depression

Question 1

what is unipolar depression?

Answer 1

depression is a mood disorder which means it affects how someone feels about themselves and the world around them, unipolar is characterised by a persistently low mood.

Question 2

what are the symptoms of depression?

Answer 2

• significant weight loss due to loss of appetite or weight gain due to overeating,
• changes in sleeping patterns - difficulty sleeping or sleeping too much,
• fatigue - feeling tired all the time,
• feelings of worthlessness or excessive inappropriate guilt,
• loss of concentration - unable to focus on tasks,
• difficulty remembering things - problems with remembering to do things or important information,
• recurrent thoughts of death or suicidal ideation - suicidal thoughts or thoughts about harming oneself.

Question 3

what are the features of depression?

Answer 3

depression is most common in females
prevalence rate is high
comorbid disorder - appears alongside other physical and psychological problems e.g. ovarian cancer

Question 4

diagnosing depression in the diagnostic manuals

Answer 4

• both DSM and ICD distinguish between single and recurrent depressive episodes and between mild, moderate and severe depression.
• both require symptoms to be present for at least two weeks.
• the DSM suggests that a person’s subjective distress and social/ occupational functioning must also be considered.

Question 5

depression in the dsm-v

Question 6

depression in the icd-10

Question 7

what are the issues with the diagnosis of depression?

Answer 7

• comorbidity
• cultural differences
• reliability of diagnosis

Question 8

what is comorbidity

Answer 8

means more than one illness or disorder coexists in someone

you are more likely to get depression if you suffer from another disor

Question 9

which disorders is comorbidity common with?

Answer 9

• borderline personality disorders
• anxiety disorders - OCD, PTSD, SAD etc.
• anorexia nervosa and bulimia
• substance misuse

Question 10

what can comorbidity of depression have implications on?

Answer 10

• the validity (accuracy) of diagnosis
• reliability (consistency of diagnosis)
• the effectiveness of treatment and therapy, so is very important for clinicians to consider

Question 11

example of comorbidity being an issue in diagnosis of depression

Answer 11

If an individual is diagnosed with unipolar depression and they are given antidepressants and CBT to treat it, however they are addicted to alcohol, substance abuse will not enable the medication to work effectively or they may forget to take it as they are too inebriated to remember. As alcohol is a depressant this may make it difficult for them to get the most out of the CBT sessions and may lead to further negative cognition.

Question 12

cultural differences make diagnosing depression difficult

Answer 12

• many cultures do not recognise depression and do not even have a word for it in their language which fully matches the English meaning.
• this doesn’t mean it doesn’t exist in these cultures, just that it is experienced in different ways.

however DSM has a section which helps diagnosis by giving information about how a person’s cultural identity may affect the expression of symptoms of a disorder. This would help clinicians to make a more valid diagnosis for disorders which are affected by culture.

Question 13

watters (2010)

Answer 13

• explains how people may have ‘shoulder or stomach pain’, ‘tightness in the chest’ or ‘burning in the gut’ depending on whether they are Chinese, Iranian or Korean - these cultures describe depression through different symptoms.
• this means a western may not diagnose depression in some people because the symptoms are influenced by culture

Question 14

reliability of the diagnosis of depression

Answer 14

• Using standardised psychometric tests such as BDI or the PHQ which consist of questions based on the DSM which give pps an overall score to determine whether an individual may have depression.
• This helps clinicians to make reliable diagnosis because the same questions can be repeated at different stages of diagnosis and treatment to check for improvements.

Question 15

what is the bdi?

Answer 15

beck’s depression inventory

Question 16

what is the phq

Answer 16

patient health questionnaire

Question 17

andrews et al

Answer 17

• found only 68% agreement between diagnoses using the ICD and the DSM on an assessment of 1500 patients.
• however, Andrews found high agreement on diagnosis for depression, substance dependence and generalised anxiety.

Question 18

brown (2001)

Answer 18

tested the reliability and validity of DSM IV for anxiety and mood disorders (depression) and found them to be ‘good’ to ‘excellent’ therefore there is some reliability.

Question 19

bromet et al

individual differences - culture

Answer 19

• A cross-cultural study, sampled 90,000 people in 18 countries.
• france and the USA were the most depressed and the poorer countries showed less rather than more depression.
• this supports the idea that depression is a disorder of Western nations, not just a psychological response to poverty, crime or war.
• however, the difference in the amount of depression might be due to differences in attitudes towards mental health and health care across cultures.

Question 20

individual differences in diagnosing depression - collectivist culture

Answer 20

• collectivist cultures, such as China and Japan put their own pressures on people to conform and feel shame and this can cause depression too.
• another view would be that in collectivist cultures people are less willing to talk about depression, so it isn’t diagnosed as often.

Question 21

individual differences in diagnosing depression - china

Answer 21

• in China, sufferers of mental health are treated as a ‘danger to society’. Most people never receive treatment as there is a stigma, they feel ashamed and embarrassed.
• However, attitudes are beginning to change - visits to hospitals are increasing, as is the use of antidepressants. People are using the internet to seek information and help privately.