Depression in Community Medicine

1. DEPRESSION
Prepared By Dr. Anees A. AlSaadi
Community Medicine Resident
March 2011

2. Depression

3. Objectives :
1. Definition of Depression.
2. Burden of Depression .
3. Causes .
4. Risk Factors.
5. Diagnosis Criteria.
6. Prevention .
7. Summary .

4. Depression
What is depression?
Depressed mood.
Common mental disorder. Loss of pleasure.
Feelings of guilt.
A depressive disorder is a syndrome.
Disturbed sleep or
appetite.
Chronic or recurrent.
Poor concentration.
4
Consequences if untreated .
http://www.who.int/mental_health/management/depression/definition/en/

5. What are the different forms of
depression?
Major depressive disorder.
Dysthymic disorder.
Psychotic depression.
Postpartum depression.
Seasonal affective disorder
5 (SAD).
http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub2

6. Depression
What is the Burden of Depression?
Loss of 850 000 lives every year.
4th leading contributor to the 121 million
global burden of disease (DALYs) people
in 2000. worldwide.
Now the 2nd cause
2020 2nd place of the ranking of of DALYs.
DALYs.
6
http://www.who.int/mental_health/management/depression/definition/en/

7. Depression
Causes

8. Depression
Modifiable Risk Factors
Age :
• Incidence with age.
• in 25-44 years.
• Atypical in elderly persons.
Gender and Ethnicity :
• More commonly in women.
• Less in the black population
Family history :
Genetic susceptibility

9. Depression
Non modifiable Risk Factors

10. Depression
Diagnosis
The DSM-IV-TR diagnostic B. Symptoms do not meet criteria for
criteria: a mixed episode.
A. At least 5 of the following,
during the same 2-week C. Symptoms cause clinically
period, representing a change significant impairment of
from previous functioning; must functioning.
include either (a) or (b):
(a) Depressed mood D. Symptoms are not due to a
(b) Diminished interest . substance or a general medical
(c) Significant weight loss or gain condition.
(d) Insomnia or hypersomnia
(e) Psychomotor agitation or E. Symptoms are not better accounted
retardation
(f) Fatigue or loss of energy for by bereavement.
(g) Feelings of worthlessness
(h) Diminished ability to think.
(i) Recurrent thoughts of death,
suicidal ideation, suicide attempt,
or specific plan for suicide
http://emedicine.medscape.com/article/286759-overview

11. Depression
Treatment
• Pharmacotherapy:
• SSRIs.
• (SNRIs).
• Tricyclic antidepressants (TCAs).
• Nonpharmacologic treatments :
• Light therapy.
• Electroconvulsive therapy (ECT).
• Acupuncture.
• Cognitive-behavioral therapy (CBT).

12. Depression
Prevention
Is Depression Preventable

13. Depression
Prevention
• Primary Prevention :
• Anti depressive Health Promotion :
• Living conditions and environment .
• Risk factors .
• Health Education .

14. Depression
Prevention
Helping Children Avoid Depression
Can Some Foods Fight Depression?
How Your Weight Affects Depression?
Stay active.
Stay connected.
Find an outlet.
Watch your alcohol intake.
Plan ahead.
Be positive .

15. Depression
Prevention
Secondary prevention :
Screening :
Risk Groups .
Screening Tests .

16. Adults Children
Socially isolated Antisocial behavior
Substance abuse, such as alcohol or street Diminished school performance
drugs Withdrawal from friends or social activities
Loss of interest in sexual activity Excessive weight gain or loss
Experiencing major life changes Substance abuse, such as alcohol or street
drugs
Financial strain
Aggression
Impoverished home environment
Agitation or irritability
Screening
Risk Groups
Medical non specific symptomatology
First-degree Patient.
Two or more chronic diseases.
Elderly age
Obesity.
Pregnant or postpartum
Chronic pain.
Multiple vague symptoms.
Fatigue or sleep disturbance.

17. Age Group Name of the Test No. of Duration to
Items complete
(minutes).
Children and Children's Depression Inventory (CDI 27 10 to 15
adolescents
Adults Beck Depression Inventory-II 21 5 to 10
Center for Epidemiological Studies 20 5 to 10
Depression (CES-D).
http://counsellingresource.com/quizzes/cesd
/index.html
Elderly Geriatric Depression Scale (GDS) 30 10 to 15
Geriatric Depression Scale-short 15 5 to 15
Post natal Edinburgh Postnatal Depression 10 less than 5
Scale

18. Depression
Prevention
Tertiary Prevention :
Interventions that reduces disability, enhance rehabilitation and
prevent relapses and recurrences of the illness.

19. Depression
Prevention
http://depression.about.com/od/famous/Famous_People_With_Depression.htm

20. Depression
Prevention
The Role of Religious knowledge in preventing the
Depression

21. Summary

22. References
 1
http://www.who.int/mental_health/management/depression/d
efinition/en/
 2.
http://www.nimh.nih.gov/health/publications/depress
ion/complete-index.shtml#pub2
 3.
http://emedicine.medscape.com/article/286759-overview
 4.
http://depression.about.com/od/famous/Famous_People_With
_Depression.htm
 5.
http://www.everydayhealth.com/depression/preventi
ng.aspx