Preventing depression in low-income mothers

It is well-established that women in low-income households have an increased risk of developing mental health problems, in particular depression | The Mental Elf

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Studies have found that these women are around twice as likely to develop the disorder compared with those from higher-income households (Hobfoll et al, 1995). Low-income women are also less likely to seek and receive appropriate treatment, in part because of the associated costs (Lennon et al, 2001).

For women who are mothers, this is especially consequential: parental depression has been linked with developmental, emotional and mental health problems in children (McDaniel et al., 2013). In the United States this has been highlighted as a public health concern, and it is increasingly being recognised that community-based services offer valuable opportunities to reach those for whom help is less accessible.

Head Start is a US government-funded service aimed at families at or below the federal poverty level with young children under five. They use a case-management structure to establish a healthy family environment in order to look after the child’s development and wellbeing. Depression affects almost half of the mothers at Head Start. A recent study by Silverstein et al. (2017) examines the efficacy of embedding a depression prevention strategy in the Head Start program.

A closer look at perinatal depression

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Postnatal depression affects around 1 in 10 women and not only impacts on the wellbeing of the mother, but can also have long term impacts on the mental and physical health of the infant.

The authors of this Lancet paper are from the Postpartum Depression: Action Towards Causes and Treatment (PACT) consortium. This is an international group who aim to gather information about PND to explore a number of questions, including whether there are distinguishable subtypes of PND which might be relevant for treatment and prognosis, in particular taking into account comorbid anxiety.

In this post via The Mental Elf, Jill Domoney looks at the methods and results of this paper, the authors of which believe has created “an important hypothesis-generating foundation for future work”.

Full reference to the research: Putman K et al. (2017) Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an International Consortium. Lancet Psychiatry 4(6) 477-485.

World Health Day 2017 – Depression

This year’s World Health Day (7 April 2017) focuses on the World Health Organisation’s one-year global campaign on depression.

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Image source: http://www.who.int

Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.

Despite being very common, depression is still under-recognized and undertreated and there is a need to open up dialogue and tackle the stigma associated with it.  The campaign provides information regarding the consequences and management of depression, and how to provide support to people living with depression. Resources include videos, handouts and posters.

Read more at World Health Organisation

Additional links:

Older people miss out on psychological therapies

Depression in older people is common, under-diagnosed, under-treated and attracts “therapeutic nihilism”, according to Professor Alistair Burns, NHS England’s National Clinical Director for Dementia | OnMedica

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Prof Burns say while one in five older people have clinical depression, “contrary to some popular and professional opinion, it is eminently treatable”. He wants clinicians to offer a wider range of treatments and therapies to target depression and anxiety which are both associated with increased risk of more serious physical and mental health problems.

“Treatments for depression in older people are largely the same as in younger people and there is high quality and convincing evidence that older people respond very well to interventions,”

While exercise is a “very effective” treatment for depression, Prof Burns cites the Health Survey for England which showed that only 18% of men and 19% of women aged 55-64 undertake the recommended amount of regular exercise, a figure falling to 10% and 2% for people aged 75-85.

Read the full news story here

Insufficient evidence to support depression prevention programmes

Cristea, I. The Mental Elf Blog. Published online: 21 February 2017

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Research on prevention differentiates between universal interventions, which are implemented for a designated population regardless of the risk (e.g., all school-age children) and targeted interventions, which are aimed at a population at high risk for a disorder. Recent large trials in adults covered on the Mental Elf showed prevention of depression is particularly effective when it is targeted.

In a recent Cochrane systematic review, Hetrick and colleagues examined whether three evidence-based psychological interventions (cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and ‘third wave’ CBT) are effective in preventing the onset of depressive disorder in children and adolescents.

Read the full overview here

Read the original research article here

Physically active children are less depressed

Zahl, T. et al. (2017) Pediatrics. 139(2) e20161711

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Objective: The prospective relation between physical activity and Diagnostic and Statistical Manual of Mental Disorders-defined major depression in middle childhood is unknown, as is the stability of depression. We therefore aimed to (1) determine whether there are reciprocal relations between moderate-to-vigorous physical activity (MVPA) and sedentary behavior, on one hand, and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition defined symptoms of major depressive disorder, on the other and (2) assess the extent of stability in depressive symptoms from age 6 to 10 years.

Conclusions: MVPA predicts fewer symptoms of major depression in middle childhood, and increasing MVPA may serve as a complementary method to prevent and treat childhood depression.

Read the full article here

Initial severity of depression and efficacy of cognitive–behavioural therapy

Furukawa, T. A. et al. The British Journal of Psychiatry. Published online: 19 January 2017

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Image source: Jasmine Parker – Wellcome Images // CC BY-NC-ND 4.0

Background: The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive–behavioural therapy (CBT) in comparison with pill placebo.

Conclusions: Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.

Read the full abstract here