Sex Difference
Anyone can get depression no matter the age, sex or even economic status. Never the less, …show more content…
there have been studies that link certain differences. For example, “with regard to sex differences, women are more likely than men to experience depressive episodes, with lifetime prevalence of 19.2 and 13.5%, respectively” (Lopez Molina et al., 2014) Molina et al. found that “the following symptoms of depression are more prevalent in women: sadness, crying, difficulty making decisions, lack of energy, self-criticism, irritability, changes in self-image, work difficulty, and loss of interest in sex.” (p. 139) This difference is now more prevalent among younger woman born in the past decade than before. For example, a Swedish sample of 1052 young adolescents Lundh showed that negative self-image, sadness, loneliness, fatigue, and somatic complaints were significantly higher among girls than among boys (As cited in Lopez Molina et al., 2014). This is of no surprise since “due to recent, historic changes, women have become increasingly responsible for financially contributing to the family by working outside of the home to generate income. At the same time, these financial efforts, combined with continued domestic duties, have led to an overload of work and responsibilities.” (Lopez Molina et al., 2014)
Another difference between woman and men is their perspective on depression. In a study of teenagers regarding the social representations of depression, Aragão et al. observed that women express depression through pain, sadness, and unhappiness and describe a depressed person as someone who is in crisis. (As cited in Lopez Molina et al., 2014) By contrast, men might see depression as someone being lonely.
Family background
Another factor to consider when treating patients with depression is their family background and economic status. There is a big debate weather a family from low income status might be more prone to depression. Compared to wealthy families, those exposed to economic stressors might be at bigger risk. Socioeconomic status to depression have been examined, such as exposure to stressful life events, financial strain, parenting behaviours, family structure, social networks, victimization, neighborhood disorder and psychosocial coping resources (Mossakowski, 2013). All this could lead to a person feeling generally negative about him or herself, making it important to consider low self esteem when talking about depression. Social evaluation theory argues that youths and young adults from families with low SES can feel inferior and internalize their perceived disadvantage when they judge themselves compared with others with higher status life- styles (Mossakowski, 2013). As the years pass by, children may accumulate all this stressors making them an easy target for depression. Longitudinal studies have demonstrated that the number of years that American families have experienced poverty status significantly increases levels of depressive symptoms among children, adolescents and young adults, regardless of current socioeconomic conditions and earlier mental health problems (Mossakowski, 2013).
Efficacy of antidepressants
Efficacy of antidepressants and substance abuse is another major concern among depressive patients. Kaminer et al. argues that depression, together with substance use disorders (SUDs), are both the most common mental illnesses in adolescents and young adults. Both disorders tend to co-occur increasingly, accounting for about three- quarters of the burden of all mental illness in this age group (as cited in Zhou et al., 2014). This may be because young people, compared to adults, are more likely to try new drugs, drink alcohol and misuse medication. For this reason, “clinicians are often reluctant to prescribe antidepressants for depressed young people with SUD” (Zhou et al., 2014, p. 38). The major controversy is whether to treat pharmacologically these depressed youths with ongoing substance abuse (Zhou et al., 2014, p39).
Depression Among College Students
College students are also at risk of depression.
The American College Health Association states that the rate of college students diagnosed with depression increased from 10% in 2000 to 15% in 2006 (as cited in Mahmoud, Staten, Hall & Lennie, 2012). From a developmental perspective this age group is considered as emerging adulthood, where they start getting more responsibilities and becoming more independent of their parents. Dusselier explains that young adult college undergraduates face numerous academic, financial, and social stressors that may negatively alter their mental health (as cited in Mahmoud, Staten, Hall & Lennie, 2012). More importantly Beck & Clark mention that Depression and anxiety are not directly caused by stressors; rather, it is a state that results from an individual’s perception and reaction to those stressors (as cited in Mahmoud, Staten, Hall & Lennie, 2012). What makes the difference is a person’s ability to to learn how to cope with such stressors in life. Blanchard-Fields et al. argues that several studies have indicated that adolescents and young adults used more maladaptive coping strategies, such as escape-avoidance, as compared to other age groups (as cited in Mahmoud, Staten, Hall & Lennie, 2012). Also, “Students who lived with someone or belonged to a social organization were less depressed, anxious, and stressed than those who did not. Students who identified themselves as religious were less depressed and anxious than those who were not religious” (Mahmoud, Staten, Hall & Lennie,
2012).
Depression Among Adolescents
Depression among adolescents has recently been a topic in research. There is no surprise that with the many physical, emotional, psychological and social changes that accompany this stage of life children going through puberty have a higher chance of getting this disorder. Even though the rate for adolescent depression has gone up there is still not enough programs to treat everyone. Altogether, the high rates and the high public health burden of depression, together with failure to seek treatment, suggest the need for effective easily accessible interventions targeting adolescents with symptoms of depression (Garvik, Idsoe & Bru, 2013).
Effective Programs for Depression:
PRP
One of the programs specifically targeted for adolescents in school is The Penn Resiliency program (PRP). It is a Cognitive Behavioral (CB) intervention for young adolescents that in is intended for delivery in schools. PRP found that the program significantly reduces depressive symptoms for at least 12 months post intervention (Gillham et al., 2012). The study for this program was successful in showing that a program can be delivered in a group setting lead by educators or regular people from the community. “PRP includes 2 major components. The first component is based on CB therapy for depression, students learn about connection between interpretations and feelings and behaviors” (Gillham et al., 2012). In the second component, students learn a variety of skills for solving interpersonal and other problems and for coping with stress. Students learn strategies for assertiveness, negotiation, creative problem solving, decision making, and relaxation (Gillham et al., 2012).
CBT
Group-based cognitive behavioral therapy (CBT) interventions for depressed adolescents have provided good effects as demonstrated through several efficacy studies for adolescents with diagnosis of major depression or dysthymia and also as prevention of further development for adolescents with subclinical depression (Garvik, Idsoe & Bru, 2013). The ‘Coping with Depression Course’ (CWDA), originally developed by Lewinsohn and colleagues, is currently one of the most widely used psychological treatments for depression in the world Studies have demonstrated efficacy for CBT group interventions not only as prevention for adolescents with subclinical depressive symptoms but also as treatment for adolescents with diagnoses of major depression or dysthymia (Garvik, Idsoe & Bru, 2013)
Moreover, a CBT-based group intervention program shows promise in assisting the reduction of negative symptoms in young adults with ASD (McGillivray & Evert, 2014).
On a study CBT group based intervention done by McGillivray and Evert (2014), the results were also promising in terms of assisting adolescents and young adults to better understand the role of stress in their lives. In particular, the participants discussed how individual perceptions can impact on the appraisal of situations, which in turn can affect physiological and emotional response. In addition to all the positive research done with CBT, it is important to note that the cost-effectiveness of CT in a group format relates to treating a greater number of clients at a time and reducing wait lists (Hallis, Cameli, Dionne & Knäuper, 2016); this could be the big benefit compared to individual CBT.
Combining Acceptance
Despite CT’s status as the gold standard treatment for depression and its widespread empirical support, some studies have shown that 30% to 60% of clients with depression fail to experience significant improvement with pure CT (Hallis, Cameli, Dionne & Knäuper, 2016). There have been many different therapies that can also benefit depressed people. For example, Acceptance and Commitment Therapy (ACT), seeks to promote psychological flexibility by encouraging clients, with the use of acceptance and mindfulness techniques, to open up to their distressing experiences in order to move forward in their lives guided by their values. (Hallis, Cameli, Dionne & Knäuper, 2016). Thus, ACT assumes that our reality changes depending on context and that it is more helpful to look at what works (work- ability or functionality) rather than what is true (reality testing). CT targets the form and frequency of mental experiences whereas ACT tends to focus on the context of thoughts, feelings and physical sensations (Hallis, Cameli, Dionne & Knäuper, 2016). Hallis et al. (2016) suggest that it can be beneficial to include traditional cognitive restructuring techniques for the treatment of depression and that two philosophical approaches (contextualism and elemental realism) can be included in one treatment as long as clients understand the differences between the approaches and are guided in selecting which strategies work best for them.
Mindfulness
Suicidality often recurs with depressive episodes. In fact, of all the noncore symptoms of depression (symptoms other than negative mood and anhedonia), suicidality has been found to be the one that reemerges most consistently (Barnhofer et al., 2015). Mindfulness-based cognitive therapy has been shown to be effective in reducing risk for relapse and recurrence in depression (Barnhofer et al., 2015). MBCT has been specifically designed to help participants become better able to recognize and disengage from maladaptive patterns of thinking. Training in mindfulness aims to serve this purpose by cultivating a metacognitive mode that allows patients to “decenter” from negative thinking, that is, to observe their “thoughts and feelings as temporary, objective events in the mind, as opposed to reflections of the self that are necessarily true” (Barnhofer et al., 2015). In a study done by Barnhofer et al., (2015), participants in the MBCT group showed a general reduction in suicidal cognitions, suggesting that in participants of this group, suicidal cognitions were less likely to spiral in response to the occurrence of depressive symptoms.
Discussion
Staff and patient experience of improving access to psychological therapy group interventions for anxiety and depression principally recommend cognitive behavioral therapy (CBT) for the treatment of most cases of anxiety and depression, and all IAPT services are required to deliver CBT alongside other NICE-approved therapies (Newbold, Hardy & Byng, 2013). Additionally, the limited existing research comparing the effectiveness of group versus individual CBT indicates only small differences in effectiveness, suggesting that group CBT may be a valid response to the high demand on primary care mental health services (Newbold, Hardy & Byng, 2013). There are 12 main factors that facilitate change in group psychotherapy. These include altruism, group cohesiveness, universality, interpersonal learning, guidance and catharsis, identification, family re-enactment, self-understanding and instillation of hope and existential factors (Newbold, Hardy & Byng, 2013). In Newbold, Hardy and Byng (2013) conducted a study where they interviewed participants that went though group therapy sessions to find out how they really felt. This allowed them to compared individual and group therapy.
In regards to self-disclosure; some patients were apprehensive about the prospect of group work because they feared revealing publicly that they had a mental health problem (Newbold, Hardy & Byng, 2013). In regards to normalization; on attending a group session, patients felt a great sense of relief that others had similar problems. This helped them feel normal, reducing anxiety (Newbold, Hardy & Byng, 2013). In regards of feeling connected; patients enjoyed having people to talk to who understood how they felt and somewhere to go to meet others with the same problem (Newbold, Hardy & Byng, 2013). In regards to group support; as the group sessions progressed, patients were able to give and receive support from each other as well as the therapist (Newbold, Hardy & Byng, 2013). In regards to the role of hope; being part of a group where people with the same problem got better brought hope for patients’ own recovery (Newbold, Hardy & Byng, 2013). Group interaction was not always positive, with some patients taking more opportunity to talk than others (Newbold, Hardy & Byng, 2013). And lastly, some suggestions were made on improving group-based work, including keeping the number of patients small enough for all to have the chance to contribute (Newbold, Hardy & Byng, 2013).
After all the research done about adolescents and young adults with depression it is best to agree that when doing group therapy, the appropriate technique to use would be CBT combined with some mindfulness and acceptance. The group should be small no more than 8-10 people. It may be a good idea to divide the group between males and females and also to consider family background and socioeconomic status as a whole. It is also best if it is a closed group where the same people come every week to maintain that inside trust. Altogether group therapy has been proven successful for the treatment of depression.