This essay discusses depression in length and further on postnatal depression and depression after cancer, its implications and public health responses. Improper diagnosis and consequent prognosis on patients who otherwise are suffering from depression has been commonplace as people tend to ignore depression as a major health issue and should be viewed as an illness. This essay also extensively expounds on postnatal depression normally suffered by mothers after childbirth and depression in relation to cancer.
Depression, therefore, is a state whereby a person experiences low mood and an aversion to any activity be it physical or mental. Depressed people usually feel sad, anxious, helpless, hopeless, worthless, full- of-guilt, irritated and at times restless. This comes along with loss of interest in once pleasurable activities, poor concentration, contemplation of suicide and loss of appetite or the extreme opposite: overeating. Patients may also experience fatigue, aches and pains, insomnia and digestive problems.
Depression can lead to various disorders classified either as Psychiatric syndromes or non-psychiatric. Psychiatric disorders are mainly due to moods. This include Major Depressive Disorder where a person experiences at least two weeks of depression, or loss of interest in all activities; chronic depressed mood condition normally referred to as Dysthymia; Bipolar disorder whereby the state of depression may not be major and Adjustment disorder where a person experiences depressed moods as a psychological response to a particular event or stressing factor, in which resultant emotional or behavioral symptoms are significant but not critical. On-psychiatric illnesses are a result of depressed moods bringing about physiological and infectious disorders such as mononucleosis, a viral disorder, and contributes as an early sign of hypothyroidism.
Depression was determined in U.S by Centre for disease control in 2010 under an analysis termed as Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS carried its survey for 235067 adults and found 9.0% as currently depressed inclusive of 3.4% of major depression. Under a clinical context, depression results in production changes of neurotransmitters in the brain that aid in communication such as dopamine and norepinephrine. Levels of these substances, when varied, bring about hormonal changes, physical illnesses, aging, brain damage and changes in genetics.
A complete medical check-up and a thorough study of explicit symptoms helps determine the root-cause of depression. Standardized questionnaires for depression quantifier such as Beck Depression Inventory and Hamilton Rating Scale provide insights to the actual cause of a patient’s depression state. Various tests are necessary to rule out other causes such as blood tests to measure levels of thyroxine to exclude hypothyroidism; ruling out metabolic disturbance by basic electrolytes and calcium tests; ESR and blood counts to rule systemic infection or chronic disease; hypogodanism is ruled out by testerone tests in men and finally side effects as a reaction to drugs previously administered or alcohol should also be done. Elderly people exhibit more cognitive complaints but this could be misread as depression but may rather be dementia which can only be distinguished by cognitive testing and brain scanning. Such as CT scans.
This essay also focuses on Postpartum or postnatal depression (PPD) is a state of illness under clinical depression which mainly affects women rather than men normally after childbirth. Research has indicated prevalence rates between 5% and 25% and lasts either for a few months or up to a year. Fathers experiencing paternity for the first time have been found to be between 1.2% and 25.5%.
Symptoms may vary from feeling sad, fatigued, loss or gain in appetite, reduced libido, crying at various times of day, anxiety, extensive or minimal sleep and irritability. In women, it is said to be caused by hormonal changes therefore necessitating support groups or counseling rather than hormonal treatment. Postpartum exhaustion is a subtype of postnatal depression caused by extreme fatigue and it normally lasts for a few days up to a maximum of 20 days. Another type of postnatal depression is baby or maternity blues which are normally mild and suffered by a large proportion of mothers. Symptoms include crying episodes, irritability, sleeplessness, hypochondrias, impaired concentration, headache and feelings of emptiness and loneliness.
There several major Symptoms of Postnatal Depression a include: Sadness, feelings of guilt, low self-esteem, changes in sleeping and eating patterns, fatigue, inability to feel comforted, anhedonia, emptiness, non-energetic, socially withdrawn, frustrations, anxiety and restlessness, decreased libido, easily angered and impaired writing skills and speech. Postpartum depression can be determined by Edinburgh Postnatal Depression Scale. A score greater than 13 indicates a high likelihood of development of this condition.
Various risk factors or causes have been identified and assigned a scale rating under the above method where a high value increases probability.
“Formula feeding rather than breast feeding (2.04), A history of depression (1.87) (.38 to.39), Cigarette smoking (1.58), Low self esteem (.45 to. 47), Childcare stress (.45 to .46), Prenatal depression during pregnancy (.44 to .46), Prenatal anxiety (.41 to .45), Life stress (.38 to .40), Low social support (.36 to .41), Poor marital relationship (.38 to .39), Infant temperament problems (.33 to .34), Baby blues(.25 to .31), Single parent (.21 to .35) Low socioeconomic status (.19 to .22) Beck (2001), Unplanned/unwanted pregnancy (.14 to .17)” (Beck, 2001)
Additive effects have been found to be: feeding formula, a history of depression and smoking and are directly correlated to PND such as high levels of prenatal depression are interlink with high levels of postnatal depression, hence implying low levels of prenatal depression consequently lead to low levels of postnatal depression. A third factor may come into play to interlink the two such as lack of social support. (O’Hara, 1985) ( Field et al., 1985) (Gotlib et al., 1991.) There is also a correlation between race, social class and sexual orientation with respect to postpartum depression.
In 2006, a study on “the extent to which ethnicity and ethnicity is a risk factor for PPD carried on 26,877 postpartum women found 15.7% were depressed. 25.2% of PPD cases were African American, 22.9% were either American Indian or Native Alaskan, 15.5% of them were Whites, 15.3% Hispanic and 11.5% Asian or of Pacific Islander. Under a controlled environment such as age, income, education, marital status, and baby’s health, African American women still emerged with significantly increased risk for…PPD”. (Segre et al, 2006). Likewise, a study conducted by Howell et al. in 2006 confirms Segre’s findings that “women who are nonwhite and in lower socioeconomic categories have more symptoms of PPD.”
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