Depression

This introductory look at research related to depression includes information that can be used by social work practitioners, educators, and policy-setters.  It includes links to depression-specific web pages, including those of the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Administration (SAMHSA), the Agency for Healthcare Research and Quality (AHRQ), the National Alliance for the Mentally Ill (NAMI) and the National Mental Health Association (NMHA). It also features a set of references which indicates the range of social work’s approach to understanding and treating people with depression.

Depression, according to the public media, is virtually omnipresent.  Media stories about anti-depression medications being inappropriate for children, stories of FDA reversal of approval for medications tested with adults but not tested with children, stories of depression in caregivers of Alzheimer’s patients, stories of depression after traumatic events, stories of depression among those living with long term illness, and stories of clinical depression and suicide risks abound.  What is the difference between feeling sad for a short time vs. feeling constantly burdened with an inability to enjoy life, work, relationships and daily living for much of one’s life?  When does depression become a motivator for self-destructive acts rather than serve as an inhibitor of enjoyment?  What can be done about it?

Mental health therapists try to distinguish between “situational” and “clinical” depression.  Situational depression is generally understood to be reactive to some unusually stressful event such as grief related to death, loss of employment, or being trapped in a situation or relationship over which one perceives a lack of control or power to extricate one’s self. Clinical depression is understood to have a biological basis which may be triggered by some relational or environmental cue, or may be so much a part of a personality that it is different to comprehend life as a joyful experience.  As with most mental illness, the distinction between “situational” and “clinical” is not always clearly delineated.  Whatever the cause, or etiology, depression is generally best treated with a combination of medication and “talk therapy.” This combination approach to treatment often also means that a combination, or team, of therapists is involved.

Social workers are important members of the depression treatment team.  Social workers do a variety of “talk therapies” which include individual counseling, crisis intervention services, family therapy, as well as the mobilization of support networks.  Social workers also perform case management functions of monitoring medication compliance and assistance with maintaining medical appointments, especially important for people for whom depression is a relapsing illness.

Social work researchers often work in teams with researchers of other disciplines. Their research focuses on such subjects as the efficacy of medications in clinical trials, work with refugees who struggle to find new meanings in new cultural contexts, issues of co-morbidity, e.g. depression co-occurring with substance abuse or eating disorders, or of inter-generational manifestations, including the testing of intervention models with children or with the elderly in assisted living settings.

The following web-page and peer-reviewed journal references are provided as resources for learning more about depression as well as to portray the ways in which the social work profession works with people who are depressed.

National Institutes of Health Web sites

National Institutes of Health (NIH)
http://www.nih.gov

Several Institutes of NIH conduct and fund research related to depression.  In addition to the National Institute of Mental Health (see below), the primary NIH resource for depression information, other Institutes which address depression in co-morbidity or as developmental issues include:

National Institute on Alcohol Abuse and Alcoholism (NIAAA)
http://www.niaaa.nih.gov

NIAAA is the primary NIH Institute resource relating alcohol abuse co-morbid with depression.

National Institute on Drug Abuse (NIDA)
http://www.drugabuse.gov

NIDA is the primary NIH Institute resource for substance abuse co-morbidity with depression, as well as a major research source of studies relating to HIV+ co-morbid with substance abuse.

National Institute on Child Health and Human Development (NICHD)
http://www.nichd.gov

A free copy of a major study of depression in young adolescents is available from NICHD:

Saluja, G., Iachan, R., Scheidt, P., et al. (2004). Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatrics and Adolescent Medicine, 158, August, pp. 760-765.  Contact salujag@mail.nih.gov

The study was based on 10,000 youths in grades 6,8, and 10 and found that 25% of the girls and 10 % of the boys reported at least five symptoms of depression. Older teens had higher prevalence of at least five symptoms.  Those who used drugs were twice as likely to be depressed. Bullies and their victims were more likely to be depressed.  The researchers also explored somatic complaints, which were at least twice as common among depressed students

National Institute of Mental Health (NIMH)

NIMH is the primary funding and information disseminating arm for depression-related research in the United States.
http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm

This is the NIMH portal to information on depression: signs and symptoms, treatment, and how to get help.

http://www.nimh.nih.gov/healthinformation/traumaticmenu.cfm – addresses information about coping with traumatic events.

http://menanddepression.nimh.nih.gov/ – Real Men Real Depression gives examples of men who had the courage to seek help

http://www.nimh.nih.gov/HealthInformation/depwomen.cfm – Targeted toward women, this web page also addresses gender-related differences in diagnosis and treatment

http://www.nimh.nih.gov/HealthInformation/depchildmenu.cfm – Information useful to parents, students, and others is provided in the site’s links, as well as the latest information related to the use of medications in treating depressed children, including an advisory from the Food and Drug Administration (FDA).

http://www.nimh.nih.gov/HealthInformation/depoldermenu.cfm – This site looks at the normal aging process and includes links to information about depression’s involvement with many of the physical illness that often accompany longevity.

RESOURCES

Web Pages

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA is the United States agency that supports publicly funded mental health services and supports the evaluation of treatment and prevention models and information on “best practices” related to mental health and substance abuse.

www.samhsa.gov

Entering “depression” in the search box on this site produces nine related categories with 970 web pages hyperlinks.  Under Mental Health Resources, the link to the Surgeon General’s report, Chapter 5 provides a synthesis of “depression” plus references. Another link addresses “SAD” or Seasonal Affective Disorder, which describes a seasonal form of depression. Under Substance Abuse, find a link on “Suicide, Depression, and Youth Drinking.”

Agency for Healthcare Research and Quality (AHRQ)

www.ahrq.org – This homepage links to the US government agency which funds and evaluates primary health care, and contains results of AHRQ-funded studies.  For example:

http://www.ahrq.gov/qual/menttoolria/menttoolria.htm#depression

Collaborative Care Program Improves Care and Outcomes for Depression

The Partners in Care (PIC) is a real-world trial to determine whether diverse primary care practices can implement previously tested, effective models of care for depression. A collaborative effort of researchers and clinicians at many institutions, the study involves more than 27,000 patients, 125 providers, and 46 primary care clinics within six nonacademic managed care practices in various locations across the United States. PIC conducted a randomized trial comparing quality improvement programs in clinics for medications (QI-meds) and for psychotherapy (QI-therapy). Two groups of clinics were randomly assigned to either the QI-meds or QI-therapy group. A third group of clinics served as a control by offering usual care for depression.….. The PIC program was also successful in treating depressed patients who had additional medical conditions such as back problems, arthritis, hypertension, asthma, diabetes, and heart disease.35 After 6 and 12 months, these intervention patients were less likely to report depressive disorders.35 In addition, after 18 months, the clinicians who participated in the intervention training programs demonstrated more knowledge about assessing and treating depression than clinicians who did not participate in the intervention training.31.  More information on the Partners in Care program can be found at www.rand.org/publications/RB/RB4528/.  PIC materials, including user’s guide, clinician’s guide, and implementation guides, are available through the PIC Web site at www.rand.org/health/partners.care/portweb/.36

National Alliance for the Mentally Ill (NAMI)
http://www.nami.org/

NAMI is a nonprofit, grassroots, self-help, support and advocacy organization of consumers, families, and friends of people with severe mental illnesses, such as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, attention deficit/hyperactivity disorder, and other severe and persistent mental illnesses that affect the brain.NAMI is dedicated to the eradication of mental illnesses and to the improvement of the quality of life of all whose lives are affected by these diseases.

From NAMI’s home page, click on “depression” under “inform yourself, “ to link to a page which includes fact sheets and links for assistance geared to the mental health consumer, families, and supportive others.

National Mental Health Association (NMHA)
www.nmha.org

The National Mental Health Association is the country’s oldest and largest nonprofit organization addressing all aspects of mental health and mental illness.  This information and advocacy organization addresses policy issues related to mental health.  Click on “Bipolar Disorder” to learn about the illness, formerly known as “manic depression” in which depression alternates with mania.  Enter “Depression” in the search box, to find 36 hyperlinks related to the subject, including:

0.9995 DEPRESSION AND CO-OCCURING ILLNESSES
0.9849 CLINICAL DEPRESSION AND AFRICAN AMERICANS
0.9833 Depression in The Workplace
0.9746 SAFEGUARDING YOUR STUDENTS AGAINST SUICIDE

References:

The following are research examples found in Social Work Abstracts, an NASW publication which culls behavioral and social science literature.  A search for “depression and social work” yielded 473 articles published between 1977 and 2004.  The following references were taken from the first 100 abstracts, which date from 2004 to 2001.  They were selected to show a range of social work research, e.g., related to type of cultural group, impact on parental and family relationships, effectiveness of social work interventions, and depression as a variable in the social work workforce.

A long-term family-oriented treatment for adolescents with substance -related disorders: an outcome study.
Deskovitz-M; Key-D.E; Hill-E.M; Franklin-J.T. Child and Adolescent Social Work Journal. 21(3): 265-284, June 2004.

This outcome study surveyed the 100 clients and their parents from the first five years of the researched Pathway Center Program, using mailed questionnaires and telephone interviews. Information was collected from 51% of clients and 61% of parents, and client-parent agreement was high. Ninety-eight percent of adolescents reported that they did not return to prior drug severity, 51% reported no use since discharge, 23% reported one or two relapses, 88.2% reported improved family relations, and 90.2% reported improved quality of life. In comparing those who remained completely abstinent with those who relapsed, the non-relapsers were twice as likely to have a diagnosis of uni-polar  depression at admission. It was hypothesized that the depression is associated with “hitting bottom,” an indication that the client may be motivated to commit to major change.

Depression In North Carolina social workers: Implications for practice and research.
Siebert-D.C. Social Work Research. 28(1): 30-40, Mar 2004.

This article explores depression in social workers, examines the potential negative professional consequences–that is, impairment–and investigates the personal and occupational variables associated with depression. One thousand active NASW members were anonymously surveyed as a part of the study “Work and Well-Being: A study of North Carolina Social Workers,” which explored a variety of health, work, and personal variables. The study found that 19% of the sample scored above the threshold on the Center for Epidemiologic Studies-Depression Scale measuring depressive  symptoms, 16% had seriously considered suicide at some time in their  lives, 20% were currently taking medication for depression, and 60% self evaluated as depressed either currently or at some time in the past. Both occupational and personal variables were related to depressive symptoms.

The role of appraisal and expressive support in mediating strain and gain in Hispanic Alzheimer’s disease caregivers.
Morano-C.L. Journal of Ethnic and Cultural Diversity in Social-Work. 12(2): 1-19, 2003.

The purpose of this study was to examine how appraisal of burden and satisfaction, and perception of expressive support mediate the effects of caregiving on depression, somatic complaints, life satisfaction, and personal gain with a sample of Hispanic Alzheimer’s disease (AD) primary caregivers. Appraisal of burden was found to mediate the effects of caregiving on depression and somatic complaints and had significant direct effects on life satisfaction. Appraisal of satisfaction did not have a mediating effect on any of the measures, but did have a direct effect on depression and personal gain. Expressive support did have a mediating effect on depression, as well as direct effects on somatic complaints and life satisfaction. These findings suggest a need for improving outreach to older minorities and developing culturally sensitive interventions that can improve caregivers’ understanding of problematic behavior, thereby altering appraisal of the situation as well as developing extended systems of support.

The effects of maternal depression, family of origin, and infant temperament on quality of parenting as mediated by maternal efficacy.
Greenstein-B. Dissertation: School of Social Work, New York University

This study tested hypotheses on parenting in family-of-origin, maternaldepression, and difficult child temperament as predictors of dimensions of  parenting. Research participants included approximately 100 mothers who sought Early Head Start (EHS) service at a New York City EHS program. These parenting dimensions included teaching, warmth, and autonomy support. The role of maternal efficacy as a mediator of the effects of these predictors on parenting was also tested. Main effects for family-of -origin parenting were found for maternal warmth and for autonomy support. A main effect for difficult child temperament was found for maternal warmth. Difficult temperament yielded a pattern of significant moderator effects. Difficult temperament moderated (exacerbated) negative family-of -origin parenting’s effects on all three dimensions of parenting. The primary implications of the findings is that quality of parenting is much more likely to be negatively affected when psychosocial risk factors co-occur with difficult child temperament.

The September 11th attacks and depressive symptomatology among older adults with vision loss in New York City.
Brennan-M; Horowitz-A; Reinhardt-J.P. Journal of Gerontological Social Work. 40(4): 55-71, 2003.

Responding to the September 11, 2001 terrorist attacks, the NIH Office of Behavioral and Social Science Research developed a measure to assess bias in studies of mental health resulting from these events. Studies that have reported a negative mental health impact from September 11th have focused on adults of all ages and have had limited preattack comparison data. However, at the time, the authors were studying depression among older adult vision rehabilitation applicants in the New York City metro area.Thus, they were in a unique position to examine any potential biasing effects of September 11th given their proximity to one of the attack sites. CES-D scores and life satisfaction were compared for those providing data 2 months prior (n = 111) or 2 months after September 11th (n = 58). Significant biasing effects of September 11th did not emerge, nor were there any interaction effects of the event with age, gender or education. Failure to find bias from September 11th in the study sample reflects, in part, the resiliency of older adults who have coped with  other stressful events in their lifetimes.

Depression in older Americans with urinary incontinence (UI): the relationship with activities of daily living (ADL) and avoidance behaviors.
Bertera-E.M. Journal of Gerontological Social Work. 39(4): 39-53, 2002.

This study uses interview responses from 986 Medicare beneficiaries with urinary incontinence (UI) to investigate the effects of behavioral responses to UI on depression in community-dwelling adults. Behavioral responses included limitations in ADLs, and avoidance of routine activities such as bending, reaching and stooping. Logistic regression models included depression in the past 3 years and “feeling blue” in the past year as proxies for depression. Avoiding 2 or more activities increased the odds of “feeling blue” and depression. ADL limitations were associated with depression, but not “feeling blue.” Implications for  depression and independent living in older adults are discussed.

Kin and nonkin social supports in a community sample of Vietnamese immigrants.
Gellis-Z.D. Social Work. 48(2): 248-258, Apr. 2003.

A two-wave longitudinal study is reported that examined the relationship between social support and depression among 79 Vietnamese immigrants living in a multicultural community in a large urban setting. Extending past work, the research employed a refined perspective on social supports, as measured by kinship networks, non-kinship networks, perceived satisfaction with the supports, and their influence on psychological distress as measured by the Center for Epidemiologic Study Depression Scale. Results indicated that socio-demographic variables did not predict depression scores. However, the non-kinship factor was associated with a reduction in depression scores over time. These findings are discussed in terms of the apparent complexities of the social support and mental health link, particularly the need to consider culturally valid measures,  interventions, and social contexts in which the Vietnamese reside.

Assessing depression in childhood and adolescence: a guide for social work practice.
Allen-Meares-P; Colarossi-L; Oyserman-D; DeRoos-Y. Child and Adolescent Social Work Journal. 20(1): 5-20, Feb. 2003.

Depression is relatively common in children and adolescents, and if left undetected and untreated, can have long-term negative consequences. Social workers providing services to families, children and adolescents need to understand the characteristics, and conduct developmentally appropriate assessments, of depressive symptoms. This paper provides a review of current literature related to the definition, prevalence, co-occurrence,and measurement of depression in childhood and adolescence. It also highlights relevant gender, race, and ethnic influences.

African-American grandmother carers of children with disabilities: predictors of depressive symptoms.
Kolomer-S.R; McCallion-P; Janicki-M.P. Journal of Gerontological Social Work. 37(3/4): 45-63, 2002.

This article reviews the current literature on grandparent caregiving with particular attention to African-American grandmother carers and discusses stressors and reports of elevated symptoms of depression among them. The demographics of a sample of 145 African-American grandmothers of children  with a developmental disability are reported here as well as the result of  a logistic regression analysis of a model of predictors of elevated (above  a score of 16 on the CES-D) symptoms of depression. Being younger than age 60, not working outside of the home, not being married, and having no further than secondary school education, were all found to be significant predictors of elevated symptoms of depression in this sample of African -American grandmothers. Interventions for this group of carers must take into account their potential for depression and health problems, economic circumstances, and lack of knowledge of financial and other assistive resources.

Screening for depression in immigrant Chinese-American elders: results of a pilot study.
Stokes-S.C; Thompson-L.W; Murphy-S; Gallagher-Thompson-D. Journal of Gerontological Social Work. 36(1/2): 27-44, 2001.

Depression is a common mental health problem among Chinese elders, but to often goes undiagnosed and untreated. Despite an increase in the population of elderly Chinese immigrants in the United States, there have been few published studies on this topic. The purpose of this study was to determine the extent of depression in the participant population, using an updated translation of the original 30-item Geriatric Depression Scale (GDS; Yesavage et al., 1983). A convenience sample of 102 Mandarin-speaking Chinese elderly in two senior centers in Santa Clara County, CA was recruited. A total of 29.4% of participants showed symptoms of depression, higher than the range found in the older adult American population (13-20%). Those most likely to be depressed ranged in age from 60 to 69 years (32%), lived with their children (37%), rated their financial and health status as below average, had less than a high school education, and lived in the United States less than five years. This updated Chinese translation of the GDS is a promising screening measure to detect depression in Chinese elders.

Stress, coping, and depression among Japanese American elders.
Shibusawa-T; Mui-A.C. Journal of Gerontological Social Work. 36(1/2): 63-81, 2001.

This study examines the correlates of depression in Japanese American elders among 131 community-dwelling Japanese American elders aged 60 years or older. Predictors of depression were examined from a stress and coping framework. Depression was measured using the Geriatric Depression Scale (GDS). Close to 20% of the respondents were mildly depressed. Multiple regression analyses revealed that health, fear of dependency on family, number of close friends, and availability of emotional support were associated with depression. Previous studies indicate that traditional Japanese values of interdependence facilitate dependency on family among Japanese American elders. The findings of this study, however, suggest that the prospect of becoming dependent on family is a source of distress in this population. Culturally appropriate ways for social workers to address fear of dependency among Japanese American elders are presented.

Reducing depression in pregnancy: designing multimodal interventions.
Cunningham-M; Zayas-L.H. Social Work. 47(2): 114-123, Apr. 2002.

Research indicates that high levels of stress, low social support networks, and depression during pregnancy have powerful negative effect on maternal functioning and infant developmental outcomes. Low-income, inner-city women from ethnic minority groups, whose levels of depression have been documented as higher than their white counterparts, are at increased risk, as are their infants. This article reviews the relevant research literature and proposes that “bundling” several social work treatments intended to reduce or prevent depression, expand social networks, and enhance mothers’ knowledge of child development is more effective than any single approach. Joining treatments into one intervention approach offers multiple treatments for multiple problems and can be designed to be evaluated.

Experience and covariates of depressive symptoms among a cohort of HIV infected women.
Richardson-J; Barkan-S; Cohen-M; Back-S; FitzGerald-G; Feldman-J; Young-M; Palacio-H. Social Work in Health Care. 32(4): 93-111, 2001.

The objectives of this study were to assess (a) the level of depressive symptoms among a cohort of HIV infected women and comparable controls and (b) the relationship with covariates including socioeconomic status, substance use, social relations, disease status. Participants were enrolled in the Women’s Interagency HIV Study (WIHS). Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CESD). Data from 1993 HIV seropositive and 551 seronegative women are presented. Of HIV positive women 57.7% of them scored 16 or higher on the CESD (ns) as compared to 55% of HIV negative women; at a cutoff of 23,  the percents were 40.4% and 35.9% respectively (p = .06). The score was high (19.8) but not significantly different between groups. Scores were higher among women who had less education, lower income, were of Hispanic ethnicity, used alcohol or drugs, experienced domestic abuse, had more than one partner, or had less supportive relationships. Lower socioeconomic status and social support and higher substance use and domestic abuse were associated with depressive symptoms similarly for both groups.

Evaluation research on the effectiveness of social work intervention on dialysis patients: the first three months.
Beder-J. Social Work in Health Care. 30(1): 15-30, 1999.

The research reported in this article examined the effectiveness of a dedicated, timed, recurring Masters level social work intervention with patients new to dialysis. Study participants were evaluated for depression and levels of adjustment when first beginning dialysis and three months later. A control group received standard, mandated social work services  while the experimental group received an additional counseling component. The experimental group showed statistically significant changes over time in lowered levels of depression and maladjustment.

From plant closure to reemployment in the new economy: risks to workers dislocated from the declining garment manufacturing industry.
Rocha-C. Journal of Sociology and Social Welfare. 28(2): 53-74, June 2001.

This study investigated financial and emotional consequences to workers as the US economy continued to shift from a manufacturing to a service economy. One hundred eighty-eight garment workers were surveyed before their plant closed in 1998 and six months later to assess reemployment opportunities, financial difficulty, and emotional well-being. All workers experienced some financial difficulty after the plant closed, with single parents reporting the greatest financial difficulty. Workers who became immediately reemployed lost an average of $2.41 in wages per hour. Sixteen percent of the sample lost their health insurance. Overall depression and anxiety scores declined over six months, but not evenly. Men and single women did not significantly decline in depression or anxiety. Financial difficulty was the most important predictor for both depression and anxiety. Immediate reemployment served to increase depression in the presence of financial difficulty.

Maternal depression and physical punishment as mediators of the effect of poverty on socio emotional problems of children in single-mother families.
Eamon-M.K; Zuehl-R.M. American Journal of Orthopsychiatry. 71(2): 218-226, Apr. 2001.

Data from a national sample of 878 4-9-year-old children in single-mother families were used to test a structural model of the effect of poverty on children’s socio-emotional problems. Results show that the effect of poverty is mediated by maternal depression and mothers’ use of physical  punishment. Maternal depression influence children’s socio-emotional problems directly, as well as indirectly through physical punishment.

Social and environmental predictors of maternal depression in current and recent welfare recipients.
Siefert-K; Bowman-P.J; Heflin-C.M; Danziger-S; Williams-D.R. American Journal of Orthopsychiatry. 70(4): 510-522, Oct. 2000.

Depression is highly prevalent in welfare recipients and is associated with failure to move from welfare to work. This paper examines the relationship between social and environmental factors in a large community-based sample of mothers who currently or recently received welfare benefits. Specific and modifiable risk factors related to poverty, gender, and race were found to predict major depression beyond traditional risk factors. Research and practice implications are discussed. (Journal abstract.)

January 10th, 2010 at 1:15 pm

Posted in Research

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