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Depression in Community Medicine
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Prepared By Dr. Anees A. AlSaadi
Community Medicine Resident
March 2011
DEPRESSIONDEPRESSION
Depression
Objectives :
1. Definition of Depression.
2. Burden of Depression .
3. Causes .
4. Risk Factors.
5. Diagnosis Criteria.
6. Prevention .
7. Summary .
4
Depression What is depression?
Common mental disorder.
A depressive disorder is a syndrome.
Chronic or recurrent.
Consequences if untreated .
Depressed mood.
Loss of pleasure.
Feelings of guilt.
Disturbed sleep or appetite.
Poor concentration.
http://www.who.int/mental_health/management/depression/definition/en/
5
What are the different forms of depression?
Major depressive disorder.
Dysthymic disorder.
Psychotic depression.
Postpartum depression.
Seasonal affective disorder (SAD).
http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub2
6
Depression What is the Burden of Depression?
Loss of 850 000 lives every year.
4th leading contributor to the global burden of disease (DALYs) in 2000.
2020 2nd place of the ranking of DALYs.
121 million people worldwide.
Now the 2nd cause of DALYs.
http://www.who.int/mental_health/management/depression/definition/en/
Depression Causes
Depression Modifiable Risk Factors
Age :• Incidence with age.• in 25-44 years.• Atypical in elderly persons.
Gender and Ethnicity :• More commonly in women.• Less in the black population
Family history :
Genetic susceptibility
Depression Non modifiable Risk Factors
Certain neurologic illnesses .
Pharmacologic agents .
Chronic pain,
medical illness.
Psychosocial contributors
.
DepressionDiagnosis
The DSM-IV-TR diagnostic criteria:
A. At least 5 of the following, during the same 2-week period, representing a change from previous functioning; must include either (a) or (b):
(a) Depressed mood(b) Diminished interest .(c) Significant weight loss or gain(d) Insomnia or hypersomnia(e) Psychomotor agitation or retardation(f) Fatigue or loss of energy(g) Feelings of worthlessness(h) Diminished ability to think.(i) Recurrent thoughts of death, suicidal ideation, suicide attempt, or specific plan for suicide
B. Symptoms do not meet criteria for a mixed episode.
C. Symptoms cause clinically significant impairment of functioning.
D. Symptoms are not due to a substance or a general medical condition.
E. Symptoms are not better accounted for by bereavement.
http://emedicine.medscape.com/article/286759-overview
Depression Treatment
• Pharmacotherapy:
• SSRIs.
• (SNRIs).
• Tricyclic antidepressants (TCAs).
• Nonpharmacologic treatments :
• Light therapy.
• Electroconvulsive therapy (ECT).
• Acupuncture.
• Cognitive-behavioral therapy (CBT).
DepressionPrevention
Is Depression Preventable
DepressionPrevention
• Primary Prevention :
• Anti depressive Health Promotion :
• Living conditions and environment .
• Risk factors .
• Health Education .
DepressionPrevention
Helping Children Avoid Depression
Can Some Foods Fight Depression?
How Your Weight Affects Depression?
Stay active.
Stay connected.
Find an outlet.
Watch your alcohol intake.
Plan ahead.
Be positive .
DepressionPrevention
Secondary prevention :
Screening :
Risk Groups .
Screening Tests .
Elderly agePregnant or postpartum
Medical non specific symptomatologyFirst-degree Patient.Two or more chronic diseases.Obesity.Chronic pain. Multiple vague symptoms.Fatigue or sleep disturbance.
Screening Risk Groups
Age Group
Name of the Test No. of Items
Duration to complete (minutes).
Children and adolescents
Children's Depression Inventory (CDI
27 10 to 15
Adults Beck Depression Inventory-II 21 5 to 10
Center for Epidemiological Studies Depression (CES-D).http://counsellingresource.com/quizzes/cesd/index.html
20 5 to 10
Elderly Geriatric Depression Scale (GDS)
30 10 to 15
Geriatric Depression Scale-short
15 5 to 15
Post natal Edinburgh Postnatal Depression Scale
10 less than 5
DepressionPrevention
Tertiary Prevention :
Interventions that reduces disability, enhance rehabilitation and prevent relapses and recurrences of the illness.
DepressionPrevention
http://depression.about.com/od/famous/Famous_People_With_Depression.htm
DepressionPrevention
The Role of Religious knowledge in preventing the Depression
Summary
References 1
http://www.who.int/mental_health/management/depression/definition/en/
2. http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub2
3.
http://emedicine.medscape.com/article/286759-overview
4.
http://depression.about.com/od/famous/Famous_People_With_Depression.htm
5. http://www.everydayhealth.com/depression/preventing.aspx