This document discusses a study on self-identification with major depressive disorder (MDD) among undergraduate college students. The study examined how exposure to diagnostic criteria and different patient accounts affected self-identification with MDD. Results showed those exposed to diagnostic criteria and an account of a clinically diagnosed patient were more likely to identify themselves as having MDD, compared to those exposed to other patient accounts or no additional information. The document provides background on rising internet use, depression prevalence among college students, and issues with primary care physicians prescribing antidepressants without oversight from mental health professionals. It argues proper diagnosis and long-term treatment are needed but often lacking.
Sample 3 bipolar on female adult populationNicole Valerio
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
www.cheapassignmenthelp.co.uk/
http://www.cheapassignmenthelp.net/
Where your md meets my jd when the doctor says yes but the treatment team say...Mrsunny4
According to the National Institute on Drug Abuse and several published studies1, 80 percent of heroin users reported using prescription opioids prior to heroin.
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
Conceptualization for tablet application for aged population, to help improve and maintain a healthy morale and mental state.
#Design #UX #User Experience #Aged Population # Old Age #Mental Health #Health
10.28.08(d): Somatoform Disorders, Factitious Disorder and MalingeringOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M2 Psychiatry sequence
View additional course materials on Open.Michigan: openmi.ch/med-M2Psych
ABS Automations are primarily engaged in Design & manufacturing of vibratory bowl feeder , linear feeder, pick & place , elevators, conveyors, special purpose machines, rotary feeder, assembly machines as per Customer requirements.
Sample 3 bipolar on female adult populationNicole Valerio
Hello Sir
We are a premier academic writing agency with industry partners in UK, Australia and Middle East and over 15 years of experience. We are looking to establish long-term relationships with industry partners and would love to discuss this opportunity further with you.
Thanks & Regards
visit our website.
www.onlineassignmenthelp.com.au
www.freeassignmenthelp.com
www.btechndassignment.cheapassignmenthelp.co.uk
www.cheapassignmenthelp.com
www.cheapassignmenthelp.co.uk/
http://www.cheapassignmenthelp.net/
Where your md meets my jd when the doctor says yes but the treatment team say...Mrsunny4
According to the National Institute on Drug Abuse and several published studies1, 80 percent of heroin users reported using prescription opioids prior to heroin.
Background: The numbers of caregivers burdened by dementia is increasing. Depression is also found more in this group and
causes higher morbidity. The aim of this study was to investigate the predictors of depression among Thai family caregivers in order to develop effective interventions in primary care Methods: A total of 177 participants were recruited in primary care setting. They were assessed for sociodemographic data, health status, caregiver burden and depressive symptoms measured by Charlsons Comorbidities (CCI), Zarit Burden Interview (ZBI) and Patient Health Questionnaire (PHQ-9), respectively. The data for dementia patients included severity and functional status. Depression was defi ned as PHQ-9 ≥ 9. Multivariate linear regression model was applied to assess the independent relationship between possible risk factors and risk of depression.
Conceptualization for tablet application for aged population, to help improve and maintain a healthy morale and mental state.
#Design #UX #User Experience #Aged Population # Old Age #Mental Health #Health
10.28.08(d): Somatoform Disorders, Factitious Disorder and MalingeringOpen.Michigan
Slideshow is from the University of Michigan Medical
School's M2 Psychiatry sequence
View additional course materials on Open.Michigan: openmi.ch/med-M2Psych
ABS Automations are primarily engaged in Design & manufacturing of vibratory bowl feeder , linear feeder, pick & place , elevators, conveyors, special purpose machines, rotary feeder, assembly machines as per Customer requirements.
Olympic Idea is a revolutionary new Multi-Level Marketing company that is based on the cooperation of consumers and business owners, to achieve a better relationship between the two sides.
Business Owners and Small or Medium Enterprices (SMEs) are always in search of new clients, promotion and increase of sales.
On the other hand, most consumers would love to have discounts on all the things or services they buy.
Olympic Idea provides new tools of promotion (creation of website and eshop) to business owners, so that they can advertise to a wider audience and attract more customers, but at the same time, it provides great discounts and deals to its members, on registered merchants and service providers. Furthermore, the company has a great compensation plan for members that can bring in more members or businesses.
Alue-erot ovat kasvaneet voimakkaasti Suomessa 1990-luvulla. Raportissa tarkastellaan eräiden julkisten liikelaitosten ja suuryritysten harjoittamaa alueellista ristiinsubventiota,
mikä tasoittaa kustannusten kautta syntyvää alueellista eriarvoisuutta. Kuljetuskustannukset eivät tällöin heijastu täysimääräisesti tariffeihin syrjäseuduilla. Näyttää siltä, että
kiinteiden ja uponneiden kustannusten ollessa merkittäviä alueellista ristiinsubventiota voi esiintyä sääntelemättömässäkin liiketoiminnassa. Alueellisen ristiinsubventoinnin vaikutuksia aluerakenteeseen eritellään Krugmanin ”uuteen talousmaantieteeseen” perustuvan
mallin laajennuksella.
Prism IT Solutions Pvt. Ltd. is a comprehensive ERP solutions company located in Pune & Mumbai with expertise of more than two decades in Accounting and Business Management solutions.
The product range offered by us consists of micro boring cartridge sandvik, cartridge and unit, combination & finished boring bar, U drill with boring & chamfer & spot face cutter. Known for their rich attributes such as excellent performance, easy operation, longer functional life.
Negocjacje w zakupach, decydujący czynnik sukcesu? - Paweł StefaniakGrupa Muszkieterów
27 kwietnia 2016r. odbył się czwarty wykład eksperta Grupy Muszkieterów na Uniwersytecie Ekonomicznym w Poznaniu. W ramach cyklu "Nowoczesne metody zarządzania w handlu" Paweł Stefaniak, Kierownik Grupy Zakupowej Bricomarché, wygłosił wykład pt. "Negocjacje w zakupach. Decydujący element sukcesu?"
Brilliant People Management in an Agile SettingMeri Williams
Agile people management is two things -- applying agile principles to managing people, and also figuring out how to manage people working with agile approaches. Traditional once-a-year reviews with annual targets are hardly very agile (or useful). How do we create space for our people to be awesome? Do we even need managers at all in agile?
Our journal has been staying at the forefront of research is essential. The International Journal of Information Technology and Computer Engineering (IJITCE) offers a unique platform that combines rapid publication with rigorous peer review, making it a valuable resource for researchers and professionals alike.
AssignmentWrite a Respond to two of these #1&2 case studies.docxnormanibarber20063
Assignment:
Write a Respond to two of these #1&2 case studies using one or more of the following approaches:
Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be considered.
Validate an idea with your own experience and additional research.
Each must have at least 2 references no more than 5 years old using APA Format
Response # 1
“The case of physician do not heal thyself”
Three questions I will ask the patient on a visit to my office and rationale thereof.
Major depressive disorder (MDD) is defined as “feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home” and it is one of the most common reasons patients present for medical care worldwide (McConnell, Carter & Patterson, 2019). Childhood traumatic experiences, including physical, sexual, and emotional abuse, neglect, and separation from caregivers, they posit significantly increase the risk of developing mental and physical illnesses later in life.
NO .1
Have you had any thoughts of death or suicide before? Are you having them now? And do you have a current plan to harm or kill yourself? What are the details of that plan?
McConnell,et .al, (2019) posit that clients with MDD often presents with feeling sad or depressed; lack of interest or pleasure in previously enjoyed activities; appetite changes (unintentional weight loss or gain); sleep difficulty (too much or little); lack of energy (fatigue); feeling of guiltiness or worthlessness; moving more slowly or pacing (others observe); difficulty with decision-making, concentration, and thinking; and/or suicidal thoughts.
Patient safety remains a central concern in every healthcare setting (Smith,2018). This patient did report several feelings of Suicide Ideation and Homicidal ideation so patients’ safety should be priority. Although the welfare of patients encompasses a broad range of concerns, the increasing prevalence of suicide in our society compels health care workers to ensure a safe healthcare environment for patients with suicidal ideation. These efforts include the elimination or, at least, the mitigation of physical setting characteristics that enable suicide attempts.
No 2.
Are you depressed? How does this problem make you feel? What makes the problem better?
According to DSM-5 (2013) diagnostic criteria, MDD requires five or more of the following symptoms during the same two-week period and represent a change from previous functioning; at least one symptom is either 1) depressed mood or 2) loss of interest or pleasure (American Psychiatric Association [APA], 2013).
According to the patient’s file, he has experienced five or more of the symptoms of MDD during the same two-week period, on more than one occasion, incl.
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
3
4
5
6
6
7
8
8
9
9
9
11
11
11
11
12
12
13
14
14
19
19
21
32
34
Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a disruption in mental well-being.
The risk factors to mental health problems are not limited and therefore everyone is entitled to the problem irrespective of gender, economic status, and ethnic group. For example, data shows that in America one out of five individuals experience mental health problems annually; with mental disorders being recognized as the leading cause of disability not only in the United States but also globally (Ritchie & Roser, 2018). Mental health disorders are seen to be complex and of many forms such as anxiety, mood, and schizophren.
For each of the learning objectives, provide an analysis of how thShainaBoling829
For each of the learning objectives, provide an analysis of how the course supported each objective.
1. Discriminate among the mechanisms of action for the major classes of drugs/medications
2. Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
3. Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
4. Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making
Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.
Provide evidence (citations and references) to support your statements and opinions.
All references and citations should in APA format.
14
Mental Health and Social Work
Shanae Hampton
Cal Baptist University
Introduction
How well a person is able to live a full life, build and maintain relationships and pursue their education, profession or other pursuits requires them to maintain their well-being ranging from physical to mental health. When assisting others to achieve good and self-motivated changes, social workers draw on their relationship-based abilities and emphasize personalization and rehabilitation. A key issue is, "What components and obstacles of an assessment are there in order to reach these outcomes?" When it comes to health promotion and public involvement, social workers are well-suited for this role since primary care is all about these things. Social workers who deal with mental health have unique challenges in assessment, which necessitates them learning and using psychiatric principles. Identifying the need for mental health care requires an understanding of assessment principles.
For this research, the focus is on urban youth's increase in mental health cases which is more influenced by lack of access to mental health care as a result of poverty that affects many children and families in the US. Young people are the most impacted by poverty, accounting for 33% of the total number of individuals in poverty. Children who live in "high risk neighborhoods" are more likely to lack access to the mental health supports they need to manage their symptoms. Stabilization, individual treatment, and symptom management are all important aspects of aftercare for children who have been hospitalized for behavioral difficulties by the time they are six years old (Hodgkinson, 2017).
Literature Review
Inequality based on race and class has been shown to be associated with a variety of negative health outcomes, including poor mental health. Increased financial disparity is associated with an increase in the prevalence of mental illness along a social gradient in mental health. However, psychiatric and psychological approaches have dominated ment ...
Research-Based Interventions: Dissociative Identity Disorder 1
THIS IS AN EXAMPLE PLEASE DO NO COPY DO NOT PLAGiarism
Research-Based Interventions: Dissociative Identity Disorder
“Dissociative identity disorder is characterized by the presence of two or more identities or personality states, each with its relatively enduring pattern of perceiving, relating to, and thinking about the environment and the self” (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). There are many characteristics used that accompany Dissociative Disorder (DID). One method to understanding would be to know how the disorders are classified and defined. DID may be conceptualized effectively using the diathesis-stress model. There are many different intervention strategies for this disorder as well. Over time researchers have discovered the most effective treatments and interventions that can be used regarding DID. When one dissociates, the person may not have conscious awareness of what is happening (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006).
Peer-reviewed Articles
One limitless, longitudinal, naturalistic, and prospective study investigated childhood maltreatment (CM) in adult intimate partner violence (IPV) victims among Dissociative Disorder (DD) patients with Dissociative Identity Disorder with CM rates of 80-95% and severe dissociative symptoms (Webermann, Brand, & Chasson, 2014). The methods of this study include 275 DD outpatient therapy patients who completed a self-reported measure of dissociation (Webermann, Brand, & Chasson, 2014). Analyses assessed associations between CM typologies, trait dissociation, and IPV (Webermann, Brand, & Chasson, 2014). The results of this study include emotional and physical child abuse associated with childhood witnessing of domestic violence, physical, and emotional IPV (Webermann, Brand, & Chasson, 2014) Two-tailed independent samples t -tests and z-tests were used in this study to represent data as well. “As an effect size, odds ratios (ORs) were calculated to predict the likelihood of a participant being in an abusive adult relationship if they experienced a particular type of CM” (Webermann, Brand, & Chasson, 2014, p. 5).
A double-blind study was conducted including 15 females with DID compared to 23 without psychopathology., chosen by self-disclosure results of a questionnaire along with a structured clinical interview by psychiatrists The objective was to examine the volumetric differences between amygdala and hippocampal volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma (Vermetten, Schmahl, Lindner, Loewenstein, & Bremner, 2006). These researchers used MRI to measure volumes of the amygdala and hippocampus. The results included the volume of the hippocampus being 19.2 % smaller and the amygdala being 31.6% smaller in patients with DID when compared to the other subjects without psychopath ...
Lesson 11 Mental Health StigmaReadings Please note that th.docxSHIVA101531
Lesson 11: Mental Health Stigma
Readings: Please note that the Corrigan article in the syllabus has been replaced with the Collins and Corrigan articles below:
Required
Collins, R. L., Wong, E. C., Cerully, J. L., Schultz, D., & Eberhart, N. K. (2012). Interventions to reduce mental health stigma and discrimination. http://calmhsa.org/wp-content/uploads/2011/12/Literature-Review_SDR_Final01-02-13.pdf
Corrigan, P., Morris, S., Michaels, P.J., Rafacz, J.D. & Rusch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services 63(10). doi: 10.1176/appi.ps.201100529. http://ps.psychiatryonline.org/article.aspx?articleid=1372999&RelatedWidgetArticles=true
Link, B., Phelan, J. Bresnahan, A.S. & Persosolido, B., (1999). Public conceptions of mental illness: Labels, causes, dangerousness and social distance. American
Journal of Public Health (89), 1328-1333.
http://ajph.aphapublications.org/cgi/reprint/89/9/1328.pdf
Swanson, J.W., Holzer, C.E., Ganju, V. K., Jono, R.T. (1990). Violence and psychiatric disorder in the community: Evidence from the Epidemiologic Catchment Area surveys. Hospital & Community Psychiatry,
41(7), 761-770.
http://www.bing.com/videos/search?q=Mental+Health+Stigma+Video&FORM=VIRE7#view=detail&mid=102935613330F098A046102935613330F098A046
http://www.bing.com/videos/search?q=Mental+Illness+Stigma&Form=VQFRVP#view=detail&mid=EC031B624F71269702CDEC031B624F71269702CD
https://www.youtube.com/watch?v=Zn6yw2KUIwc&feature=youtu.be
Optional
Pettigrew, L. R. & Tropp, T.F. (2005). Relationships between intergroup contact and prejudice among minority and majority status groups. Psychological Science (16)12, 951-957.
Summary
Introduction
As many of you have noted in your discussion posts, mental health stigma is a pervasive problem that profoundly affects the lives of those suffering from mental illness. Aided by newspapers, books, movies and television, persons with mental illness have been portrayed and perceived as persons with bad character, demonically possessed, weak, unpredictable, and violent. As a result, many people have separated themselves from those with mental illness out of “distrust, stereotyping, fear, embarrassment, anger and/or avoidance.” (Surgeon General’s Report, 1999).
While some progress has been made in the past 50 years, stigma (often referred to as discrimination) continues to be a significant barrier to persons with mental illness. As we have seen in our readings, several recent documents have given prominence to the issue of stigma. In SAMSHA’s 2011 strategic plan “Leading Change: A Plan for SAMHSA’s Roles and Actions, 2011-2014”, Goal 4.3.2 is to “create a behavioral health awareness campaign focused on decreasing discrimination and improving employment outcomes for persons with mental and substance use disorders.” (p. 59). SAMHSA’s most recent strategic plan: Leading the Change 2.0: Advancing the Behavioral Health of the Nation 2 ...
Creating a Needs AssessmentIn this assignment, create a needs CruzIbarra161
Creating a Needs Assessment
In this assignment, create a needs assessment outline that describes and documents the health status issue that your project will address and the target population it will serve. The purpose of the needs assessment is to help reviewers understand the community and/or organization (i.e., the population) that will be served by your proposed project.
The needs assessment document should describe the need for the project in the proposed locale and include baseline data on the prevalence and demographic characteristics of the targeted population as well as supporting racial/ethnic data. The document should provide a description of the prevalence of health indicators (e.g., overweight, obesity) in the proposed geographic area. It should describe the current availability of preventive health services that address the health issue in the targeted group. In addition, discuss any relevant barriers in the service area that your project hopes to overcome. You should also describe gaps in the current provision of services as well as gaps in knowledge and the capacity of health care providers and key public/private community agencies to adequately screen, routinely assess, effectively intervene, and/or coordinate their efforts within a comprehensive network of preventive health services.
Here is a suggested structure for your needs assessment outline. It should be between 3 and 5 pages in length.
I. Health Status
a. Introduce the health issue
b. How does the health issue affect the target population?
II. Community Description
a. Describe the setting, which might include national, state, local, or campus
information depending on the program scope
III. Needs Assessment
a. Qualitative assessment
b. Quantitative assessment
IV. Community Link
a. What is currently being offered to the specific population?
b. Will the proposed program be complementary, competing, or new to the area?
1
3
Mental Health in college students
Alexis Heard
Program Design in Kinesiology
Dr. G. Palevo
Columbus State University
February 9, 2022
Mental Health in College Students
Mental health is a serious public health issue that impacts society at large. It includes mental conditions, depression, anxiety, and physical symptoms such as insomnia, fatigue, headaches, and back pain. When compared to other people, college students are routinely found to experience high rates of mental distress. For example, compared with the rest population, Australian medical students exhibited much higher levels of psychological distress. According to studies, mental anguish is more common among college students in Asian and Sub-Saharan African countries. According to Mboya et al. (2020), the largest incidence reported was 71.9 percent among medical students at Jizan Higher education institution in Saudi Arabia, almost identical to the percentage observ ...
Behavioral avoidance mediates the relationship betweenanxi.docxikirkton
Behavioral avoidance mediates the relationship between
anxiety and depressive symptoms among social
anxiety disorder patients
§
Ethan Moitra, James D. Herbert *, Evan M. Forman
Department of Psychology, Drexel University, 245 N. 15th Street, MS 988, Philadelphia, PA, USA
Received 26 September 2007; received in revised form 20 December 2007; accepted 4 January 2008
Abstract
This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult
patients with Social Anxiety Disorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder
associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In
most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might lead to depression in some people. The
present study addressed this question by investigating the mediational role of behavioral avoidance in this clinical phenomenon,
using self-report data from treatment-seeking socially anxious adults. Mediational analyses were performed on a baseline sample of
190 individuals and on temporal data from a subset of this group. Results revealed behavioral avoidance mediated this relationship,
and supported the importance of addressing such avoidance in the therapeutic setting, via exposure and other methods, as a possible
means of preventing depressive symptom onset in socially anxious individuals.
# 2008 Elsevier Ltd. All rights reserved.
Journal of Anxiety Disorders 22 (2008) 1205–1213
Keywords: Social anxiety disorder; Depression; Behavioral avoidance
The lifetime prevalence of Social Anxiety Disorder
(SAD) in Western societies is quite high, ranging from
7% to 13% (Furmark, 2002). In fact, SAD is the most
common anxiety disorder in the U.S. and the third most
common psychiatric disorder, exceeded only by alcohol
dependence and Major Depressive Disorder (MDD;
Kessler et al., 1994). SAD is a disabling condition;
compared to people without psychiatric morbidity,
adults with SAD report lower employment rates, lower
§
Portions of this research were previously presented at the annual
meeting of the Anxiety Disorders Association of America in March
2006.
* Corresponding author. Tel.: +1 215 762 1692;
fax: +1 215 762 8706.
E-mail address: [email protected] (J.D. Herbert).
0887-6185/$ – see front matter # 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.janxdis.2008.01.002
income, and lower socio-economic status (Patel, Knapp,
Henderson, & Baldwin, 2002).
1. SAD and depression
SAD is also the most common comorbid anxiety
disorder with MDD, with estimates of SAD ranging
from 15% to 37% of depressed patients (Belzer &
Schneier, 2004; Fava et al., 2000; Kessler et al., 1994).
Comorbid SAD and MDD has been associated with an
earlier onset of MDD, more depressive episodes, longer
duration of episodes, a two-fold increased risk of
alcohol dependence, and an incr ...
Psychological Illness and Crime Growing in Urban life by Dr.Mahboob Khan PhdHealthcare consultant
“I believe that -Weather it is MH 370 Co-Pilot or recent thane mass murderer these people have some sort of psychological illness in common and there is greater need to do psychological assessment of every one as a mandatory test”.Public opinion surveys suggest that many people think mental illness and violence go hand in hand. A 2012 national survey found, for example, that 60% of indians thought that people with schizophrenia were likely to act violently toward someone else, while 32% thought that people with major depression were likely to do so.
The title of this chapter derives from a book of the same title .docxgloriab9
The title of this chapter derives from a book of the same title by David Healy (1997). Healy points out the important but overlooked fact that depression proper (what the DSM-5 calls Major Depressive Disorder) [American Psychiatric Association (APA), 2013] was basically unheard of as recently as 50 years ago. For Healy, the antidepressant era unfolded against a backdrop of battles within the psychiatric profession (people endorsing the medical model perspective battling those endorsing models emphasizing a psychological perspective), regulatory agencies such as the Food and Drug Administration (FDA), and the pharmaceutical industry. Antidepressant medications are among the medications most advertised directly to consumers and evidence is mounting that this does not in fact increase consumer knowledge about depression and antidepressants but rather increases misperceptions like the discredited chemical imbalance theory of depression (Park, 2013).
This chapter is divided into seven sections. Section One provides an overview of the current impact of antidepressants and Major Depressive Disorder. Section Two describes early theories of antidepressant action. Section Three covers the neurotrophic/plasticity theory of antidepressant action and other newer findings. Section Four begins coverage of the classes of antidepressant medications with what are called first generation antidepressants. Section Five is devoted to selective serotonin reuptake inhibitors (second generation antidepressants). Section Six covers third-generation antidepressants like bupriopion and duloxetine and experimental drugs like ketamine. Section Seven covers important psychological, cultural, and social perspectives on anti-depressants including the concerns about violent behavior being correlated with antidepressant therapy.
Learning Objectives
• Know what the point and lifetime prevalence of Major Depressive Disorder is.
• Understand the conditions that are often comorbid with depression.
• Be able to articulate sex differences in reported rates of depression.
• Know what meta-analytic studies note as the overall efficacy of antidepressants.
A television commercial features a grimacing young man with his face against a wall. The commercial's narrator lists several symptoms of fear and anxiety related to Social Anxiety Disorder (previously Social Phobia in DSM-IV). The last scene in the commercial shows the same young man smiling, rising from a table in a crowded room apparently to receive acclaim for some accomplishment. The ad ends by repeating the name of the medication and informing the viewer, “Your life is waiting.” As we noted in , there is vigorous debate as to whether such ads are a valuable source of information or prey on the misconceptions many people have about such drugs being “magic potions” to change their lives.
At this writing, antidepressants are still one of the most advertised and prescribed psychotropic medications. Over $11 billion is spent annually.
Running head and connection to substance abuse1comorbidity an.docxtoddr4
Running head: and connection to substance abuse 1
comorbidity and connection to substance abuse 6Literature Review
Comorbidity and Its Connection to Substance Abuse, Treatment, and Relapse
Paula King
Walden University
Capstone
Dr. Jane Lyons
June 23, 2019
Comorbidity and Its Connection to Substance Abuse, Treatment, and Relapse
Comorbidity is considered as two or more conditions that occur in one person. These disorders can happen one after another or at the same time. Comorbidity has a strong connection with substance abuse, treatment, as well as relapse (Kelly & Daley, 2013). It is essential to note that many of those who suffer from substance use disorder usually develop other mental disorders, which is a similar case to many of those diagnosed with mental disorders. Research indicates that about half of those experiencing mental illnesses have a high probability of experiencing substance abuse disorders at some time in their life. Some few research have been conducted on children, and the result indicates that youths with substance abuse disorder typically have a high rate of co-occurring mental diseases like anxiety and depression (Child, 2012). Clinicians must find an effective way to treat individuals with substance use and addictions mental health disorders. To be effective they need to prescribe the right medication to treat alcohol, opioid, and nicotine addiction and there are also medications to alleviate symptoms of mental disorders. There are some behavioral therapies that have promise in treating comorbid conditions. The programs are tailored for the clients according to age, drug misused, and other factors, which can be used alone or with medication. Some effective therapies for treating comorbid conditions: cognitive behavioral therapy, Dialectical therapy, assertive community treatment, therapeutic communities, and contingency management (Kelly & Daley, 2013).
According to Woody and Blaine (1979) for over 25 years there has been a correlation between substance abuse illnesses and other mental disorders is not a visible indication that one resulted in another, albeit one came after another. Understanding the directionality or causality can sometimes be difficult because of different reasons. For instance, emotional or behavior issues may not be severe enough to raise the alarm for diagnosis. However, sub-clinical mental health concerns may prompt abuse of drugs. The main factors that contribute to comorbidity between mental illnesses and drug abuse disorders include the aspect of conventional risk factors, the possibility of mental diseases contributing to addiction and drug abuse, and the possibility of drug abuse and addiction contributing to the growth of mental health disorders (Bukstein & Horner, 2015). Drug use and mental health illnesses can result from coinciding aspects such as epigenetic and genetic exposures, concerns with related parts of the brain, and environmental factors.
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
CHAPTER FIVEThe Antidepressant EraThe title of this chapter deri.docxtiffanyd4
CHAPTER FIVEThe Antidepressant Era
The title of this chapter derives from a book of the same title by David Healy (1997). Healy points out the important but overlooked fact that depression proper (what the DSM-5 calls Major Depressive Disorder) [American Psychiatric Association (APA), 2013] was basically unheard of as recently as 50 years ago. For Healy, the antidepressant era unfolded against a backdrop of battles within the psychiatric profession (people endorsing the medical model perspective battling those endorsing models emphasizing a psychological perspective), regulatory agencies such as the Food and Drug Administration (FDA), and the pharmaceutical industry. Antidepressant medications are among the medications most advertised directly to consumers and evidence is mounting that this does not in fact increase consumer knowledge about depression and antidepressants but rather increases misperceptions like the discredited chemical imbalance theory of depression (Park, 2013).
This chapter is divided into seven sections. Section One provides an overview of the current impact of antidepressants and Major Depressive Disorder. Section Two describes early theories of antidepressant action. Section Three covers the neurotrophic/plasticity theory of antidepressant action and other newer findings. Section Four begins coverage of the classes of antidepressant medications with what are called first generation antidepressants. Section Five is devoted to selective serotonin reuptake inhibitors (second generation antidepressants). Section Six covers third-generation antidepressants like bupriopion and duloxetine and experimental drugs like ketamine. Section Seven covers important psychological, cultural, and social perspectives on anti-depressants including the concerns about violent behavior being correlated with antidepressant therapy.
SECTION ONE: THE CURRENT IMPACT OF ANTIDEPRESSANTS
Learning Objectives
• Know what the point and lifetime prevalence of Major Depressive Disorder is.
• Understand the conditions that are often comorbid with depression.
• Be able to articulate sex differences in reported rates of depression.
• Know what meta-analytic studies note as the overall efficacy of antidepressants.
A television commercial features a grimacing young man with his face against a wall. The commercial's narrator lists several symptoms of fear and anxiety related to Social Anxiety Disorder (previously Social Phobia in DSM-IV). The last scene in the commercial shows the same young man smiling, rising from a table in a crowded room apparently to receive acclaim for some accomplishment. The ad ends by repeating the name of the medication and informing the viewer, “Your life is waiting.” As we noted in Chapter Four, there is vigorous debate as to whether such ads are a valuable source of information or prey on the misconceptions many people have about such drugs being “magic potions” to change their lives.
At this writing, antidepressants are still one o.
CHAPTER FIVEThe Antidepressant EraThe title of this chapter deri.docx
Identification With MDD
1. Running head: SELF-IDENTIFICATION WITH MAJOR DEPRESSIVE DISORDER IN
UNDERGRADUATE COLLEGE STUDENTS: A STUDY ON THE EFFECTS OF SELF-
DIAGNOSIS AND THE INTEGRATION OF PRIMARY CARE AND MENTAL HEALTH
Self-Identification with Major Depressive Disorder in Undergraduate College Students: A Study
on the effects of Self-Diagnosis and the Integration of Primary Care and Mental Health
Brynn J. Lipira
Stetson University
2. SELF-IDENTIFICATION WITH MDD 2
Abstract
The aim of this study is to form a better understanding about the way individuals relate to Major
Depressive Disorder (MDD) from a perspective of self-diagnosis. This study presented
participants with a form containing a list of diagnostic criteria for MDD taken from the DSM-5,
an emotionality scale (NEO-PI-R), extraversion scale (NEO-PI-R), vulnerability scale (NEO-PI-
R), depression scales (NEO-PI-R and CES-D), questions about self-identification with MDD,
and questions about the use of internet for information-seeking behaviors. There were three
forms: one contained an account of a patient who has been clinically diagnosed with MDD, the
second contained an account of a patient who displayed some depression symptoms but had been
clinically proven not to have MDD, and a control without a patient account. The findings of this
study support the hypothesis that individuals who are exposed to a list of diagnostic criteria and
an account of a clinically diagnosed patient were more likely to claim the probability of
themselves having MDD than individuals who were exposed to a list of diagnostic criteria and an
account of a patient with some depression symptoms who had not been diagnosed with MDD, or
a control in which no supplemental information regarding MDD was given.
3. SELF-IDENTIFICATION WITH MDD 3
Self-Identification with Major Depressive Disorder in Undergraduate College Students: A Study
on the effects of Self-Diagnosis and the Integration of Primary Care and Mental Health
According to the U.S. census (2011) 89.9% of Americans who have attained a
bachelor’s degree or higher level of education have Internet access in their home. The use of
Internet by all Americans is on the rise as home Internet access has more than doubled in the past
fourteen years. Google Trends (2013) reports the search query “symptoms” as the most
frequently searched term in the United States in the category of health. Searches for doctors are
included in the health category but aren’t on the list of the most popular search queries—
depression is. Depression is the ninth most commonly searched term in the health category on
Google. The number of searches preformed on “Major Depression” is at an all-time high, with
“Major Depression Symptoms” in a breakout phase which means that the search term has
experienced a change in growth greater than 5000%.
These facts indicate that Americans are using the Internet more frequently than ever in
relation to their concern for mental health and diagnosis. A recent study demonstrated one of the
many ways young Americans are using the Internet in relation to mental health, specifically
Depression. In the study performed by Moreno et al. (2012) several Facebook profiles were
monitored for indicators of depression. It was found that 33% of participants displayed
depression symptoms on Facebook, a commonly used social networking site. These findings are
in accordance with a previous study which found that 33% of college students reported
symptoms of depression (Wells, Klerman, & Deykin, 1987).
Depression is known to be prevalent in young populations with 30% of college students
reporting feeling so depressed in the last 12 months that it was difficult for them to function
4. SELF-IDENTIFICATION WITH MDD 4
(American College Health Association, 2009). The rate at which college students are being
diagnosed with depression is also on the rise. The number of college students diagnosed with
depression grew 56% from 2006-2012. Major Depressive Disorder (MDD) has a yearly
incidence of almost 8% in this age group (Hunt & Eisenberg, 2010). An astounding 22% of
adolescents and young adults also suffer from depressive symptoms at the sub-diagnostic level—
these individuals suffer from many of the symptoms of MDD, but don’t have a severe enough
case to be diagnosed. Although so many individuals, particularly of this age group, are affected
by depression only about 10% of college students report seeking any type of mental health care
in the past year (Rosenthal & Wilson, 2008).
The idea that so few people affected by depression are seeking help should be alarming.
The mentality that finding adequate help is not necessary, however, is reinforced by society.
Results from a study conducted in 2003 suggest that 9% of all adults will experience MDD in
any given year and approximately 16% of American adults will experience MDD in their
lifetime (Kessler, et al., 2003). Less than one third of Americans currently taking antidepressants
have seen a mental health professional in the last year (Pratt, Brody, & GU, 2011). There is a
certain stigma attached to having a mental illness which could have an effect on diagnosis and
help-seeking behaviors. Patients often wish to be treated outside the realm of personality
disorders because these diagnoses often have fewer stigmas associated with them than ‘severe’
mental illness (Kernberg & Yeomans, 2013). This calls into question the understanding of the
general public about mental illness.
Mental illness is a very complex topic. The exact cause of mental disorders is largely
unknown to the psychological community although several theories have been developed in an
attempt to explain what mental disorders are and why they occur (Uher, 2013). Some of the most
5. SELF-IDENTIFICATION WITH MDD 5
current theories include the exploration of genealogy. The relatively vague understanding of the
cause of mental illness makes accurate diagnosis and treatment all the more difficult.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is one of the most
commonly used guides for diagnosis (Clegg, 2012). The DSM is published by the American
Psychiatric Association (APA) and has been in existence since 1952. The DSM is a product of
almost one hundred years of transformations beginning in 1918 when the first standardized
classification manual, Statistical Manual for the Use of Institutions for the Insane, was published
(National Committee for Mental Hygiene, 1918). This manual persisted as the primary method
of diagnosis until 1946 when Medical 203 was published (Office of the Surgeon General, Army
Service Forces, 2000).
The DSM as we know it did not develop until 1952 and was used alongside other
manuals such as Medical 203 until further development and publication of the DSM-II
(American Psychiatric Association, 1968). From that point forward the DSM has been revised
and rewritten five times to reflect more modern and perhaps more accurate interpretations of
symptomology in relation to clinical diagnosis (Clegg, 2012). The most current issue of the
DSM, the DSM-5 (American Psychiatric Association, 2013), is in accordance with the most
recent theories and findings about psychiatric disorders.
The complexity and difficulty of diagnosis is highlighted in the DSM. There are sections
following each possible diagnosis pertaining to similar diagnoses which should be considered
and ruled out before any official diagnoses are made. Many mental illnesses, depression in
particular, have a high level of comorbidity (the circumstance in which two or more disorders
exist in an individual simultaneously) which contributes to the overall complexity of diagnosis
(Widdowson, 2011). In a previous study that examined the diagnostic complexities of
6. SELF-IDENTIFICATION WITH MDD 6
depression, 46.3% of participants who had MDD had comorbidity with personality disorders or
mental retardation (Morrison, Bradley, & Westen, 2003). The study also identified that 76.9% of
participants had comorbidity with characterological issues which are mental illnesses outside the
realm of personality disorders or mental retardation.
Diagnosis is a crucial aspect of the mental health profession for numerous reasons
(Dennis & Lederman, 2013). Namely, diagnosis aids in patient education, provides a common
understanding of a condition, aids in treatment planning and medical management, is
fundamental to record keeping, and is necessary for reimbursement by insurance companies.
Achieving optimal mental health is the goal of the mental health profession. Many treatment
plans are contingent upon diagnoses which may take several visits with the most qualified
professional to obtain. While some disorders, or disorders of certain severity, are well-served
utilizing only traditional therapeutic methods, more severe degrees of mental illness are more
readily helped in combination with medication.
Only two professions are qualified to prescribe medications for the mentally ill—medical
doctors such as primary care physicians, and psychiatrists. This fact conflicts with the notion that
mental health professionals are the most qualified individuals to accurately identify and diagnose
mental illness. Psychiatrists are by all means qualified to aid the mentally ill but the
qualifications of primary care physicians should be called into question.
Psychiatrists are required to complete coursework in psychology, biology, chemistry, and
pharmaceutical study as well as completing residencies in order to obtain licensure. Primary care
physicians are not as well versed in the field of psychology and tend to have relatively little
understanding about mental illness. These types of doctors typically have years of training and
experience regarding physical ailments such as the flu, and minor aches and pains. In the
7. SELF-IDENTIFICATION WITH MDD 7
integration of primary care and mental health, there tends to be a gap of communication between
mental health professionals and primary care physicians (Fischer, Heinrich, Davis, Peek, &
Lucas, 1997).
The problematic nature of primary care physicians prescribing medications for the
mentally ill is intensified by current insurance debacles. Many insurance providers do not cover
mental health visits, therapy or testing so the financial burden of obtaining treatment by the
proper professional often rests fully on the shoulders of the patient (Uebelacker, Smith, Lewis,
Sasaki, & Miller, 2009). It is important to understand that visits to primary care physicians are
covered by most insurance companies and those without insurance can often visit primary care
physicians at a reduced rate under provisions of hospitals or other large medical networks.
Commonly covered primary care visits may include concerns of mental health as there are often
physical symptoms of mental illness.
Even if an insurance provider does not cover mental health visits by a primary care
physician, most visits are covered such as annual wellness visits. As previously mentioned,
physical symptoms of mental illness are common and can therefore lead to a visit to a primary
care physician for mental health concerns (Uebelacker, Smith, Lewis, Sasaki, & Miller, 2009). In
the circumstance that the appointment with a primary care physician is not the result of a
physical symptom of mental illness, mental health concerns may still be discussed and treated by
the primary care physician. In turn of either circumstance, issues of mental health are being
covered by insurance companies because the visit is not being coded as a mental health visit,
rather as a wellness visit (Fischer, Heinrich, Davis, Peek, & Lucas, 1997).
Given that less than one third of Americans currently taking antidepressants have been
seen by a mental health professional in the past year (Pratt, Brody, & GU, 2011), it must be
8. SELF-IDENTIFICATION WITH MDD 8
inferred that someone other than a mental health professional (psychiatrist) is maintaining
prescriptions for these patients. This should be a rather disconcerting realization and understood
as a major disservice to the mentally ill. Through such easy access to mental health medications,
many problems arise (deGruy, 1997). It implies that there is a ‘quick fix’ for such illnesses and
that long-term commitment to treatment is unnecessary. In fact, a large part of the reason many
patients prefer to be diagnosed with non-personality disorders is because acute treatment plans
are often based on pharmacological interventions rather than long-standing combinations of
pharmacology and therapy (Kernberg & Yeomans, 2013).
Mental illnesses such as MDD require long-standing therapy and monitoring of progress.
Morrison et al. (2003) identified the first noticeable signs of clinical change in depressed patients
in the twentieth therapy session, and did not identify relatively permanent change until the
fiftieth session. A study conducted by Kopta, Howard, Lowry, and Beutler (1994) identified that
104 sessions were necessary for 50% of a given population of depressed patients to overcome
characterological symptoms. The remaining 50% of the participants needed more than 104
sessions. These findings, as well as expert testimony, indicate that severe mental disorders
require a long-standing commitment to therapy.
By removing mental health professionals from the process of prescribing mental health
medication, there is also a significant chance of misdiagnosis and incorrectly medicating
patients. Medications used to treat mental illnesses can have life-threatening physical and mental
side-effects when not administered and monitored properly or carefully (Strejilevich, et al.,
2011). Even patients who are properly diagnosed and medicated can experience a significant
negative impact on emotional health, behavior, cognitive and physical functioning as side-effects
of such medications. Adverse reactions to mental health medications are common, especially in
9. SELF-IDENTIFICATION WITH MDD 9
the mentally ill who already have impaired cognitive functioning, and can cause additional
traumas which can be detrimental and irreversible. A common side-effect of antidepressant use
is increased risk of suicide.
Misdiagnosis is common in patients with bi-polar disorder, which includes depressive
symptoms, and is often diagnosed with MDD (American Psychiatric Association, 2013). This
often leads to inadequate or inappropriate treatment (Soloman, et al., 2006). Under-diagnosis of
depression occurs in 44.3% of patients coming into primary care (Gabarron, et al., 2002). The
effects of misdiagnosis and mis-medication effect the prognosis of many mental illnesses
including MDD. There are many sub-types of depression which may be diagnosable under MDD
but have very different ideal treatment plans and pharmacological recommendations (Kernberg
& Yeomans, 2013). Approximately 30% of patients with MDD develop chronic refractory
depression which is the persistent reoccurrence of depressive episodes over the course of many
years, and can further enhance the need for adequate care and accurate diagnosis (McGrath &
Miller, 2008).
The belief that mental illnesses are uncomplicated and can easily attain diagnosis should
be avoided at all costs. The model set forth by primary health care is influencing the general
public’s understanding of mental health. Primary care physicians often make official diagnoses
in as little as ten minutes (Kates & Craven, 1998). This is highly discouraged as diagnostic
questions around bipolar illness, major depressive episodes, Attention Deficit/Hyperactivity
Disorder, and severe personality disorders are extremely important for clinicians to make
appropriate treatment recommendations (Kernberg & Yeomans, 2013). If mental health
professionals are not present, such critical questions may not be asked and may not be assessed
accurately.
10. SELF-IDENTIFICATION WITH MDD 10
There has been a reciprocal effect between the commonality of MDD diagnosis, easily
available medication, and commercialism and advertising. A recent study measured the effects of
exposure to a Cymbalta (antidepressant) television commercial on how much information
participants learned, and self-reported likelihood of seeking an antidepressant medication
(Callaghan, Laraway, Snycerski, & McGee, 2013). It was found that participants who were
exposed to the commercial had a significantly greater level of drug knowledge than the control
group. Although the control group and the group exposed to the commercial showed no
significant difference in their desire to seek pharmacological treatment, drug-knowledge scores
and drug-seeking scores were negatively correlated. This indicates that the more information a
person knows about a disorder, the more likely they will be to seek pharmacological treatment. A
depression inventory was also completed by participants and those with higher depression scores
were more likely to report a desire to seek pharmacological aid.
Commercials and advertisements such as the one used in the 2013 study by Callaghan et
al. often instruct people to discuss pharmacological options with their doctor if they think they
may be suffering from a mental illness such as depression. This advice and information may also
lead one to perform additional Internet research on the disorder they are concerned about having.
This would explain the tremendous growth of the number of Google searches preformed on
“Major Depressive Symptoms”. Upon performing this Google search, many resources such as
WebMD and MayoClinic return results. These resources can often be ambiguous and non-
specific regarding the actual requirements of clinical diagnosis.
As of November 11th
, 2013 WebMD’s depression guide lists eleven primary symptoms of
depression (WebMD, 2013). The guide warns that depression can be severe and life-threatening
if not diagnosed and treated properly. The guide also gives two shocking statistics—that
11. SELF-IDENTIFICATION WITH MDD 11
approximately half of the people who experience symptoms never get diagnosed or treated for
their illnesses and that more than one out of every ten people battling depression commit suicide.
These statements are not cited and their credibility is unknown, but they seem very serious. The
website explicitly warns that medical help should be sought out if any of the listed symptoms are
keeping a person from leading a normal, active life. The list of symptoms are not discriminatory,
do not warn about the possibility of the symptoms being attributed to a disorder outside of the
one listed on the guide, and the symptoms do not line up with the symptoms found in the DSM.
As similar information appears not only in television commercials for drugs , but also on
Internet resources, the number of people exposed to such ambiguous information regarding
mental illness is steadily increasing. Current statistics and health care circumstances indicate that
people are more frequently receiving pharmacological depression treatment from primary care
physicians than from mental health professionals (deGruy, 1997). All of these factors call into
question whether or not diagnosis can be influenced in the patients mind—can we influence how
likely people are to self-diagnose based on the information they are being given? The idea of
self-diagnosis has been long thought of in regard to medical students and the phenomenon has
been given the name “Medical Student Syndrome.”
For purely hypothetical purposes, say a person saw a drug commercial for an
antidepressant and could relate to some of the symptoms mentioned. This person then looks up
information online and realizes that they can relate to quite a few of these symptoms, which are
rather ambiguous in nature, and end up questioning whether or not they have the disorder. After
a few days of dwelling on the idea, the person becomes convinced they have said disorder. At
this point, the person decides to make an appointment with their primary care physician to
discuss pharmacological options, or brings the topic to discussion in their existing appointment.
12. SELF-IDENTIFICATION WITH MDD 12
They claim that they have been doing some research on depression and are fairly certain they are
suffering from the disorder and desire the relief described in the commercial they saw. The
doctor will likely conduct a brief questionnaire about depression and elicit a diagnosis, as
previously cited in ten minutes or less, and prescribe a medication.
The outcome of this highly probable hypothetical situation was completely based on
commercial influence and self-diagnosis. It is hypothesized that individuals who are exposed to a
list of diagnostic criteria and an account of a clinically diagnosed patient will be more likely to
claim the probability of themselves having MDD than individuals who are exposed to a list of
diagnostic criteria and an account of a patient with some depression symptoms who has not been
diagnosed with MDD, or a control in which no supplemental information regarding MDD is
given.
Method
Participants
Nineteen undergraduate males and 36 undergraduate females of various majors from
Stetson University participated in the study. Participants ranged in age from eighteen to twenty
three years old.
Materials and Procedure
A list of diagnostic criteria for MDD was taken from the DSM-5 (American Psychiatric
Association, 2013). Emotionality, extraversion, vulnerability, and depression scales were taken
from the NEO-PI-R (Costa & McCrae, 1992). Scale questions were randomized in order to
prevent participants from responding to similar questions consecutively. Participants were asked
to rate each scale item using a five point Likert scale where one represented “Never like me”,
two represented “Almost never like me”, three represented “Sometimes like me”, four
13. SELF-IDENTIFICATION WITH MDD 13
represented “Almost always like me”, and five represented “Always like me”. Negatively keyed
items were translated and the totals of individual tests were calculated by adding item scores.
The CESD Short Scale was also used (Andresen, Malmgren, Carter, & Patrick, 1994).
Subjects responded to the CESD by rating each given item in terms of the frequency that each
mood or symptom had occurred during the past week on a four point scale, ranging from zero
(“none of the time”) to three (“most of the time”). A score was assigned by translating negatively
keyed items and totaling all item scores.
Questions about the use of internet for information-seeking behaviors were developed
(Appendix A). Some questions about information-seeking behaviors were multiple choice and
others were statements rated using a five point Likert scale where one represented “definitely
would not”, two represented “probably would not”, three represented “maybe”, four represented
“probably would”, and five represented “definitely would”.
Questions about self-identification with MDD were also developed (Appendix B,
Appendix C). Items were rated using a five point Likert scale where one represented “Not at all
likely”, two represented “Not very likely”, three represented “Somewhat likely”, four
represented “likely”, and five represented “very likely”.
Additionally, two variations of a one-paragraph description of a patient were created. The
first was a synopsis of a patient who had been clinically diagnosed with MDD (Appendix D) and
the second was a synopsis of a patient suffering from some symptoms of depression, but not
suffering from MDD (Appendix E). Participants were also asked to identify their age group by
circling a set of numbers that best described their current age (18-20, 21-23, 24-26, 27-29, 30+)
and their gender by circling male or female.
14. SELF-IDENTIFICATION WITH MDD 14
Participants registered via public bulletin located in an academic hall on campus.
Participants received one of three forms at random: the control, the diagnosed condition, or the
undiagnosed condition. Participants receiving the diagnosed and undiagnosed conditions were
first asked to read a full list of diagnostic criteria for Major Depressive Disorder taken from the
DSM-5 (American Psychiatric Association, 2013). Participants were not informed of the source
of the diagnostic criteria. Upon completion of reading the excerpt participants were given the
questionnaire portion of the survey.
Participants receiving the diagnosed form received a synopsis of a patient who had been
clinically diagnosed with MDD (Appendix D), and questions about self-identification with MDD
(Appendix B). Participants receiving the undiagnosed form received a synopsis of a patient
suffering from some symptoms of depression, but not suffering from MDD (Appendix E), and
questions about self-identification with MDD (Appendix B). Participants receiving the control
form received questions about self-identification with MDD (Appendix C) and no client
synopsis.
All participants were presented with a questionnaire containing the following: an
emotionality scale (Costa & McCrae, 1992), extraversion scale (Costa & McCrae, 1992),
vulnerability scale (Costa & McCrae, 1992), depression scales (Costa & McCrae, 1992)
(Andresen, Malmgren, Carter, & Patrick, 1994), and questions about the use of internet for
information-seeking behaviors (Appendix F).
Once participants completed answering all questions, they handed in their surveys, were
debriefed, and released. Debriefing was consistent among all participants and included
reassuring participants that no information about their identity could be known from any
information provided on the survey and that no information regarding their identity had been
15. SELF-IDENTIFICATION WITH MDD 15
retained from the sign-up period of the study. Participants were also informed that none of the
information gathered in the study was sufficient for diagnosis. The participants were told which
personality traits were being measured (depression, vulnerability, emotionality, and extraversion)
and they were informed of the source of all scales and questions on the survey. Finally,
participants were explained that there were three forms of the survey they had taken—a control
with no supplemental information regarding MDD, an undiagnosed form which contained a
symptom list of MDD taken from the DSM 5 and a synopsis of a client with depressive
symptoms that was not suffering from MDD, and a diagnosed form which contained a symptom
list of MDD taken from the DSM 5 and a synopsis of a client suffering from MDD. Participants
were welcomed to ask questions about the research.
Results
A univariate ANOVA found a significant Form Difference on ratings for the statement “I
think I am currently suffering from Major Depressive Disorder.” The Form Difference was
F(2,49)=3.007, p=0.059 and shows that there was a significant difference in the way participants
rated the statement dependent on which form of the survey they had been given. The mean score
for the suffering statement in the control group was m=1.111 (s=0.251). The mean score for the
suffering statement in the undiagnosed group (Appendix A) was m=1.250 (s=0.208). The mean
score for the suffering statement in the diagnosed group (Appendix B) was m=1.750 (s=0.166).
A univariate ANOVA also found a significant Gender Difference on ratings for the
statement “I think I am currently suffering from Major Depressive Disorder.” The Gender
Difference was F(1,49)=6.677, p=0.013 which means that males and females rated the suffering
statement differently dependent on their gender. The mean rating for males was m=1.056
16. SELF-IDENTIFICATION WITH MDD 16
(s=0.205). The mean rating for females was m=1.685 (s=0.132). There was no interaction
between gender and form on the suffering statement.
The CESD had a maximum score of 30 and the average score on the CESD was m=10.8
(s=0.899) indicating that participants generally had not experienced a large number of
depression symptoms in the past week. It was also found that 58.2% of participants either agreed
or strongly agreed with the statement “I fully understand Major Depressive Disorder”.
Discussion
The findings of this study support the hypothesis that individuals who were exposed to an
account of a clinically diagnosed patient were more likely to claim the probability of themselves
having MDD than individuals who were exposed to an account of a patient with some depression
symptoms that had not been diagnosed with MDD, or a control in which no supplemental
information regarding MDD was given. Participants who were exposed to the synopsis of a
patient suffering from MDD were more likely to self-diagnose by thinking they were currently
suffering from MDD. Participants in the control group received no information pertaining to
MDD and were the least likely of the three groups to self-diagnose. This indicates that there is a
positive relationship between the amount of information a person has about MDD and the
likelihood to self-diagnose—as more information is present, the likelihood to self-diagnose
increases.
The increase in the level of self-diagnosis from the undiagnosed group to the diagnosed
group indicates that the type of information people have access to affects their tendency to self-
diagnose. The only difference between the two variable groups was whether the patient they
were presented with had been diagnosed with MDD or not. Participants who read about a patient
suffering from some symptoms of depression, but not MDD, were less likely to self-diagnose
17. SELF-IDENTIFICATION WITH MDD 17
than participants who read about a patient suffering from MDD. A possible explanation for this
is that reading about a patient who has been diagnosed with MDD increases the likelihood that
someone will diagnose themselves with MDD.
The aim of this study was to form a better understanding about the ways in which
individuals relate to MDD from a perspective of self-diagnosis. It is now understood that the
amount and type of information someone has influences and increases the likelihood that they
will self-diagnose. This plays a tremendous role in the marketing aspect of mental health.
Advertisements for pharmaceuticals often portray an individual suffering from an illness, or list
symptoms of disorders. Exposure to that information is likely to influence the audience in a way
that encourages self-diagnosis. The act of self-diagnosis may have a reciprocal effect on
utilization of medication in which an individual self-diagnoses and seeks medical attention or
purchases medication. Further research regarding the relationship between self-diagnosis and
pharmacology is needed in order to reach an accurate conclusion.
It is also important to understand how much people think they know about a disorder. An
astounding 58.2% of participants agreed that they fully understood Major Depressive Disorder.
In actuality, no one fully understands MDD. The exact nature and cause of mental illness is
largely unknown and is currently being investigated (Uher, 2013). The fact that so many
participants believed they fully understood MDD suggests that people generally have a false
sense of knowledge. Future studies should further investigate the relationship between perceived
understanding of disorders and self-diagnosis.
The implications of self-diagnosis are vast and should be considered seriously. One of the
largest implications of self-diagnosis is misdiagnosis as it may lead to improper treatment and
other consequences. Treatment of mental disorders is often an extensive process requiring years,
18. SELF-IDENTIFICATION WITH MDD 18
if not a lifetime, of commitment to treatment and the desire to become well (Widdowson, 2011).
Without proper treatment, the mental health of an individual may continue to deteriorate and
potentially prevent them from fully recovering.
The high rate of comorbidity in disorders such as MDD complicates diagnosis for
clinicians who are trained in diagnosing and treating mental disorders let alone the general
population (Morrison, Bradley, & Westen, 2003). Mental disorders often occur simultaneously
(comorbidity) or can be masked by one another. Some disorders, such as delusional disorders, do
not present symptoms in a manner that the person experiencing them can properly identify
(Kernberg & Yeomans, 2013). Confusion and lack of knowledge about which symptoms are
actually present would likely decrease the accuracy of self-diagnosis.
It is often the case that a physical problem causes symptoms similar to or the same as
those of a mental illness. Something such as hormone imbalance can significantly impact general
mood, anxiety levels and the ability to lead a normal life. If a person has more or less symptoms
than what they’re reading about, that may influence their self-diagnosis regardless of whether or
not the quantity of symptoms relates to the true problem. Misdiagnosis by self-diagnosis can also
lead people to believe that they have a disorder far more severe than the disorder they actually
have, or don’t have. The worry of having a severe disorder can create a more intense reaction in
the individual being ‘diagnosed’ such as increased or worsened anxiety or depression.
The findings of this study have also indicated that not everyone is equally as likely to
self-diagnose. Women were significantly more likely to self-diagnose MDD than men. This tells
us that women are also more likely to face the challenges of self-diagnosis such as misdiagnosis
and mistreatment. Future studies should explore the ways in which self-diagnosis and
misdiagnosis effect women in particular. It can be hypothesized that women and men face the
19. SELF-IDENTIFICATION WITH MDD 19
same consequences of self-diagnosis and misdiagnosis; however they may face these
consequences at different rates.
Future research should focus on the reasons why people self-diagnose. The implications
of self-diagnosis are such that mental health professions may be at risk. Understanding why self-
diagnosis occurs could enable us to prevent or better the practice of self-diagnosis as a whole. It
is possible that people are ‘forced’ to self-diagnose because they cannot afford healthcare or
medication. Conducting research regarding income level and availability of affordable and
adequate mental health care may provide additional insight to this theory. Another angle to
explore would be whether individuals who are self-diagnosing mental disorders are also seeking
the care of mental health professionals or not. Understanding if individuals are seeking
professional care following self-diagnosis may ease the perceived impacts of self-diagnosis.
Alternative disorders should also be investigated in future research. This study was
strictly relevant to MDD and it must be acknowledged that the general principle of self-diagnosis
may vary among different disorders. Understanding which disorders and illnesses have the
highest rates of self-diagnosis could assist us in stopping self-diagnosis, or providing better
resources for people to consult. Understanding which disorders are affected by self-diagnosis
could also alter marketing strategies used by pharmaceutical companies, insurance companies
and healthcare providers.
20. SELF-IDENTIFICATION WITH MDD 20
References
American College Health Association. (2009). National College Health Assessment II:
Reference Group Data Report Fall 2008. Baltimore: American College Health
Association.
American Psychiatric Association. (1968). Diagnostic and Statistical Manual of Mental
Disorders (2nd ed.). Washington: Author.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders. Washington: Author.
Andresen, E., Malmgren, J., Carter, W., & Patrick, D. (1994). Center for Epidemiological
Studies Short Depression Scale. Retrieved from PsycTESTS, doi: 10.1037/t10141-000.
Callaghan, G., Laraway, S., Snycerski, S., & McGee, S. (2013). Antidepressant Advertising
Effects on Drug Knowledge and Drug Seeking. Journal of Consumer Marketing, 267-
272.
Clegg, J. (2012). Teaching about Mental Health and Illness Through the History of the DSM.
History of Psychology, 364-370.
Costa, P., & McCrae, R. (1992). Revised NEO Personality Inventory (NEO-PI-R).
Psychological Assessment Resources.
deGruy, F. (1997). Mental Healthcare in the Primary Care Setting: A Paradigm Problem.
Families, Systems, & Health, 3-26.
Dennis, J., & Lederman, R. (2013, January 24). ADHS: Division of Behavioral Health Services:
Enhanced Assessment Training for Behavioral Health Technicians. Retrieved from
21. SELF-IDENTIFICATION WITH MDD 21
Arizona Department of Health Services:
http://www.azdhs.gov/bhs/tr_resources/ea/pdf/rd.pdf
Fischer, L., Heinrich, R., Davis, T., Peek, C., & Lucas, S. (1997). Mental Health and Primary
Care in an HMO. Families, Systems, & Health, 379-391.
Gabarron, H., Vidal, R., Haro, A., Boix, S., Jover, B., & Arenas, P. (2002). Prevalencia y
deteccion de desordenes depresivos en atencion primaria (Prevelance and detection of
depressive disorders in primary care). Atencion Primaria, 329-336.
Google. (2013, December 6). Google Trends. Retrieved from Google:
http://www.google.com/trends
Hunt, J., & Eisenberg, D. (2010). Mental Health Problems and Help-Seeking Behavior Among
College Students. Journal of Adolescent Health, 3-10.
Kates, N., & Craven, M. (1998). Managing Mental Health Problems: A Practical Guide for
Primary Care. Seattle: Hogrefe & Huber.
Kernberg, O., & Yeomans, F. (2013). Borderling Personality Disorder, Bipolar Disorder,
Depression, Attention Deficit/Hyperactivity Disorder, and Narcissistic Personality
Disorder: Practical Differential Diagnosis. Bulliten of the Menninger Clinic, 1-22.
Kessler, R., Berglund, P., Demler, O., Jin, R., D, K., Merikangas, K., & Wang, P. (2003). The
Epidemology of Major Depressive Disorder: Results from the National Comorbidity
Survey Replication (NCS-R). Journal of the American Medical Association, 3095-3105.
Kopta, S., Howard, K., Lowry, J., & Beutler, L. (1994). Patterns of Symptomatic Recovery in
Psychotherapy. Journal of Consulting and Clinical Psychology, 1009-1016.
22. SELF-IDENTIFICATION WITH MDD 22
McGrath, P., & Miller, J. (2008). Pharmacologic Management for Treatment-Resistant Unipolar
Depression. Psychiatry, 2372-2389.
Moreno, M., Christakis, D., Egan, K., Jelenchick, L., Cox, E., Young, H., . . . Becker, T. (2012).
A Pilot Evaluation of Associations Between Displayed Depression References on
Facebook and Self-Reported Depression Using a Clinical Scale. The Journal of
Behavioral Helath Services & Research, 295-304.
Morrison, K., Bradley, R., & Westen, D. (2003). The External Validity of Controlled Clinical
Trials of Psychotherapy for Depression and Anxiety: A Naturalistic Study. Psychology
and Psychotherapy: Theory, Research and Practice , 109-132.
National Committee for Mental Hygiene. (1918). Statistical Manual for the Use of Institutions
for the Insane. New York: Author.
Office of the Surgeon General, Army Service Forces. (2000). Medical 203 Nomenclature of
Psychiatric Disorders and Reactions. Journal of Clinical Psychology, 925-934.
Pratt, L., Brody, D., & GU, Q. (2011). Antidepressant use in persons aged 12 and over: United
States, 2005–2008. Hyattsville: National Center for Health Statistics.
Rosenthal, B., & Wilson, W. (2008). Mental Health Services: Use and Disparity Among Diverse
College Students. Journal of American College Health, 61-68.
Soloman, D., Leon, A., Maser, J., Truman, C., Coryell, W., Endicott, J., . . . Keller, M. (2006).
Distinguishing Bipolar Major Depression from Unipolar Major Depression With the
Screening Assessment of Depression-Polarity (SAD-P). Journal of Clinical Psychiatry,
434-442.
23. SELF-IDENTIFICATION WITH MDD 23
Strejilevich, S., Martino, D., Marengo, E., Igoa, A., Fassi, G., Whitham, E., & Ghaemi, S.
(2011). Long-Term Worsening of Bipolar Disorder Related with Frequency of
Antidepressant Exposure. Annals of Clinical Psychiatry, 186-192.
U.S. Census Bureau. (2013, May). Computer and Internet Use in the United States. Retrieved
from United States Census Bureau: http://www.census.gov/prod/2013pubs/p20-569.pdf
Uebelacker, L., Smith, M., Lewis, A., Sasaki, R., & Miller, I. (2009). Treatment of Depression in
a Low-Income Primary Care Setting with Colocated Mental Health Care. Families,
Systems & Health, 161-171.
Uher, R. (2013). The Changing Understanding of the Genetic and Environmental. The Canadian
Journal of Psychiatry, 67-68.
WebMD. (2013, November 18). Signs of Clinical Depression: Symptoms to Watch For.
Retrieved from WebMD: http://www.webmd.com/depression/guide/detecting-depression
Wells, V., Klerman, G., & Deykin, E. (1987). The Prevalence of Depressive Symptoms in
College Students. Social Psychiatry, 20-28.
Widdowson, M. (2011). Depression: A Literature Review on Diagnosis, Subtypes, Patterns of
Recovery, and Psychotherapeutic Models. Transactional Analysis Journal, 351-364.
24. SELF-IDENTIFICATION WITH MDD 24
Appendix A
Questions about Information-Seeking Behaviors
About how often do you use the internet to research information regarding your health (physical
or mental)?
a. Once per week or more
b. Twice per month
c. Once every couple of months
d. A few times per year
About what percentage of your internet research about health is regarding physical health?
a. 0-25%
b. 26-50%
c. 51-75%
d. 76-100%
About what percentage of your internet research about health is regarding mental health?
a. 0-25%
b. 26-50%
c. 51-75%
d. 76-100%
Please select websites you are familiar with:
- WebMD - HealthCentral
- MayoClinic - MedicineNet
- Yahoo Answers - PsychCentral
- Other
Please rate the following items where:
5 = You definitely would 4 = You probably would 3 = Uncertain
2 = You probably would not1 = You definitely would not
______ Would seek information on the internet if you felt more tired than normal.
______ Would seek information on the internet if you felt nauseous several days in a row.
______ Would seek information on the internet if you felt more irritable than normal.
______ Would seek information on the internet if you were experiencing back pain.
______ Would seek medical attention if you felt more tired than normal.
______ Would seek medical attention if you felt nauseous several days in a row.
______ Would seek medical attention if you felt more irritable than normal.
______ Would seek medical attention if you were experiencing back pain.
______ Would consult a Primary Care Physician or Family Doctor for physical health concerns.
______ Would consult a Primary Care Physician or Family Doctor for mental health concerns.
______ Would consult a Mental Health Professional for mental health concerns.
______ Wouldn’t consult any professional about a concern unless it interfered with daily life.
25. SELF-IDENTIFICATION WITH MDD 25
Appendix B
Questions Regarding Self-Identification with MDD for Diagnosed & Undiagnosed Conditions
I am at risk for major depressive disorder.
I think I am currently suffering from Major Depressive Disorder.
I am like the client given in the synopsis above.
Others around me think I have Major Depressive Disorder.
I fully understand Major Depressive Disorder.
26. SELF-IDENTIFICATION WITH MDD 26
Appendix C
Questions Regarding Self-Identification with MDD for Control
I am at risk for major depressive disorder.
I think I am currently suffering from Major Depressive Disorder.
Others around me think I have Major Depressive Disorder.
I fully understand Major Depressive Disorder.
27. SELF-IDENTIFICATION WITH MDD 27
Appendix D
Diagnosed Condition
Jack is a 23-year-old male who has been clinically diagnosed with Major Depressive Disorder.
He is in his final year of undergraduate study at Appletown College. Until recently, he was a
cheerful individual who always loved going to school and hanging out with friends. He used to
go running four or five times a week to keep up his figure and alleviate stress. The last two
months, Jack has been skipping class regularly because he is too tired to get out of bed in the
morning. He feels that his collegiate work will never pay off and that he will never amount to
anything. He is now failing half of his classes and is at risk of being put on academic probation
by the college. On days that Jack does get out of bed, he has little to no energy and finds that he
can’t concentrate on anything. He has not been spending much time with his friends and hasn’t
been answering their calls or texts. To top it all off, Jack has gained a significant amount of
weight in the last two months and has been much more hungry than he used to be.
28. SELF-IDENTIFICATION WITH MDD 28
Appendix E
Undiagnosed Condition
Jack is a 23-year-old male in his final year of undergraduate study at Appletown College. He is
generally a cheerful individual who enjoys going to school and hanging out with friends. He goes
running four or five times a week to keep up his figure and alleviate stress but has managed to
gain almost 10 pounds in the last couple of months. Jack has been missing class because he is
extremely tired and spends most of his day sleeping. He worries that he may not be successful
after he graduates and wonders if he will make it in the corporate world. Jack has been very
irritable lately, too. Jack is partying more frequently than he used to, consuming as many as eight
drinks per night at least two nights per week. He has also been more promiscuous lately, seeing
one or two partners in the same week with no intentions of long-term commitment. Jack has been
seeing a licensed psychologist and it has been confirmed that he is not suffering from Major
Depressive Disorder as he does not meet the necessary criteria.