HLTB lecture 7-12.docx

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University of Toronto St. George
Trinity College Courses
Michelle Silver

1 Lecture 7: Theoretical Perspectives on Aging A Few Words on Theory  What does it mean to Age? o It is not simply the process of growing weaker o Acquire strength as we age; suggests an increase in positive attributes of aging o Accumulating knowledge and experience (wiser) o Aging necessarily means deteriorating  Theory o General Purpose  Can be thought of as a set of lenses for viewing actions and interactions  To help us make sense of what we observe  Can be used to help a researcher choose his or her research methods, questions, and the sample to focus on  To construct explicit explanations that account for empirical findings  A ―set of lens‖ for viewing actions and interactions o Theory vs. Other aspects of knowledge  ―Like the scientific method‖  Steps in thinking about theories 1. Statements describing regularities detected in the process of systematic observations  Similarities are observed 2. Prototypical models are formed which attempt to depict how empirical generalizations are related to each other  Generalizations are made 3. Empirical generalizations and models are accumulated and use to form theories  Theory is made o Theory in Gerontology  These theories that will give a better understanding of aging  Early gerontologists looked for conceptual frameworks that might explain human aging by looking at popular and ancient models  Looked at individual differences in factors , such as well being  Compared ancient and current to formulate theories to explain aging  In gerontology, no one theory can explain all the facts about aging  It is a multidisciplinary field, and draw on theory from other disciplines  Build on a variety of aspects 2 o For example: family theory, current bio/non-bio markers (blood tests), survey methods, and self assessments  Researchers often use a combination of theoretical perspectives to gain a fuller understanding on their research topic  Theories help us and social life distingue history, biology and social life  Theory o Two Levels of Theory  Micro-level theories  Focus on individuals; ―the self‖  Explains phenomena such as: o Changes in memory with age o Effects of attitude on self image o Relationship between adult children and their parents  Macro-level theories  Focus on examining social structures; ―not the individual‖  Explains the phenomena such as‖ o Economic conditions on social politics o Explain effects of industrialization on older people’s status o Impact of changes in auto industry in the adults in Mid West o Impacts of changes in work conditions Theoretical Perspectives on Aging from Anthropology  Anthropology o ―Study of human kind‖ o There are 4 kinds: Linguistic, archeological, sociocultural and biological  Deals with the origins of human kind in all these fields o It seeks to understand human existence in geographic space and evolutionary time  Companies across time and cultures are central to the discipline  Age as a cultural construct  Cultural construct: the idea that characteristics that people attribute to social categories, gender, illness or adolescence are culturally defined (not biologically defined) and therefore not fixed. o Images of beauty can be different in cultures, age groups… o Methods  Ethnography  Type of research method in anthropology o Observes people in their natural setting rather than in formal setting ex. laboratory 3  Fieldwork and participant observation  Contributed to findings such as:  The killing of frail elderly was not rare (Simmons 1945)  Elders provided education by sharing knowledge in the Kalahari Desert in the absence of formal teachers and schools (Shostak 1981)  It helps for the understanding of social changes on aging adults in Gerontology  Anthropological Perspectives on Aging o Early theoretical formulations linked the marginalization (place in a position of importance) of older people to modernization o Most current frameworks are informed by:  Contexts in which older adults live  Special populations i.e. baby boomers  Complexity and heterogeneity of difference experiences  Cultural contexts  Age versus Aging o Theories about age  Explain cultural and social phenomena  Theories about aging are theories about living, the changes experienced during the life course, and the interdependencies throughout life among different generations o Example: at certain age we have different norms (dressing) o Theories about aging  Theories about living, the changes experienced during the life course, and the interdependencies throughout life among the different generations and cohorts.  Cultural Conceptions of Time and Age o Relative time  Things, events, are ordered in time but don’t have a precise measurement and span  Temporal order or sequencing (don’t necessarily know how much) o For example: two sisters- ones older and you can tell, but you don’t know how much older. o Absolute time  Involves measurement and is the imposition of culture on natural regularities  Uses clocks and measurements  Example: we know older sister is 5 years older than the younger  It is something we created 4 o Thinking of absolute time is a cultural construct o Time zones (way we keep track of time) are man -made; no real lines to tell us how to do it, it was decided by people Relative Age Absolute Age Age-ambiguous -Intersection of relative age Age-aware Informal Knowledge of Age and informal knowledge -Know how old someone is -Involves family telling you? by using a calendar, but -No idea of knowing relatively informal (relative imprecise) Age-forced contexts -In societies where it was Age-explicit once; age ambiguity -Concepts of absolute time Formal Knowledge of Age  Birthdays were -Can answer how old someone is -Involves society assigned by census -Society keeps a record of it markers -Will all have specific  Sometimes age was birthdates and its recorded wrong  Culture and Age Structuring o Key concepts:  Cultural contexts  Longing to be a certain age; like beauty, what age group is allowed to do  Life Courses  Give people an understanding of time  Age Structuring o How a society organizes the interdependency between people of the same and different ages is the structuring of the life course as individuals pass through that society from birth to death  For example: idea that you should marry at a certain age is cultural context  On the other hand; what is biological is: women cannot conceive after a certain age  Problems of Aging o Across time and cultures, for most of humanities existence old age has not been a society wide problem o Since humans have been sustain long lives physically and culturally, old age has had its problems  Old age has not been considered a society problem, but since humans have been able to sustain long lives, it has been an issue; problems include:  Poverty 5  Disability  Dependency  Demographics (baby boomers  Aging o Aging involves complex interactions among biological, environmental, and cultural domains Biological Perspectives on Aging  Genetic, Molecular & Cellular and System level all effect each other both ways, so all levels interact and effect aging together  Aging could be a result of: o Genetic  Best evidence=fixed differences between life span and species  Shows that life expectancy is predetermined by genes  Human: 120 years  Housefly: 30 days  House mouse: 4 years  Squirrel: 16 years  Catfish: 60 days  Giant tortoise: 152 years 1. Genetic: a. Programmed Cell death  When cells are no longer needed: programmed cell death (apoptosis); they commit suicide by activating an intracellular death program b. Stochastic Processes  Aging is due to the gradual accumulation of non-intentional genetic damage  Random (stochastic) errors in genes homeostasis=repair (backups) eventually backups run out gradual accumulation of damage organ damage c. DNA repair Mechanisms (damaged DNA)  Loss or repair efficiency with age leads to progressive loss of potential to make necessary proteins 2. Molecular & Cellular  Theories Produce Aging a. Oxidation  Free Radial Theory  Free radicals are generated during oxidation 6 o Free radicals means unstable, therefore becomes destructive disrupts roper cell functioning b. Lipofusion  Some theories of aging assume that aging is caused by accumulation of certain substances, like lipofucion  Lipofusion-been considered as the most significant biomarker of aging  Small granular yellow/brown spots of skin  Assumes that aging is caused by the accumulation of this substance c. Heat Shock Proteins  Also called stressed proteins, are a group of proteins that are present in all cells in all life forms  They are induced when a cell undergoes various types of environmental stresses like heat, cold and oxygen deprivation  Its protects cells against all kinds of stress-promote health y cell growth, apoptosis and repair  Aging leads to poor responses to stress=disequilibrium 3. System-level a. Homeostasis  Proper balance of the organism’s internal environments  If homeostasis cannot be maintained, it means death  Aging downgrades the maintenance of homeostasis b. Wear and Tear Theories  The effects of aging are caused by damage done to cells and body systems over time  Once we wear out body; we no longer function properly  For example: alcohol, smoking, sun damage o Body expires after excessive use and abuse c. Stress  Exposure to chronic stress accelerates the aging process, thus shortening the life span  Counter example of: extreme stress: calorie restrictions longevity Psychosocial Theories of Aging  Psychological Perspectives o Erikson  Developed these in 1956 7  Ego Integrity vs. Despair  Ego Integrity: feel their lives were worth living or satisfying  Despair: consumed by fear of death  Erikson believe if other stages are successful, then individual will feel integrity, if not then despair o Jung (1933)  Young adulthood is spent confirming to adult social role conventions  Individuation:  Involves development of self-knowledge, bringing unconscious material into consciousness and developing one’s true capacities  Generally takes place in the last half of life o Goal is to become an individual , not to conform  First part of life we focus on conforming, in the last half we become an individual  The individual seeks fulfillment through acceptance of one’s individuality and holistic reflection  Contribution to thinking about adulthood? 8 o Piaget  Development of mature though  Conservation: they develop logical thinking  Child understands how amounts stay the same o Kohlberg  Like Jung  Three Stages  Pre-conventional Level (0-9 years)  Conventional Level (9-12 years)  Post conventional Level (13 years) 9 o Maslow  Psychological Perspectives 10 o Internal Processes o Development has a goal  Autonomy (Maslow, Jung, Kholberg, Piaget)  Reflection and Acceptance (Maslow, Erikson)  Non-conformity (Maslow, Jung, Kholberg)  Logical reasoning (Maslow, Piaget)  Morality (Kholberg), Creativity (Piaget) & Acceptance (Erikson) ( all three: Maslow, Jung) Sociological Perspectives on Aging  Role theory o The roles an individual plays at different stages in his or her lifetime are the basis of self-concept o Older adults experience changes in well being when role transitions occur  Disengagement theory o As people approach the later part of the life-course, they decrease activity levels, interact less with others and become more introspective  Has been relatively well disproven by the current generation because people stay on and don’t retire  Another thing that disproves the disengagement theory  Activity theory o Older adults seek to maintain statuses achieved earlier in life and that role losses need to be replaced by activity  Continuity theory 11 o The aging person substitutes new roles for lost ones, and continues to maintain typical ways of adapting to the environment  The Life Course perspective o To make sense of old age, we need to understand the entire life history  Different cohorts have developed differently o People are socialized into different roles, but the meaning and experience of aging varies by culture and socioeconomic factors o Important life events, transitions are influential o Involves social, psychological, socio-historical, biological and processes o Time, transitions, and context shape human development o Individuals are dynamic and shaped by environmental factors throughout different stages in life  Socio-Economical Selectivity Theory o A process by which older people strategize and optimize their outcomes by deciding where to place their emotional bets or where to cut their losses o Declines and withdrawals are selective as older people choose what aspects of society to engage in 12 Lecture 8: Ethics and Research Methods Research Ethics  Unethical Research Practices Motivated the need for Protocols o World War II Nazi Medical Experiments  During World War II (from 1939-1942)  A number of German physicians conducted painful and often deadly experiments on thousands of concentration camp prisoners without their consent  One category consists of experiments aimed at facilitating the survival of Axis military personnel  High altitude experiments to determine the maximum altitude troops could parachute to safety  Freezing experiments to treat hypothermia  Potable seawater  A second category aimed at developing and testing pharmaceuticals and treatment methods for injuries and illnesses which German military and occupation personnel encountered in the field  Prisoners were exposed and/or subjects to o Phosgene and mustard gas in order to test possible antidotes o Bone-grafting experiments o Treatments for malaria, typhus, tuberculosis, typhoid, fever, yellow fever, and infectious hepatitis o Testing to determine the efficacy of new sulfa drugs  A third category sought to advance the ideological tenets of the Nazi worldview  Experiments to determine how different ―races‖ withstood various contagious diseases o Sterilization experiments  Bring them to fill out some paperwork, and while standing be exposed to x ray radiation that would sterilize them o Twin studies o Miligram Study of “Obedience”  Stanley Milgram  Psychologist at Yale University  The study  Began in July 1961, a year after the trial of Adolf Eichmann 13  Focused on the conflict between obedience to authority and personal conscience  Examined justifications for acts of genocide offered by those accused at the World War II, Nuremberg War Criminal trails o The defense often was based on ―obedience‖—that they were just following orders of their superiors  In the experiment, so called ―teachers‖ (who were actually the unknowing subjects of the experiment) were recruited by Milgram  ―Teachers‖ were asked to administer electric shocks to a ―learner‖ for each mistake made during the experiment  60% of the ―teachers‖ obeyed orders to punish the learner to the very end of the 450-volt scale!  No subject stopped before reaching 300 volts! o Tuskegee Syphilis Study  Aim to study the natural progression of syphilis  Conducted from 1932 and 1972  By 1942 penicillin had become the standard treatment  Doctors recruited 399 black men who were thought to have syphilis  A control group of 201 healthy men  A leak to the press terminated the study in 1972  By then, of the 399 infected participants  28 had died of syphilis  Another 100 had died from medical  40 wives of participants had been infected and 19 children o Zimbardo’s Mock Prison Research  Aka: Stanford Prison Experiment 14  Philis Zimbardo (1971)  Psychologist at Stanford University  A planned 2 week investigation into the psych prison life  Ended pre-maturely after 6 days  College students were subjects  What happens when you put good people in an evil place? Does humanity win over evil, or does evil triumph?  A lot of psychological trauma faced by criminals o Inflicted by their guards  People really took their roles to heart  Response to Ethical Violations in Human Subjects Research o 1906 Pure food & Drug Act (U.S) o 1948 Nuremberg Code  First document advocating for voluntary participation  Informed consent  However, no enforcing power 1.Voluntary consent 2.Yield results for good of society 3.Base on animal experimentation 4.Avoid unnecessary suffering 5.Not acceptable if death may occur 6.Minimize risk 7.Adequate facilities 8.Conducted by qualified persons 9.Subject should be able to discontinue participation 10. Researcher must be prepared to terminate if necessary o The World Medical Associations Declaration of Helinki  First adopted in 1964  Guiding principle is the right to self determination and to make informed decisions regarding participation in research  Declared that research must be approved by a research committee that ensures that the benefits outweigh the risks  Professionals conduct experiment  Participants have informed consent o 1974 National Research Act  Passed in response to publicity from the Tuskegee Syphilis Study  Created the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research  War charged to identify the basic ethical principles that should underlie the conduct of biomedical 15  And behavioral research involving human subjects and to develop guidelines  The Commission drafted the Belmont Report o 1979 The Belmont Report  Created in the United States in 1979  7 years after Tuskegee exposure  Respect for  Persons: recognition of person dignity & autonomy  Beneficence: minimizing harm, maximizing benefits  Justice: fair distribution of benefits + burdens among participants  Established Institutional Review Boards (IRB) at institutions sponsoring research o Late 1970’s (1997) Tri-Council Policy  Guiding Ethical Principles of the Tri-Council Policy (Canada)  Respect for o Human Dignity o Free and Informed Consent o Vulnerable Persons o Justice and Inclusiveness o Privacy and Confidentiality o Balancing harms and benefits o Minimizing harm o Maximizing benefit  IRBs/REBs (United States and Canada) o Institutional Review Boards (IRB) o Research Ethics Boards (REB) o Commonly used in health studies and social sciences o Purpose: to assure that appropriate steps are taken to protect the rights and welfare of humans participating in a research study o Task: to review research protocols and related materials to assess the ethics of the research and its methods  Ethical Issues in Health Research o True voluntary participation o Informed consent o Decisional capacity  Ability to understand o Privacy and confidentiality o Advocacy and intervention  Researchers should be able to intervene on behalf of participants 16 Research Methods  Quantitative Analysis o Measures of Central Tendency  Summary statistics  Ex. 52, 85, 90, 85  Mean: the average: 78  Mode: the value of a distribution that occurs most frequently: 85  Median: the midpoint of a distribution: 85 o Mean  A measure of central tendency  Issue: influenced by outliers  Example: the mean score for an illness, four people  Person 1=52  Person 2=85  Person 3=90  Person 4=85 o = 52+85+90+85/4 =78  Mean: 78 o Median  The middle of the distribution  Less sensitive to extreme scores than the mean  Example: the median score for an illness of 4 people  Person 1=52  Person 2=85  Person 3=90  Person 4=85 o 52, 85, 85, 90  Median: 85 o Variance  A measure spread  1 = closest to the average  The average of the squared differences from the Mean  i.e. how spread out is the data?  Higher variance means that we are more like to observe values away from the average 17 o Covariance and Correlation  Covariance: is a measure of how much two variables change together  example: age vs. getting flu this season  Correlation: indicates the strength and direction of a linear relationship between two random variables  Age is a variable that can be used  Correlation-there is a linear trend  Correlation is a scale version, giving a more intuitive number 18  Covariance  Multiplying x-m by y-m instead of squaring it (like for variance)  Concerns with covariance o Covariance has no upper or lower limits o The size of the covariance depends on the variability of the variables o As a consequence, it can be difficult to evaluate the magnitude of the covariation between two variables  Correlation  Defined as a standardized covariance  The larger the absolute value of this index, the stronger the association between two variables  A quantitative index of the association between two variables  Smoking and lung capacity-is a linear negative correlation 19  Correlation  The value of r can range between -1 and +1  If r=0, then there is no correlation between the two variables  If r=1 (or -1), then there is a perfect positive (or negative) relationship between the two variables.  Correlation is a scale version, giving more intuitive number  Correlation o A quantitative index of the association between two variables o An indicator of the strength and direction of linear relationship between two variables o The larger the absolute value of this index, the stronger the association between two variables o Range between -1 and 1 20 Lecture 9: Mental Health Research and Policy Mental Health Research and Policy  How would you describe your health? o Everyone may have different interpretation, therefore researchers must specify  General Response=fine  Temporal descriptions: today, yesterday, the year…  Physical vs. Mental health descriptions o Ordinal variables to rank health- 1. Poor, 2. Fair, 3. Good, 4. Very good, 5. Excellent  Health o A state of complete physical, mental, and social well-being, and not just the absence of disease or illness  Includes social, economic and physical environmental factors that contribute to health  Aging and Health o Overall people 65 and over were positive about their health  Mental Health o Defined by the World Health Organization (2005) as a ―state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”  It is a holistic definition; therefore how might this apply to older adults (for ex. Making productivity and fruitfully especially) o Mental Health Problems  Approximately  20% of Canadians population suffer from mental health problem  2% suffer from severe mental illness 21  12% of Canadians will experience a major depressive episode over their lifetime  5% experience a major depressive episode annually  In Canada, it is estimated that family physicians (majority) manage 80% of all mental health problems  In Ontario, more than half of all psychiatric patients are treated in primary care settings, in contrast to specialized settings.  Defining the Problem o Society must figure out what to do with individuals who engage in socially disruptive forms of deviant behavior o If the problem is defined as a criminal problem, then legal solutions are advised o If the problem is defined as biological, then medical solutions will be applied o But if there is uncertainty with how to define the problem…  The Sociology of Mental Illness and Mental Health o Trans-institutionalization:  The process of shifting the mentally ill from one institution to another  In Toronto, there are many cases of this; individuals go back and forth between mental institutions and jail. o Estimating the Costs of Mental Health Problems  Direct costs  Hospital stays  Medications  Visits with psychologist  Visits with social workers  Indirect costs  Lost productivity  Unemployment  Reduced quality of life  Non-institutional treatments o Mental Health Policy in Canada  Mental health is provincial responsibility  Throughout there is an emphasis on  Mental health promotion  The prevention of mental disorders  The protection of human rights and freedoms  Community care  Coordination of care  The Myths of Mental Illness o People with mental illness are violent and dangerous 22  The truth is that, as a group, a mentally ill people are no more violent than any other group. In fact, they are far more likely to be the victims of violence than to be violent themselves. o People with mental illness are poor and/or less intelligent  Many studies show that most mentally ill people have average or above average intelligence. Mental illness, like physical illness, can affect anyone regardless of intelligence, social class or income level. o Mental illness is caused by a personal weakness  A mental illness is not a character flaw. It is an illness, and it has nothing to do with being weak or lacking will-power. Although people with mental illness can play a big part in their own recovery, they did not choose to become ill, and they are not lazy because they cannot just ―snap out of it‖. o Mental illness is a single, rare disorder  Mental illness is not a single disease but a broad classification for many disorders. Anxiety, depression, schizophrenia, personality disorders, eating disorders and organic brain disorders can cause misery, tears, and missed opportunities for thousands of Canadians  Some Measures of Mental Health o Anxiety Disorders  Up to one in four adults has an anxiety disorder sometimes in their life  One person in 10 is likely to have an anxiety disorder in the past year  Most common mental health problem in women, and are second only to substance use disorders in men  Are characterized by:  Irrational excessive fear  Apprehensive and tense feelings  Difficulty managing daily tasks & or distress related to these tasks  Six Main Categories of Anxiety Disorders  Phobias  Panic disorder (with or without agoraphobia) o Agoraphobia: fear of being in public  Generalized anxiety disorder  Obsessive-compulsive disorder  Acute stress disorder  And posttraumatic stress disorder o Obsessive Compulsive Disorder  Involves recurrent obsession or compulsions that are severe enough to be time consuming or cause marked distress or significant impairment 23  Obsessions are uninvited or ―intrusive‖ thoughts, urges or images that surface in the mind over and over again.  Compulsions are behaviors or ―rituals‖ that the person follows to try to reduce or suppress his or her obsessive thoughts, such as concerns about contamination.  Examples of symptoms of OCD  Cognitive: ―I am going to get sick and infect everyone if I touch the handle:‖  Physical: muscle tension and discomfort.  Behavioral: excessive washing, cleaning and or checking. Avoidance of doors and public washrooms. o Schizophrenia  A disturbance of the brain’s functioning  Around 1 in 100 develops schizophrenia  Men and women are affected equally  Men first episode in their teens or early 20s  For women, the onset is usually a few years later  The Three Phases of Schizophrenia  Prodromal phase (can last weeks or months) o Lost interest in their usual activities  Withdrawn from friends and family  May become easily confused, have trouble concentrating and feel listless and apathetic  May also become intensely preoccupied with religion or philosophy  Active phase o Delusions, hallucinations, marked distortions in thinking and disturbances in behavior and feelings  Residual phase o After an active phase, people may be listless, have trouble concentrating, and be withdrawn o Symptoms in this phase are similar to the prodromal phase  Schizophrenia: Cause and Treatment  No single cause has been found for schizophrenia o Although there is a clear genetic link  People with it may be treated as outpatients in hospitals  Treatment is medical and psychosocial intervention  Some recover totally  Others need social support for rest of life. 24 o Depression  Main symptoms  A sad, despairing mood that: o Is present most days and lasts most of the day o Lasts for more than two weeks o Impairs the person’s performance at work, at school or social relationships  Other symptoms of depression may include:  Changes in appetite and weight  Sleep problems  Loss of interest in work, hobbies, people or sex  Withdrawal from family members and friends  Feeling useless, hopeless, excessively guilty, pessimistic or low self-esteem  Agitation or feeling slowed down  Irritability  Fatigue  Trouble concentrating, remembering and making decisions  Crying easily, or feeling like crying but being not able to  Thoughts of suicide (which should always be taken seriously)  A loss of touch with reality, hearing voices (hallucinations) or having strange ideas (delusions)  Types of Depression  Seasonal affective disorder o Usually affected by the weather/time of the year  Most commonly in the winter  Postpartum disorder o Occurs in women following the birth of a child  13% of women will experience this  Depression with psychosis o Depression becomes so severe that they lose touch with reality and experience hallucinations (hearing voices, seeing things) or delusions (beliefs that have no basis in reality)  Dsthymia o Chronic low mode with moderate symptoms of depression  Depression in Women, Men, Older Adults and Children  Women o Major depression occurs in 10-25% 25 o Almost twice as much as men  Higher in women, because more reported (as women talk about it, and attempt more suicide)  Men o Depressed men typically have higher rate of feeling irritable, angry and discouraged, which can make it harder to recognize depression in men o Rate of completed suicide in men is 4 times higher than women, though more women attempt it.  Older Adults o Some people have mistaken idea that it is normal for older adults to feel depressed o Often goes undiagnosed and untreated because symptoms for example, fatigue, loss of appetite, sleep problems or loss of interest in sex-may seem to be cause by other illness o Older adults often don’t want to discuss hopelessness, sad feelings, a loss of interest in normally pleasurable activities, or prolonged grief-reluctant to seek help when they are feeling down. o Have less obvious symptoms-feel dissatisfied, with life in general, bored, helpless or worthless, or may always want to stay at home, rather than going out to socialize or doing new things. o Suicidal thinking or feelings is a sign of serious depression that should never be taken lightly  Children o A child who is depressed may pretend to be sick, refused to go to school, cling to a parent or worry a parent may die o Older children may sulk, get into trouble at school, be negative or grouchy, and feel misunderstood o Young children: sadness, irritability, hopelessness and worry o Adolescents: anxiety, anger, avoidance of social interaction o Change in thinking and sleep are common signs of depression in adolescents and adults o In children and teens, often occurs along with behavior problems and other mental health conditions, such as anxiety, or attention-deficient/hyperactivity disorder 26 o Normal behavior vary from one childhood stage to another, it can be difficult to tell whether a child is just going through a temporary phase has depression  Depression Causes  Genetic or family history of depression  Psychological or emotional vulnerability to depression o Personality type  Biological factors o Such as an imbalance brain chemistry and endocrine  From hormones or medications  A major stress in the person’s life o Death or financial problems  Another illness that shares the same symptoms such as lupus or hypothyroidism  A reaction to another illness, such as cancer of heart attack  Depression may be caused by an illness itself, such as stroke where neurological changes have occurred  Depression often accompanies other diseases  Rates of depression among those with diabetes is twice of those without diabetes  Risk factor for stroke, CHD  Less chances of survival after heart attack  Approximately 32% of people with dementia are depressed  Approximately 20% of people with Alzheimer’s diseases are depressed  Treatments  Pharmacotherapy (medications)  Psycho-education  Psychotherapy  Electroconvulsive therapy o Shocks to the brain; alternation in brain chemistry  Recovery o Clinical depression needs to be managed over a person’s lifetime o Watching for early warnings of a relapse can possibly prevent a full depressive episode o Important to talk through your problems and dreams  Measurement of Depression  Major Depressive Disorder (DSM-IV) 27 o You have had an episode of depression lasting at least two weeks with at least 5 of the following symptoms  You are depressed, sad, blue, tearful  You have lost interest or pleasure in things that you previously liked to do  Your appetite is much less or much greater than usual and you have lost or gained
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