Reflections on depression, Hilary Bradley

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  • Before next slide: Improvements in early detection and treatment... In addition to the difficulties cancer patients and their families face during diagnosis … When someone is diagnosed with cancer, its impact extends beyond the physical effects of the disease. Impacts significantly on a person’s quality of life, psychologically, emotionally, socially, spiritually and functionally.
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  • 1. Reflections on Depression Hilary Bradley Cheryl Woolley Dave Clarke
  • 2. Presentation Outline This Study Method and Analytical Approach Results Limitations Conclusions
  • 3. This Study Much is known about the prevalence of depression, but little about the qualitative experiences of people who have experienced depression. This study explores the experiences of previously clinically depressed adults in New Zealand. It is unique in that this group of people were able to reflect on what depression meant to them – causes, coping strategies etc. - from their current non-depressed outlook.
  • 4. MethodParticipants 13 volunteers – 5 women, 8 men All had DSM-IV diagnosis of unipolar depression at the beginning of a Dietary Intervention Study (DIS) Present research utilised interview data collected one year after completion of that studyData Collection Semi-structured in-depth interviews by independent interviewer Explored perceptions of causes of depression, attachment, earliest recollections, trauma, school life, changes since original study, aspects of original study that were helpful
  • 5. Analytical ApproachThematic Analysis Flexible Inductive latent analysis Six phases of thematic analysis (Braun & Clarke, 2006)
  • 6. Predominant ThemeStress and Anxiety
  • 7. Quote “I just put it down to being so stressed out, not coping. Yeah. It’s many factors but putting your finger on it, I don’t know” “If I’ve got assignments due or lots of stuff happening that I can’t control then I’ve noticed that like, at Teachers College when I was actually there full time, it triggered it again and I just couldn’t cope and I had to get sleeping pills and things so I could sleep...”
  • 8. Common Sub Themes Early Trauma Bullied Attachment Avoidance
  • 9. Early Trauma 11/13 perceived to have experienced childhood trauma Earliest memories Childhood illness Multiple traumas including loss and adjustment
  • 10. Loss of Support “...I have come to the conclusion that I was suffering from a degree of depression at that period I left home and got to Auckland. I had no social network up there at the time. I was boarding rather than flatting. I was an 18 year old, fundamentally lonely I suppose for those first few months...”
  • 11. Bereavement INT: “You had a couple of fairly major traumas happen when you were younger. You had a friend who was killed. How did that affect you?” “Um, quite bad. I can still remember just about everything that happened that afternoon. It would have been 10 years ago last week...Pretty messed up...I didn’t sleep for God knows how many days, let alone eat.”
  • 12. Bullied 9/13 bullied at school Attribute to cause of depression “That’s a good question. Probably fairly young. Probably just before or just after I started primary school maybe. Just when the bullying started.”
  • 13. Bullied Cont. Bullied as source of anger Not changed over last generation – needs to be addressed “…because when you’re bullied you do get a lot of anger and I have kids in my class who are bullied at school and they have so much anger and it reminds me so much of me.” Linked to suicidality?
  • 14. Negative Attachment Styles Overprotected – dependency “Because when you are in formative years doing those things are part of growing up and you’re forming your own personality but if they are suppressed, physical or mentally, then you don’t develop them and so therefore I believe it has an effect on my total overall depression.” “Oh because I was a soft touch. Because I was mollycoddled at home...It was certainly a desire on the part of the bullies to dominate and I was a subject that wasn’t too difficult to dominate at the time I think.”
  • 15. Attachment Cont. Poor communication/conflict Father’s expected therefore accepted “No. I never really talked to him”; “He was so busy making ends meet”; “working such long hours at work...he was just too tired to be dealing with us...” Abuse, mostly parental, mostly emotional Problematic sibling relationships
  • 16. Avoidance Avoiding situations that cause distress – ignoring stress increased its intensity Dependence on significant others Hiding and escaping Avoid confrontation Often starting at school or before
  • 17. Quote “I, um, would hide pretty much. Try to escape things. I am not one for confrontation. I don’t like it so yeah, my friend and I, at school, we would just try to stay away from the other girl who was bullying me because it was just easier and even now I think I still try to avoid things if I’m not comfortable with it, try to stay away from it.”
  • 18. Discussion Perceived stress and factors associated with it strongly correlated to clinical depression GP’s prescribing anti-depressants without addressing causes Stress can be successfully addressed at school level Bullying needs to be addressed in schools Social components including context rather than biological or medical model
  • 19. Context “I think being able to talk about it. You know, the idea, because I don’t you see, I keep it to myself and I have also tried talking it over with my doctor and also a doctor I have got here and it’s clear cut they’ve got no bloody idea of what I’m talking about, you know because, you know, the first time I tried to talk about that problem, I mean, the psychologist gave me a book to read and that was just, I mean you had to be frigging stupid to come up with that as a possible solution to someone who’s saying “I don’t study”. That book caused me heaps of problems!”
  • 20. Limitations Small sample size Emotional content difficult to ascertain The presence of the interviewer may have influenced their responses. Participants had regular contact with previous researchers which might influence how they currently perceive their depression.
  • 21. Conclusions Perceived stress, anxiety, trauma, avoidance, loss and bullying strongly correlate to clinical depression Social components including context Bullying needs to be addressed Relapse likely if social issues are not addressed Research the role of avoidance with regard to depression Anxiety or depression?
  • 22. ReferencesBraun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101.Fight Crime: Invest in Kids. (2003). Bullying prevention is crime prevention. Retrieved May 15, 2008, from http:// www.fightcrime.org/reports/BullyingReport.pdf.Goldstein, B., & Roselli, F. (2003). Etiological paradigms of depression: The relationship between perceived causes, empowerment, treatment preferences, and stigma. Journal of Mental Health, 12(6), 551-563. 12(6),Granek, L. (2006). What’s love got to do with it? The relational nature of depressive experiences. Journal of Humanistic Psychology, 46(2), 191-208. 46(2),Katz, D. (2007). The right Rx for sadness. U.S. News & World Report, 143(4), 58-61.Moffitt, T.E., Caspi, A., Taylor, A., Kokaua, J., Milne, B.J., Polanczyk, G. & Poulton, R. (2009). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine 1, 1-11. 1,Oakley-Brown, M.A., Wells, E., Scott, K.M., & McGee, M.A. (2006). Lifetime prevalence and projected lifetime risk of DSM-IV disorders in Te Tau Hinengaro: The New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry, 40, 865-874.
  • 23. Hilary.Bradley@bopdhb.govt.nz