Definition, causes, symptoms, recovery strategies, treatments including the stepped-care approach and available apps, child aware practice, and possible social work practice approach
This page has three sections:
Background Material that provides the context for the topic
A suggested Practice Approach
A list of Supporting Material / References
Feedback welcome!
Background Material
Depression affects one in five Australians over their lifetime. Depression arises from the feelings of sadness and grief that all people experience at times. For a person to be clinically diagnosed with a depressive disorder, his or her symptoms are usually much more intense and must have been present for at least two weeks. Children and adolescents may present with an irritable or cranky mood rather than being sad or dejected.
Depression is also referred to as a mood disorder. People may experience depression as a result of any one (or more) of a range of factors including biochemistry, physical stress, chronic or sustained illness, seasonal influences, genetic predisposition, life stressors, and personality factors. Depression may have an acute or gradual onset and can be experienced any time over the course of a person’s life.
The primary subtypes are major depression, dysthymia (chronic and usually milder depression), and atypical depression.
What causes depression?
significant loss
loss of control over our lives e.g. prolonged stress, rising debt, relationship breakup
unrealistic expectations of ourselves
disappointment
perceived failure
negative thinking which gradually becomes self-defeating
interpersonal problems
ongoing health problems
poor diet/lack of exercise
inner conflict over spiritual, philosophical or existential beliefs
Core symptoms of depression include:
Sleep disturbance
Appetite or weight changes
Dysphoria (a ‘bad mood’, irritability, or sadness)
Anhedonia (loss of interest in work, hobbies, sex, etc.)
Fatigue (often manifesting as difficulty completing tasks)
Agitation or retardation, especially in the elderly
Diminished concentration, difficulty with simple tasks, conversations, etc.
Low self-esteem or feelings of guilt
Suicidal thoughts (present in two-thirds of people experiencing depression)
Depression can accompany both physical and mental problems. It can also present as an early sign of dementia.
Appropriate goals for caring for a person with depression include:
Develop a relationship with the person based on empathy and trust.
Promote the person’s sense of positive self-regard.
Promote effective coping and problem-solving skills in a way that is empowering to the person.
Promote positive health behaviours, including medication compliance and healthy lifestyle choices (for example diet, exercise, not smoking, limit consumption of alcohol and other substances).
Promote the person’s engagement with their social and support network.
Ensure effective collaboration with other relevant service providers through development of effective working relationships and communication.
Support and promote self-care activities for families and carers of the person with depression.
How to regain a positive outlook
Make a weekly list of your positive accomplishments.
Make a weekly schedule of your daily activities – include more pleasurable and social activities.
Find a hobby or two.
Exercise daily and eat healthy foods.
Learn to use self-relaxation techniques whenever you feel tense.
Set realistic short, medium and long-term goals.
Be assertive – learn to say “no”.
Learn to accept that everyone has different abilities and focus on your unique characteristics and positive accomplishments.
Get to know and develop your strengths.
Check in with your emotional self and ask: Do I need a hug or other support? Do I need someone to listen? Do I need to vent and let off steam?
Treatment for depression
Black Dog Institute: https://www.blackdoginstitute.org.au/resources-support/depression/treatment/
From this Black Dog Institute website:
It’s important to get help and the right treatment for depression.
There are a range of effective treatments, that can help you recover/manage. Start by talking to your GP.
Important things to know about getting treatment for depression:
Different types of depression respond to different kinds of treatments. You need a thorough check from a health professional before treatment is prescribed.Depression can sometimes go away by itself. But left untreated, it may last for many months or get significantly worse. Always seek help early, so you can recover sooner.
Depending on the nature of your depression, self-help and alternative therapies can be helpful. They can be used alone or combined with physical and psychological treatments.
Most people who have had depression have been able to seek help and live active, fulfilling lives.
There are three broad categories of treatment for depression:
psychological
physical
self-help and alternative therapies.
Often, a combination of treatments works best. Different types of depression require different treatments. As we are all individuals with different contributing factors, we all respond differently to treatment. Remember with help, you can recover from depression.
A stepped care approach to treating major depressive disorder
Doctors from the Black Dog Institute have recently developed a ‘stepped care approach’ to treating patients with major depressive disorder. Essentially, it involves managing patients according to how severe their depression is when they first see their doctor. Care is ‘stepped up’ if the initial treatment is not providing a sufficient response.
Overview of the ‘stepped care approach’ developed by doctors and researchers at the Black Dog Institute.
Step 1: Mild depression
Patients with mild depression may initially be observed, educated and advised about self-help and lifestyle changes such as exercise, good sleeping patterns, and mood monitoring to help manage their symptoms. The Black Dog Institute also recommends using eMental Health interventions in conjunction with professional advice, such as: myCompass and/or This Way Up
Step 2: Moderate depression
Patients with moderate depression may also benefit from eMental Health programs mentioned above, and face-to-face psychological or ‘talking therapies’ such as interpersonal psychotherapy (IPT) and cognitive behaviour therapy (CBT). This should be combined with self-help therapies and lifestyle changes. In some cases, antidepressants are considered.
Step 3: Severe depression
When patients have depression that’s resistant to the treatments mentioned above, or who present initially to their doctor with severe or melancholic depression, they need to get help in conjunction with a psychiatrist. Severely depressed people may benefit from antidepressant medication and combined treatments, including psychotherapy approaches. Doctors and health professionals should always consider local public after-hours or crisis services as part of the care team.
Step 4: Severe depression with marked functional impairment
Treatment in hospital may be required when patients have depression with:
psychotic symptoms
impaired functioning
an ineffective response to multiple courses of antidepressants
life threatening/suicidal thoughts.
Treatment may include electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS).
Practice Approach
Build empathy and trust through exploring the person’s situation. As part of this conduct a BPSS assessment: social relationships, employment, finance, family situation, leisure interests, substance use, fatigue/sleep, appetite/weight change, overall mood, suicidal thoughts. Be aware a person’s cultural background can influence the way symptoms of mental illness are expressed or understood.
Problem-solving approach that empowers the person may be appropriate—build on past successes (solution-focused).
Suggest lifestyle change, e.g. positive health behaviours—exercise, limiting drug and alcohol intake.
Exercise daily and eat healthy foods.
Make a weekly schedule of daily activities and include more pleasurable and social activities. An eMental Health intervention such as myCompass or This Way Up or MindSpot may be appropriate. There is more detail about this approach, called Behavioural Activation, on this website here.
Promote engagement with social and support network.
Write a list of friends who could be contacted when extra support is needed, or identifying interests that could be expanded upon by joining a group of like-minded people.
Contact family members (with permission).
Gently challenge negative assumptions by providing alternative perspectives.
“What would you say to a good friend in these circumstances?”
With the person, make a weekly list of positive accomplishments and encourage the person to value these as well as relationships and good health.
Set realistic, short-term goals.
Focus on the person’s unique characteristics and positive accomplishments.
Use self-relaxation techniques.
Child Aware Practice
Parents with mental health, addiction, homelessness and family violence issues can cause major difficulties for children. These can have life-long consequences, e.g. suicide, eating disorders, drug and alcohol abuse, high-risk sexual behaviour, violence and criminal offending, homelessness and abuse and neglect of one’s own children.
Therefore, it is important that those supporting adults also assess the impact of adults’ issues on children and take steps to support adults in their parenting role.
This is what Child Aware Practice is about. You will find this topic covered in more detail on the website at https://www.thesocialworkgraduate.com/post/child-aware-practice
Supporting Material
(available on request)
Assessment Tools for Schools: Andrews, J. H., Cho, E., Tugendrajch, S. K., Marriott, B. R., & Hawley, K. M. (2020). Evidence-based assessment tools for common mental health problems: A practical guide for school settings. Children and School, 42(1), 41-52. doi: 10.1093/cs/cdz024
This paper provides a concise guide to evidence-based assessment tools for school social workers and other school mental health personnel. This guide includes (a) a brief overview of the different properties of measures that may be most important to consider when selecting an evidence-based assessment tool; (b) tips for efficiently investigating different measures and choosing between them; and (c) a review of the practical characteristics of specific, psychometrically sound measurement tools that are free and feasible to use for school-based assessment of one or more of the most common youth mental health concerns: anxiety, depression, and disruptive behaviour.
Black Dog Institute Website (2020): https://www.blackdoginstitute.org.au/resources-support/depression/treatment/
Adult guide to depression – steps (Black Dog Institute, 2016)
Beyond Blue: What works for depression (2019)
Beyond Blue: Brochure – Understanding anxiety and depression (2019)
University of Tasmania – Depression (2016)
“MyCompass” Brochure
“This Way Up” summary
Mental Health First Aid Australia: Depression Guidelines (2019)
Managing Mild-Moderate Depression and Anxiety in Adults (2018) https://www.saxinstitute.org.au/wp-content/uploads/19.04_Evidence-check_Prevention-and-early-intervention-for-adults-with-mild-to-moderate-depression.pdf
Lowry, F. (2021).Depressive symptoms plus inflammatory diet add up to higher frailty risk.Medscape, March 31, 2021.Retrieved from https://www.medscape.com/viewarticle/948404?src=WNL _dne_210331_mscpedit&uac=410643FT&impID=3281866&faf=1#vp_1