Depression

NAME: SITI NOORASIKIN BINTI HAJI OSMAN STUDENT NO: 7690584 TUTOR: JUDITH MEIKLEJOHN

** __TOPIC : DEPRESSION - SHOULD WE BE CONCERN ABOUT IT OR NOT?__ **

** __CULTURAL ARTEFACT__ **

In the present case study our subject is ‘mental depression’. Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. The extreme form is the ‘mental disorder’ that is characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. There is no laboratory test for major depressions, but the physicians generally check the physical conditions that may cause similar symptoms. Objective questionnaire based scales such as ‘Hamilton Depression Rating Scale’ and ‘Montgomery-Åsberg Depression Rating Scale’ are the two rating scales, mostly used by the psychiatrics to measure the severity of depression symptoms for a patient to find out the depression levels.

** __THE PUBLIC HEALTH ISSUE__ ** The depression is one of the major public health concerns at the present day. Depression varies from person to person, but there are some common signs and symptoms.

**Signs of Depression** When these symptoms are overwhelming and disabling, that's when it's time to seek help. Common signs and symptoms of depression Smith (2011): - Feelings of helplessness and hopelessness. - Loss of interest in daily activities. - Appetite loss, weight changes, sleep changes. - Anger or irritability. - Loss of energy. - Reckless behavior. <span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 12pt; text-align: left;">- Concentration problems.

<span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 12pt; text-align: left;">**Depressions leading to suicides** <span style="display: block; font-family: Arial,Helvetica,sans-serif; font-size: 12pt; text-align: left;"><span style="font-family: Arial,Helvetica,sans-serif;">Depression leads to suicides, hence is a major risk factor. The hopelessness with depression create conditions for people to commit suicides, they feel like it is the only way to escape the painful life. Hence the depression is a warning signs of a person, who is thinking about committing suicide.

** __LITERATURE REVIEW__ ** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Over centuries depressions or mental health disorders were neglected by the individuals and the entire society. But at the present day depressions are among the largest morbidity deaths and main cause for most of the suicides. As per WHO, Mental health is as important as physical health to the overall well-being of individuals, societies and countries. Yet only a small minority of the 450 million people suffering from a mental or behavioural disorder are receiving treatment. Advances in neuroscience and behavioural medicine have shown that, like many physical illnesses, mental and behavioural disorders are the result of a complex interaction between biological, psychological and social factors. While there is still much to be learned, we already have the knowledge and power to reduce the burden of mental and behavioural disorders worldwide.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Causes of Depression** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">As per Beck and Alford, (2009) depression is a paradox, it is the contrast between the person’s image and the objective facts. As per them, depression depends on person to person for example, A wealthy women moans that she doesn’t have financial resources to feed her children. A widely acclaimed movie star beg for plastic surgery in the belief that he is ugly. An eminent physicist berates himself “for being stupid”. Attitudes of such kind seems puzzling because they contradicts the most established axioms of human nature.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">In a broader sense short term depression can cause by loss or extreme trauma, where as the chronic or life-long depression is caused by trauma in childhood that includes: emotional, physical or sexual abuse; yelling or threats of abuse; neglect (even two parents working); criticism; inappropriate or unclear expectations; maternal separation; conflict in the family; divorce; family addiction; violence in the family, neighborhood or TV; racism and poverty. There may be a genetic basis to some depression, but even if there is that genetic propensity must be triggered by some traumatic or stressful event.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">The other aspect of mental health associated with the physical health. The scientific evidence from the field of behavioural medicine has demonstrated a fundamental connection between mental and physical health, for instance, that depression predicts the occurrence of heart disease. Research shows that there are two main pathways through which mental and physical health mutually influence each other.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Different Faces of Depression** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Depression in men:__ As per Smith (2011), depression is a loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. This is especially true with men. Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Other signs and symptoms of depression in men include anger, aggression, violence, reckless behavior, and substance abuse.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Depression in women:__ As per Smith (2011), rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression. As for signs and symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Depression in teens:__ As per Smith (2011), while some depressed teens appear sad, others do not. In fact, irritability—rather than depression—is frequently the predominant symptom in depressed adolescents and teens. A depressed teenager may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains are also common symptoms of depression in young people.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Depression in older adults:__ As per Smith (2011), the difficult changes that many older adults face—such as bereavement, loss of independence, and health problems—can lead to depression, especially in those without a strong support system. However, depression is not a normal part of aging. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression, and so the problem often goes unrecognized. Depression in older adults is associated with poor health, a high mortality rate, and an increased risk of suicide, so diagnosis and treatment are extremely important.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Research papers & Reports on Depression**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**WHO Research reports** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Mental and behavioural disorders are estimated to account for 12% of the global burden of disease, yet the mental health budgets of the majority of countries constitute less than 1% of their total health expenditures. The relationship between disease burden and disease spending is clearly disproportionate. More than 40% of countries have no mental health policy and over 30% have no mental health programme. Over 90% of countries have no mental health policy that includes children and adolescents.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**American Medical Association research reports** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">As per the research by Pan et. al, (2011) of American Medical Association shows that depression is associated with a significantly increased risk of stroke morbidity and mortality. The research carried out on prospective cohort studies that reported risk estimates of stroke morbidity or mortality by baseline or updated depression status assessed by self-reported scales or clinician diagnosis. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">The result of this research was astonishing, as per the research the estimated absolute risk differences associated with depression were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke for per 100000 individuals per year. The increased risk of total stroke associated with depression was consistent across most subgroups.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Independent NGO research reports** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year. This includes major depressive disorder, dysthymic disorder, and bipolar disorder. Murry, B., & Fortinberry, A., (2005)

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__**CULTURAL AND SOCIAL ANALYSIS**__ <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Depression or mental health problems are closely associated with the cultural and social aspects. The social factors such as urbanization, poverty and technological change have been associated with the development of mental and behavioural disorders.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Importance of Social and Cultural factors** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Importance of Societal and Cultural factors, identified by World Health Organization in their research, as per WHO report (2001) the mental and physical health are two vital strands of life that are closely interwoven and deeply interdependent. Advances in neuroscience and behavioural medicine have shown that, like many physical illnesses, mental and behavioural disorders are the result of a complex interaction between biological, psychological and social factors. The report advocates policies that are urgently needed to ensure that stigma and discrimination are broken down and that effective prevention and treatment are put in place.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">The report identified that between 1950 and 2000, the proportion of urban populations in Asia, Africa, and Central and South America increased from 16% to fully one half of the populations of these regions. The nature of modern urbanization may have deleterious consequences for mental health through the influence of increased stressorsand adverse life events, such as overcrowded and polluted environments, poverty and dependence on a cash economy, high levels of violence, and reduced social support. Approximately half of the urban populations in low and middle income countries live in poverty, and tens of millions of adults and children are homeless. In some areas, economic development is forcing increasing numbers of indigenous peoples to migrate to urban areas in search of a viable livelihood.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Vicious Cycle of Poverty and Mental disorders** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">The relationship between poverty and mental health is complex and multidimensional. It is a vicious cycle as referred in (picture 1).In its strictest definition, poverty refers to a lack of money or material possessions. In broader terms, and perhaps more appropriately for discussions related to mental and behavioural disorders, poverty can be understood as the state of having insufficient means, which may include the lack of social resource.



<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Awareness programmes for Depressions & Suicides** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Awareness of this issue is important to fight with this menace. A safe, targeted and effective suicide prevention awareness campaigns that can be incorporated into depression that will help in reducing the suicide rates in the society.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">NGO SAVE (Suicide Awareness Voice of Education) has used their multi-media public service announcements to educate and aware the society for the awareness about depressions and associated challenges like Suicides. They use various modes such as: <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Brochures__: Materials on suicide prevention and mental illness that are specific to the target group. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Posters:__ Raise awareness in schools, hospitals, clinics and other community settings. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Billboard Graphics__: A great medium to reach the public 365 days a year, 24 hours a day. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Print Ad Graphics:__ For distribution to newspapers, magazines and other print publications. <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__Classroom Curriculum:__ LEADS is an interactive, educational program designed for schools.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**Political aspects** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">From the political point of view European commission has identified mental health as a challenge and formulated policy around it, Europa,eu (2008). As per EU Sustainable Development Strategy adopted by the June 2006 European Council, improving mental health and tackling suicide risks was identified as one of the operational objectives of the strategy in the field of public health. Similar policies and regulations are required in other nations as well to deal with this challenge.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**__ANALYSIS OF THE ARTEFACT AND REFLECTIONS__** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">With the detail analysis of different aspects of depressions and mental health it can now be concluded that depression is a great concern in our society. It is not only the cause of suicides but also a diseases. The depressions and mental health has several causes with complex biological, psychological and social factors involved in it.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">For centuries, people with mental and behavioural disorders have been ill treated and considered as burden on the family or society. The care of people with mental and behavioural disorders has always reflected prevailing social values related to the social perception of mental illness. However with the advancement of medical sciences and society it is considered as a medical disorder and treated under medical supervision along with the help of family, friends and society.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Despite all efforts at the individual levels, NGO and from political sides, the cases of Depressions and Suicides are increasing. There are several causes, some of the most alarming are the growing globalization and urbanization. With this the rural economy is transforming into urban sectors thereby a change in traditional social structure. With this change a section of society especially aged and seniors left alone with insecurity and loneliness. As per Watts (2008) this decline of local communities was felt to have a detrimental effect on our lives, not living in caring communities, social isolation, depression, loneliness and the fear of personal and community safety. The cut throat competitions in every sphere of life lead to mental pressure on all the citizens especially on teenagers.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">To fight with this menace there is a requirements of awareness among the society and efforts from all the section of life to fight this challenge.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">__**REFERENCES**__

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Pan A., et. al., (2011) JAMA, Journal of the American Medical Association, Depression and Risk of Stroke Morbidity and Mortality, retrieved on 1-Nov 2011, []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Murry, B., & Fortinberry, A., (2005), Uplift Program, Depression Facts and Stats, retrieved on 1st Nov 2011, []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Smith M, (2011), Understanding Depression, retrieved on 1st Nov 2011, []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">WHO Report, (2001), The world health report, retrieved on 1st Nov 2011, []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Beck, A., & Alford, B., (2009), Depression- Cause and Treatment, 2nd edition, University of Pennsylvania press, USA

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Watts, B., (2008), What are today’s social evils? By Joseph Rowntree Foundation, retrieved on 1st November 2011, []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">Europa,eu, (2008), Prevention of Depression and Suicides, Director general of Health and Consumers European Union, retrieved on 1st Nov 2011, []

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 12pt;">**__REFLECTIVE COMMENTS__**

**Running like a Girl: How Equitable is the Playing Field when it comes to Women in Sport?** **By Sam Turner** Hi Sam.

I really like what you're saying in your wiki. I agreed nowadays women are rarely seen from their sporty talent but how they look in the sports they are doing. I'm majoring in physical education and every time i told guys about it, they would always say you're beautiful or sexy enough to do sports, never would i hear guys say anything on my talent or skills in sports.

Another thing is women are always taken to be an advantage to take men's attention in sports. Take for example, if i'm not mistaken for the Olympics, women's beach volleyball is always the first tournament which would have a sold out event, due to the fact that women are competing when wearing a bikini or something sexy.

What i am trying to say here is women are never taken seriously in sports. I hope it would change in the future because there are a lot of skilful women in sports out there, but if you're not sexy nor beautiful, people wouldn't want to watch their match or event support them.

Great topic by the way, i really enjoyed reading it.

Posted: 6th November 2011, 7.32pm.

**'You Freak' - the effect of stigma on mental health** **By Alita Rushton** Hi.

I love that you discuss the topic thoroughly. People should know a lot on stigmatisation on mental health. As you can see, bullying statistics in Australia has increased for the past 5 years, but even with a lot of media attention and support from the government, the statistics are still increasing. I have experienced this before, same like your artefact on the cloud boy, my friend likes to cut her hand whenever she is stress or depressed with boys, family or even studies. I never knew about it but when i found out, it shocked me to bits. I could never thought a girl so beautiful and intelligent could do a stupid like that. From what I know, i just talked to her, listen to what she has gone through and support her.

What i am trying to say is people don't know who are dealing with mental health unless they saw them do stuff like cutting their hands or try to kill themselves. I guess we should just be more open and try to help those who are suffering from mental illness.

Great topic and a very good understanding on the topic.

Posted: 6th November 2011, 7.51pm.