Chapter 7: Mood Disorders & Suicide
Depression
Groups:
– 3 signs have you seen that a student could be depressed?
• No usual activities, no exercise
– 3 aspects of college could precipitate a depressive episode?
• Stress, exams, projects, work
– 3 reasons that college students might not seek help for depression symptoms?
• Embarrassment, no time, in denial, get over alone
– 3 things college students might do to cope with depression?
• Alcohol, drugs, caffeine
Depression and College Students
– 30 % US college students reported feeling "so depressed that it was difficult to function"
at some time in the past year
– 25% of students who visits a university health center for a routine cold turns out to be
depressed.
– Stress is a major cause of depressive episodes
– More than 80 percent of college students felt overwhelmed by all they had to do in the
past year and 45 percent have felt things were hopeless (American College Health
Association, 2012)
Depression, Stress and College Students
– Stressors for college students include
• Greater academic demands
• Being on your own in a new environment
• Changes in family relations
• Financial responsibilities
• Changes in your social life
• Exposure to new people, ideas, and temptations
• Awareness of your sexual identity and orientation
• Preparing for life after graduation
Depression and College Students
– College students who have depression are more likely to:
• Self-medicate by
Drinking to get drunk
Using street drugs
Smoking tobacco
• Experience problems related to alcohol abuse, such as engaging in unsafe sex
Depression and College Students
– Getting help: many don’t (per NIMH)
• may not know where to go for help
• believe that treatment won't help
• think their symptoms are just part of the typical stress of college
• worry about being judged if they seek mental health care
• Depression and College Students
– Getting help
• 45% of young adults who stopped attending college because of mental health
related reasons did not request accommodations
• 50% of them did not access mental health services and supports either.
Depression and College Students
– Getting help: reality (per NIMH)
• UW-L and most colleges offer free or low-cost mental health services.
, • Depression treatments can be very effective.
• Early diagnosis and treatment of depression can relieve depression symptoms,
prevent depression from returning, and help students succeed in college and after
graduation.
Unipolar Depression Symptoms
– Anhedonia (loss of interest)
– Psychomotor retardation/agitation
– In severe cases
• Hallucinations
• Delusions
– Major depression—acute
– Dysthymic disorder—chronic
Subtypes of Depression
– Depression with Melancholic Features
– Depression with Psychotic Features
– Depression with Catatonic Features
– Depression with Atypical Features
– Depression with Postpartum Onset
– Depression with Seasonal Pattern (SAD)
Postpartum depression: Burden
– Approximately 500,000 of the 4 million American women giving birth each year
experience postpartum depression (PPD)
– PPD is under detected and under treated
– Many barriers exist to detection and treatment
Perinatal Psychological Disorders
– The Blues
– Postpartum Depression
– Postpartum Psychosis
Perinatal Depression: Prevalence
Postpartum Blues
– Most common, 50-80%
– Relatively brief
• Few hours to several days
– Onset usually in first week to 10 days PP
– Typically remit spontaneously
• May represent the initial stages of PPD/PPP
Typical Blues Symptoms
– Low Mood
– Mood Lability
– Insomnia
– Anxiety
– Crying
– Irritability
Postpartum Psychosis
– Rare: 1/1000 postpartum women
– Hallucinations and/or Delusions
– Risk Factors:
• History Bipolar Affective Disorder/Psychosis
• Family history of psychosis
• Having first child
– Aggressive intervention absolutely necessary
, Postpartum Depression
– Not as mild or transient as the blues
– Not as severely disorienting as psychosis
– Range of severity
– Often undetected
Postpartum Depression: Risk Factors
– Lower SES/unemployment
– Past depression or anxiety disorder
– Past history of alcohol abuse
– Stressful life events
– Poor marital relationship
– Inadequate social support
– Child-care related stressors
– African American ethnicity
Postpartum depression in men
– 10% of new fathers
– Symptoms of hostility/aggression more that women
– Example: Rob Sandler
• Looked forward to birth
• Felt overwhelmed and trapped
• Left for work earlier and stayed late, lost appetite, cried more, felt anxiety and
guilt
Effects of Perinatal Depression: An Overview
Depression negatively effects:
– Mother’s ability to mother
– Mother—infant relationship
– Emotional and cognitive development of the child
Postpartum Depression: Maternal Attitudes
– Infants perceived to be more bothersome
– Make harsh judgments of their infants
– Feelings of guilt, resentment, and ambivalence toward child
– Loss of affection toward child
Postpartum Depression: Maternal Behaviors
– Gaze less at their infants
– Take longer to respond to infant’s utterances
– Show fewer positive facial expressions
– Lack awareness of their infants
– Increased risk for abusing children
Postpartum Depression: Maternal Interactions
– Flat affect, low activity level, and lack of contingent responding
– OR Alternating disengagement and intrusiveness
Effects of Maternal Depression
– Infants- lowered Brazelton scores, frequent looking away, fussiness
– Toddlers- poorer cognitive development, insecure attachment
– Children- cognitive development of low ses boys
– Adolescents-higher cortisol levels
Symptoms of Depression
– Cognitive
• Poor concentration, indecisiveness, poor self-esteem, hopelessness, suicidal
thoughts, delusions
– Physiological and Behavioral
Depression
Groups:
– 3 signs have you seen that a student could be depressed?
• No usual activities, no exercise
– 3 aspects of college could precipitate a depressive episode?
• Stress, exams, projects, work
– 3 reasons that college students might not seek help for depression symptoms?
• Embarrassment, no time, in denial, get over alone
– 3 things college students might do to cope with depression?
• Alcohol, drugs, caffeine
Depression and College Students
– 30 % US college students reported feeling "so depressed that it was difficult to function"
at some time in the past year
– 25% of students who visits a university health center for a routine cold turns out to be
depressed.
– Stress is a major cause of depressive episodes
– More than 80 percent of college students felt overwhelmed by all they had to do in the
past year and 45 percent have felt things were hopeless (American College Health
Association, 2012)
Depression, Stress and College Students
– Stressors for college students include
• Greater academic demands
• Being on your own in a new environment
• Changes in family relations
• Financial responsibilities
• Changes in your social life
• Exposure to new people, ideas, and temptations
• Awareness of your sexual identity and orientation
• Preparing for life after graduation
Depression and College Students
– College students who have depression are more likely to:
• Self-medicate by
Drinking to get drunk
Using street drugs
Smoking tobacco
• Experience problems related to alcohol abuse, such as engaging in unsafe sex
Depression and College Students
– Getting help: many don’t (per NIMH)
• may not know where to go for help
• believe that treatment won't help
• think their symptoms are just part of the typical stress of college
• worry about being judged if they seek mental health care
• Depression and College Students
– Getting help
• 45% of young adults who stopped attending college because of mental health
related reasons did not request accommodations
• 50% of them did not access mental health services and supports either.
Depression and College Students
– Getting help: reality (per NIMH)
• UW-L and most colleges offer free or low-cost mental health services.
, • Depression treatments can be very effective.
• Early diagnosis and treatment of depression can relieve depression symptoms,
prevent depression from returning, and help students succeed in college and after
graduation.
Unipolar Depression Symptoms
– Anhedonia (loss of interest)
– Psychomotor retardation/agitation
– In severe cases
• Hallucinations
• Delusions
– Major depression—acute
– Dysthymic disorder—chronic
Subtypes of Depression
– Depression with Melancholic Features
– Depression with Psychotic Features
– Depression with Catatonic Features
– Depression with Atypical Features
– Depression with Postpartum Onset
– Depression with Seasonal Pattern (SAD)
Postpartum depression: Burden
– Approximately 500,000 of the 4 million American women giving birth each year
experience postpartum depression (PPD)
– PPD is under detected and under treated
– Many barriers exist to detection and treatment
Perinatal Psychological Disorders
– The Blues
– Postpartum Depression
– Postpartum Psychosis
Perinatal Depression: Prevalence
Postpartum Blues
– Most common, 50-80%
– Relatively brief
• Few hours to several days
– Onset usually in first week to 10 days PP
– Typically remit spontaneously
• May represent the initial stages of PPD/PPP
Typical Blues Symptoms
– Low Mood
– Mood Lability
– Insomnia
– Anxiety
– Crying
– Irritability
Postpartum Psychosis
– Rare: 1/1000 postpartum women
– Hallucinations and/or Delusions
– Risk Factors:
• History Bipolar Affective Disorder/Psychosis
• Family history of psychosis
• Having first child
– Aggressive intervention absolutely necessary
, Postpartum Depression
– Not as mild or transient as the blues
– Not as severely disorienting as psychosis
– Range of severity
– Often undetected
Postpartum Depression: Risk Factors
– Lower SES/unemployment
– Past depression or anxiety disorder
– Past history of alcohol abuse
– Stressful life events
– Poor marital relationship
– Inadequate social support
– Child-care related stressors
– African American ethnicity
Postpartum depression in men
– 10% of new fathers
– Symptoms of hostility/aggression more that women
– Example: Rob Sandler
• Looked forward to birth
• Felt overwhelmed and trapped
• Left for work earlier and stayed late, lost appetite, cried more, felt anxiety and
guilt
Effects of Perinatal Depression: An Overview
Depression negatively effects:
– Mother’s ability to mother
– Mother—infant relationship
– Emotional and cognitive development of the child
Postpartum Depression: Maternal Attitudes
– Infants perceived to be more bothersome
– Make harsh judgments of their infants
– Feelings of guilt, resentment, and ambivalence toward child
– Loss of affection toward child
Postpartum Depression: Maternal Behaviors
– Gaze less at their infants
– Take longer to respond to infant’s utterances
– Show fewer positive facial expressions
– Lack awareness of their infants
– Increased risk for abusing children
Postpartum Depression: Maternal Interactions
– Flat affect, low activity level, and lack of contingent responding
– OR Alternating disengagement and intrusiveness
Effects of Maternal Depression
– Infants- lowered Brazelton scores, frequent looking away, fussiness
– Toddlers- poorer cognitive development, insecure attachment
– Children- cognitive development of low ses boys
– Adolescents-higher cortisol levels
Symptoms of Depression
– Cognitive
• Poor concentration, indecisiveness, poor self-esteem, hopelessness, suicidal
thoughts, delusions
– Physiological and Behavioral
