Depression, Anxiety Disorders and Risk

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Depression, Anxiety Disorders and Risk

• Vikki Ryall
• Vikki.ryall_at_mh.org.au
• ORYGEN Youth Health

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The Burden of Depression
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Depression is really a dimensionSymptoms
associated with increased severity

• anergia (low energy),
• loss of interest,
• loss of sexual interest,
• observed depression,
• self depreciation,
• low self confidence,
• loss of appetite,
• hopelessness,
• subjective thinking problems,
• social withdrawal
• weight loss due to poor appetite,
• early morning awakening,
• psychomotor retardation,
• diurnal variation in mood

Increasing Severity
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Depression Across the Lifespan

• Adolescence is associated with a dramatic rise in
  the incidence of depression
• By 18 years of age at least 25 of adolescents
  have had at least one depressive episode

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Recognition of Depression in Young People - I

• 55 of people who have one episode of depression
  will have a subsequent episode, and the
  likelihood of recurrence increases with each
  episode
• Symptoms of depression are experienced by 15-40
  of young people
• after age 15, females are approximately twice as
  likely to become depressed as males

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Recognition of Depression in Young People - II

• Duration of an episode varies from 2 weeks to
  several years, with most episodes resolving
  within a year
• 20 of adolescents who experience a depressive
  episode will experience a manic episode later in
  life
• 60-90 of young people who attempt suicide have a
  history of depression

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Recognition of Depression in Young People - III

• the consequences of experiencing depression in
  adolescence (developmental tasks)
• difficulty recognising depression in adolescents

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Diagnosis

• Major Depressive Disorder
• emotional cognitive and behavioural symptoms
• lasting 2 weeks or longer, all day every day
• significant impact on functioning
• Dysthymic Disorder
• less severe
• more protracted (1 year lt18, 2yrs gt18)
• lesser impact on functioning

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Depression in Young Peoplewhat to look out for

• Mood may be irritable, not depressed
• Prevalence of insomnia
• Problems with memory, concentration, decision
  making (impact of this)
• Somatic complaints (e.g., headaches, pain,
  gastrointestinal symptoms)

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Common Comorbidity

• Anxiety
• Harmful substance use (self medication)
• Conduct problems
• (Manic symptoms)
• (Psychosis)
• (Eating disorder)

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Why does it occur?The biopsychosocial model

• BIOlogical predisposition to depression
• PSYCHOlogical view of the world which increases
  vulnerability to depression
• SOCIAL situation which exposes individual to
  stress and other triggering events

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Causes of Depression
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Anxiety Disorders

• Agoraphobia
• Panic Disorder
• Specific Phobia (animal, natural environment,
  blood-injection, situational)
• Social Phobia
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Acute stress disorder
• Generalized Anxiety Disorder

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Post Traumatic Stress Disorder

• Person exposed to trauma which involved actual or
  threatened death or serious injury response
  involved fear, helplessness or horror
• Traumatic Event is reexperienced flashbacks,
  dreams, acting/feeling like event is recurring,
  distress in response to cues
• Persistent avoidance of stimuli associated with
  the trauma and numbing of responsiveness (avoid
  thoughts, feelings, avoid activities, places,
  inability to recall aspects of trauma,
  detachment)
• Symptoms sleep, irritability, concentration,
  hypervigilance, exaggerated startle response
• More than 1 month
• Causes significant impairment

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Generalised Anxiety Disorder

• Excessive anxiety or worry for more than 6 months
  about a number of things
• Difficulty controlling the worry
• Symptoms restlessness, easily fatigued,
  concentration, irritability, muscle tensions,
  sleep disturbance

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Obsessive Compulsive Disorder

• Either obsession OR compulsions
• Obsessions- recurrent persistent thoughts or
  images that are intrusive
• Compulsions repetitive behaviours or mental acts
  which are aimed at reducing distress
• Recognition that obsessions/compulsions are
  excessive
• Cause distress and are time consuming

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Risk Factors for Suicide - I

• Mental health problems
• Past suicide attempts
• Psychosocial problems
• Academic failure
• Interpersonal conflict
• Sexuality issues (homosexuality)

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Risk Factors for Suicide - II

• Family problems
• Loss, abuse or neglect
• Family history of psychiatric disorder or suicide
• Cultural conflict
• Exposure to suicide
• Physical health
• Change in status (STD, HIV)
• Pregnancy
• Onset/exacerbation of chronic illness

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Conducting a Risk Assessment- I

• MUST be undertaken with a depressed young person
• Will NOT cause the young person to become
  suicidal
• Confidentiality is NOT absolute
• Have things got so bad that youve been thinking
  life isnt worth living any more?
• Some people in your situation might think about
  hurting or killing themselves has that thought
  crossed your mind?

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Factors to consider when evaluating suicide risk
- I

• Suicidal ideation (thoughts about suicide). This
  can also manifest as a preoccupation with death
  or dying (continuum)
• Suicidal intent how likely is that the young
  person thinks (s)he will actually hurt
  themselves?
• Suicide plan

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Factors to consider when evaluating suicide risk
- II

• Means or opportunity to carry out that plan
  (e.g., access to weapons)
• Previous suicide attempts or deliberate self harm
• Other factors such as a family history of
  suicide, the recent suicide of a peer, etc.

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Depression and suicide When to be concerned and
what to do

• If in any doubt at all, refer to your local
  mental health service or discuss with
  them via secondary consultation
• Look out for deterioration in functioning
• Others expressing concern about the young person
  (peers, family)
• Health risk behaviours
• Deliberate self harm or suicide attempts