related to the menopause Learning disabilities and the menopause Conclusion Reflection and discussion Discuss the importance of attaining a correct diagnosis for PMS and PMDD Why is it important to diagnose depression in pregnancy? Why is it important to recognize postpartum depression? Why is it important to consider depression during the menopause? References The impact of stress and depression upon work and well-being Introduction Causes of work-related stress and depression Bullying and harassment in the workplace Bullying in the workplace Depression and the ability to work The economic impact of stress and depression in the workplace Improving health and well-being and employer s responsibility Men and depression Paternal perinatal mental health Unemployment and retirement PTSDinmenandwomen Persistent symptoms experienced by PTSD sufferers Conclusion... 68

4 viii Contents Reflection and discussion What causes work-related stress and depression? Describe the types of workplace bullying How can employers help to improve health and well-being? How do you ensure that depression in men is addressed? Why is it important to understand posttraumatic stress disorder (PTSD)? References Depression in chronic disease and long-term conditions Introduction Depression and coronary heart disease Depression and stroke Depression and chronic obstructive airways disease Depression and renal disease Depression and diabetes Depression and cancer The role of the clinical nurse specialist in palliative care Neurological conditions Evidence regarding long-term conditions Conclusion Reflection and discussion Discuss the impact of depression on long-term conditions Give some examples of chronic diseases where depression is evident Discuss the importance of the role of the clinical nurse specialist in palliative care References Depression in later life Introduction Causes and incidence of depression in late life Depression and dementia Alcohol misuse in old age Anorexiainoldage Beliefs about depression The Geriatric Depression Scale Management of depression in old age Treatment Adherence, compliance and concordance... 99

5 Contents ix Types of treatment available Medication Psychological interventions Electroconvulsive therapy Suicide and older people Morbidity and mortality Perceptions of care workers caring for older depressed adults NationalServiceFrameworkforolderpeople Bereavementandgrief Kubler Ross stages of dying Ethnicity and depression Lifespan developmental theories Normalgriefreactions Abnormal or complicated grief Conclusion Reflection and discussion What factors influence depression in late life? Discuss adherence, compliance and concordance of treatment in relation to older people with depression Discuss the impact of suicide in older people Discuss the importance of the grieving process and the difference between normal and abnormal grieving References Useful website resources Suicide and self-harm Introduction Background on suicide Suicide rates and statistics Potential reasons for reduction in reported suicide rates in England National strategies to reduce suicide The role of the GP in the prevention of suicide Socio-economic factors associated with suicidal behaviour Discharge liaison, the role of the community psychiatric nurse and the care programme approach Potential guidelines and recommendations on suicide prevention prior to discharge Suicidal behaviour People associated with higher incidence of suicide Young people

6 x Contents Suicide and depression in young people with learning disabilities Prisoners Clergy Alcohol abuse Psychiatric illness associated with suicide HIV and AIDS Olderpeople Antidepressants and the risk of suicidal behaviour The importance of managing suicidal risk Risk assessment No-suicide contracts Review of risk assessment scales Self-harm Reasons why young people self-harm Self-harm and high suicidal risk The professional s role in suicide prevention Thedoctor srole Thenurse srole Conclusion Reflection and discussion Casescenariosandkeyobservations Reflect on the two case scenarios and discuss your actions with colleagues References Treatment for depression Introduction Antidepressants Types of antidepressants Psychological therapies Problem-solving therapy Counselling Cognitive behaviour therapy Guided self-help Groupwork Interpersonal psychotherapy Electroconvulsive therapy Exercise and dance Electromagnetic stimulation Compliance with treatment Accessing treatment Nurse prescribing Crisis resolution services

7 Contents xi Conclusions Reflection and discussion Casestudyscenarios Reflect on the case study and discuss your actions with colleagues Reflect on the case study and discuss your actions with colleagues References Ethnicity and depression and mental health and learning disabilities Introduction Prevalence of depression by race or ethnicity Ethnicity and diversity Monitoring ethnicity and inequality Depression in immigrants and ethnic minorities Treatment of depression Physical health, ageing and depression Supporting race equality Provision of services Depression in people with learning disabilities Low self-esteem in people with learning disabilities Leaning disabilities and self-harm Learning disabilities and self-injury Conclusion Reflection and discussion Why is it important to consider culture and diversity when providing care for people with depression? Why is it important to consider treatment options for ethnic minorities? What factors need to be considered in relation to physical health, ageing and depression? How can race equality be ensured in mental health care? What factors need to be considered in relation to people with learning disabilities who self-harm or self-injure? References Managing depression in primary and secondary care and evidence-based practice Introduction Evidence-based care for depression in primary care Management of depression in primary and secondary care

8 xii Contents National guidance for depression in children and young people Guidance on posttraumatic stress disorder in adults and children Patient s experience of depression and the expert patient Theexpertpatient Patient safety in mental health Nationalpatientsafetyagency Root cause analysis Barrieranalysis Suicide prevention: good practice guidelines Evidence-based practice Medicine management Improving access to cognitive behavioural therapy Mental health policy National suicide prevention strategy Care programme approach Screening for depression Progress on mental health reform Media reporting on suicide Mental health research Conclusion Reflection and discussion Using a step approach/model where should depressed peoplebetreated? What two key questions should be asked when assessing people for depression? What four key underlying principles need to be considered when balancing care needs against riskneeds? What key questions does root cause analysis ask? Name four barriers to managing risk? Share four examples from your clinical practice with your team. Discuss with your colleagues policies and strategies in relation to suicide and self-harm in your organization References Index

Depression care across the lifespan

Depression care across the lifespan Lynne Walsh MSc, BSc (Hons) RMN, RGN, RNT Dip Prof Practice, Cert Ed, Cert Health Promotion Lecturer School of Health Science Swansea University A John Wiley & Sons,