Major Mental Disorders and Depression

Depression in Families,Depression Is A Descriptive Term,What is Family,Genetic and Biological Research On Depression,Psychological Research In Depression,Family Response to Mental Depression.

Depression in Families

    Depression
is a major mental health problem affecting 25 million Americans and their
families. By 2020, depression will be the third leading cause of disability
worldwide. 

    Most people suffering from depression live with their families,
usually their spouses and children, and the negative impact of depression on
families has been well-documented (Coyne et al., 1987; Keitner , Archambault,
Ryan, & Miller, 2003; Lee, 2003; Miller et al., 1992). 

    Nursing has long
viewed families- as a context for caring for the individual with depression,
but only recently has focused on the whole family.

Depression Is A Descriptive Term

    Depression
is a rather vague descriptive term with a broad and varied meaning ranging from
normal sadness and disappointment to a severe incapacitating psychiatric
illness. 

   William Styron (1990) describes in Darkness Visible the unsatisfactory
descriptive nature of the term depression: “a noun with bland tonality and
lacking any magisterial presence, used indifferently to describe the economic
decline or rut in the ground, a true wimp of a word for such a major
illness” (p. 37).

    Depression
is a universal mood state with all people experiencing a lowered mood or
transient feelings of sadness related to negative life events such as loss. For
most, the feelings of sadness or disappointment resolve with time and normal
functioning resumes. 

    In contrast, the symptoms associated with the psychiatric
illness of depression can disrupt normal functioning, influence mortality and
morbidity, and can cause a myriad of problems within the family (Badger, 1996a;
Bluementhal et al., 2003; Cuijpers & Smit, 2002; Katon , 2003). 

    The
psychiatric illness of major depressive disorder (MDD) is diagnosed if five out
of the following nine symptoms are present for a minimum of 2 weeks most of the
day, nearly every day: 

(a) depressed mood

(b) loss of interest or pleasure in
all activities

(c) decrease or increase in appetite or significant weight
change

(d) insomnia or hypersomnia

(e) psychomotor retardation or agitation

(f) fatigue or loss of energy

(g) feelings of worthlessness or excessive
guilt

(h) difficulty concentrating or indecisiveness

(i) recurrent
thoughts of death, recurrent suicide ideation or attempt (American Psychiatric
Association (APA), 1994). 

    One of the five symptoms must be depressed mood or
loss of interest or pleasure. Together, these symptoms cause significant
functional impairment. In addition to MDD, depression is further classified in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994)
into other diagnostic subtypes such as minor depression or dysthymia by signs
and symptoms, onset, course, duration, and outcomes.

What is Family

    Family
refers to any group that functions together to perform tasks related to
survival, growth, safety, socialization, or health of the family. Family
members can be related by marriage, birth, adoption, or can self identify
themselves as family. 

    This definition is sufficiently broad to be inclusive of
all types of families; however, it is recommended that researchers provide
specific definitions of family appropriate to their research.

Genetic and Biological Research On Depression

    Genetic-biological
research of depression in families includes genetic and biological marker
studies ( Flaskerud , 2000; Viguera & Rothschild, 1996). The four research
approaches to the genetics of mood are: 

(a) familial loading studies (eg,
comparing families with depression to families without the disease)

(b)
studies evaluating the inheritability of mood disorders (eg, twin studies)

(c
) studies of incidence of the risk for, but not yet ill from, mood disorders to
determine biological or psychological antecedents

(d) in theory, studies
using genetic probes to determine which relatives and which phenotypes are
associated with the genetic contributions to mood disorders ( Suppes &
Rush, 1996). 

    The results of the familial loading studies are clear whether the
approach used is the “top-down” ( ie , studies of children with
depressed parents) or the “bottom-up” approach ( ie , studies of
relatives of depressed children ) ( Birmaher , Ryan, & Williamson, 1996;
Jacobs & Johnson, 2001). 

    Children with depressed parents have a
significantly greater risk of developing depressive disorders and other
psychiatric disorders than do children with parents without depression
(Buckwalter, Kerfooot , & Stolley , 1988; Peterson et al, 2003; Nomura,
Wickramaratne , Warner, Mufson , & Meissman , 2002). 

    Biological marker
studies have focused on growth hormone, serotonergic and other neurotransmitter
receptors, sleep, and hypothalamic pituitary axis (Keltner, 2000; Viguera &
Rothschild, 1996). 

    Despite evidence from genetic studies about the strong
support for the genetic inheritance of depression, and the fact that
abnormalities in biological markers persist throughout the life span, the
relationship between genetic-biological predisposition and environment remains
unclear.

Psychological Research In Depression

    Psychosocial
research of depression in families has focused on communication, mar ital
problems and dissatisfaction, expressed emotion, problem-solving, coping, and
family functioning (Beach, Sandeen , & O’Leary, 1990; Biglan et al., 1985;
Keitner , Miller, Epstein, Bishop, & Fruzzetti , 1987). 

    The evidence
strongly supports that families who contain members with depression have
greater impairment in all areas than matched control families, and then
families whose members are diagnosed with alcohol dependence, adjustment
disorders, schizophrenia, or bipolar disorders (Coyne et al., 1987; Keitner ,
Miller, & Ryan, 1993). 

    It is not surprising that depression has its most
negative impact on families during acute depressive episodes (Miller et al.,
1992), yet families with depressed members consistently experience more
difficulties than matched control families even 1 year after initial treatment
(Billings & Moos, 1985). 

    Family members) living with members with depression
report greater health problems, with about 40% of adults being sufficiently
distressed themselves to require therapeutic intervention (Coyne et al., 1987). 

    The majority of recent studies of families with members with depression have
used primarily inpatient samples, have focused on women as the identified
patient, have often excluded parents with depression, and have been
quantitative in nature (Schwab, Stephenson, & Ice, 1993). 

    Few studies have
used qualitative approaches to understand family members’ perspectives and
treatment needs. Badger (1996a) used a grounded theory method to describe the
social psychological process of families living with members with depression. 

    The process, family transformations, refers to the cognitive and behavioral changes
that occur within the family from the time the member initially exhibits
symptoms through recovery and at. remission. 

    As family members moved through
the three stages (acknowledging the strangers within, fighting the battle,
gaining a new perspective), all members are transformed and family functioning
forever altered.     

These results support findings from previous studies and
provide perspectives of family members not normally included in depression
research.

Family Response to Mental Depression 

    Despite
identifying the multiple problems in these families, the role of the family in
the treatment process has received less attention. Systematic family
interventions have only begun to be developed and modeled after programs used
with people with other psychiatric disorders and their families (Holder &
Anderson, 1990; Kietner et al., 2003). 

    For example, Lee (2003) found that in
mothers who participated in a program to improve maternal coping skills, these
coping skills moderated between depression and negative life events, reducing
the negative effects on children. 

    To date, few clinical trials have validated
the effectiveness of these interventions. Families have identified the need for
information about how to facilitate communication, decrease negative
interactions, handle stigma, gain a new perspective, care for self and redesign
their relationships (Badger, 1996b). 

    In theory, education, support and
partnering could move family members more quickly through the stages to prevent
depression from becoming a recurrent and chronic illness for the entire family.
Future research should develop and test psychoeducational and support
interventions with families. 

    Although a common concern with research with
families remains the unit of analysis (individual, dyad, or family as a whole),
research representing all perspectives is needed for nursing to more fully
understand and treat depression in families.