This paper seeks to contribute towards improved mental health through a better understanding of depressive disorders that account for 5-20% of illnesses among adults .
(WHO 2012; Ishtiaq et, al. 2018; Scholten, et al., 2016), and affect about 4.4% of the world’s population (WHO, 2017, p. 5)
Abstract
Depressive Disorders, together with anxiety disorders, are part of the common mental disorders described by the Joint Commissioning Panel for Mental Health (2013). The commission separates common mental disorders from the severe mental illnesses which include Schizophrenia – a mental disorder characterized by distortions in thinking, perceptions and emotions, language, sense of self and behavior, and having experiences that include hallucinations (hearing of voices or seeing things that are not there), delusions (fixed, false beliefs) (WHO, 2019), and Bipolar Disorders- severe fluctuations in a person’s moods in a way that far surpasses normal mood changes. These fluctuations affect an individual’s entire life (work, relationships, school) and may be coupled with substance abuse and suicidal attempts (International Bipolar Foundation, 2009).
This paper starts with a presentation of a depressive disorder case followed by definitions, prevalence and distribution of the disorders. It then presents the types of depressive disorders, as well as factors contributing to the disorders. Later, it gives the effects, interventions as well as barriers to the interventions. In the end, it sheds light on the relationship between depressive disorders and stress, as well as that between the disorders and suicide. The findings are that a lot has been researched on depression. In these studies, the Developed world sees a concern linking depressive disorders to chronic illnesses and disability. In the developing world however, health policies are still in their pristine stages focusing on communicable and non-communicable diseases, substance abuse, need to improve on policy, and strengthen efforts to provide affordable universal health care.
In all, depressive disorders continue to be a major concern in these developing countries due to illiteracy levels, poverty, chronic illnesses, communicable and non-communicable infections, ageing, as well as stigma, linking mental challenges to witchcraft and to the spiritual domain. It is therefore highly recommended that studies continue to be carried out in the area of mental health and its link to social transformation.
Inclusion/Exclusion Criteria
The paper is informed by a literature systematically selected. This literature, was sought discretely from online scholarly material: Google Scholar, Academia, and ResearchGate. Material from EbscoHost and Elsiever was also included. In addition, formal reports from World Health bodies were included. Terms used in the search included depression: definition, factors influencing, causes, effects, interventions. Inclusion of Africa, was inserted only when specificity on the region was needed. Additional specific terms emanating from the first search were included for clarification. Articles that emerged on the first search pages were selected as per their relevance to the study.
Definitions, Prevalence and Distribution of Depressive Disorders (DD)
Definition of depression and depressive disorders
“Depression comes from the Latin “depressio” which means sinking. The person feels sunk with a weight on their existence. It is a mood disorder that varies from: normal transient low mood in daily life itself, to clinical syndrome, with severe and significant duration and associated signs and symptoms, markedly different from normality (Bernard, 2018, p.6)”. Addressing the co-relation between Depression and heart failure as well as stress, Pasic, Levy, and Sullivan, (2003) define Major Depression as “a disorder that involves abnormalities in the central monoaminergic neurotransmitter system and gives rise to behavioural changes and alterations in neurohormonal pathways” (p. 184). The “Monoamine neurotransmitters include serotonin and the catecholamines dopamine, adrenaline, and noradrenaline… [which] have multiple functions including modulation of psychomotor function, cardiovascular, respiratory and gastrointestinal control, sleep mechanisms, hormone secretion, body temperature, and pain” (Pons, 2010, p. 64). They thus also regulate emotions, arousal as well as certain types of memory (Mele, Čarman-Kržan, Jurič, 2010). Though linked to melancholy, Depression differs from melancholy in that it describes experiences that are associated with “high levels of sadness,
discomfort, loss of interest, mental confusion and alterations in the execution of daily activities” (p.6). Melancholy on its part however, relates to “longing or memories of the past, more accurately related to sadness of past time(s) ‘that will not return’ (p.6)” For a further understanding of the definition, refer also to Jiménez (2002). In this paper, depression is defined as a mental condition characterized by severe feelings of hopelessness and inadequacy, typically accompanied by a lack of energy and interest in life (TOED, 2008). Critical is that depression hinders one from operating normally.
Depressive disorder explains “persistent feeling of sadness and worthlessness, and a lack of desire to engage in formerly pleasurable activities” (Psychology Today, 2019). Other terms used for the depressive disorders include major depressive disorders (MDD), clinical depression (CD), major depression (MD), and unipolar depression (UD).
In relation to Hen’s case, lack of knowledge on what is depression and its symptoms, led Tim and the mother, into deep lengthy moments of anguish. The close family members also joined in the suffering. There were moments when some spiritualized: what sins has the family committed that God is punishing you? For others, it was drenching in pity and uncertainty. Tim had to stop working to keep 24-hour watch over his father. Diagnosis from a general practitioner in one of the hospitals that the family visited was also wanting as he was diagnosed of cerebral malaria. Certainly, continued information on the part of health practitioners, and on the general public is needed. This would shed light on depressive disorders and other related ailments. This would also go a long way in avoiding the current quick labelling that individuals carry out on themselves and on their close colleagues, following some shallow contact with the internet.
Types of Depressive Disorders and Symptoms
According to the classification systems in ICD-10 (International Classification of Diseases, 10th ed.) (WHO, 2010) and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) (APA, 2000), there are two types of depressions.
(i) Depressive episode or otherwise referred to as single major depressive disorder involves symptoms such as depressed mood, loss of interest and enjoyment, and increased fatigability. It may be classified as a mild, moderate, or severe depressive episode, depending on the number of symptoms, the length of time the symptoms take, and the severity. The following are the notable symptoms related to depression:
|
Loss of |
Reduced |
Feelings of |
Others |
|
(i) weight |
(i) energy/activity |
(i) guilt |
(i) marked tiredness |
|
(ii) libido |
(ii) capacity to enjoy |
(ii) worthlessness |
(ii) agitation |
|
(iii) appetite |
(iii) interest |
(iii) disturbed sleep |
|
|
(iv) interest in pleasurable things & feelings |
(iv) concentration |
(iv) unresponsive to circumstances |
|
|
(v) self-esteem |
(v) low mood |
||
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(vi) self-confidence |
With both depressive disorders and anxiety disorders, the effects can range from mild to severe. The duration of symptoms, as well as the severity or the intensity typically experienced by patients determine the level of the disorder.
Another classification of depressive disorders is given by Bruce (2021)
|
Type |
Explanation |
|
Anxious Distress |
Feelings of tension and restlessness; Trouble concentrating due to thoughts of something awful may happen, or a feeling that you might lose control of self. |
|
Melancholy |
Feel sad and lose of interest in activities that one previously enjoyed; Feeling bad even when good things happen; Feeling particularly down in the mornings; Weight loss; Poor sleep; Suicidal thoughts; Lack of appetite. |
|
Agitated |
Feel constantly uneasy; Talk a lot; Fidgeting and pacing around; Act impulsively |
|
Persistent Depressive Disorder (Dysthymia) |
This entails a depression that lasts for 2 years or longer; Also describes dysthymia (hat lasts for 2 years or longer, it’s called persistent depressive disorder. This term is used to describe dysthymia (low-grade persistent depression) and chronic major depression. Symptoms include: change in appetite (eating too much or too little), sleeping too much or too little, lack of energy/ fatigue, low self-esteem, trouble making decisions, feeling hopeless. |
|
Bipolar Disorder/ Manic Depression |
Having mood episodes that range from high energy (up mood) to low energy (depressive periods). When in low energy, symptoms are of major depression. |
|
Seasonal Affective Disorder (SAD) |
A period of major depression. In Europe it happens during the winter months. In Africa it may be when there is less sunlight. |
|
Psychotic Depression |
Exhibit symptoms of major depression along with “psychotic” symptoms, such as: Hallucinations (seeing or hearing things that are not there), delusions (false beliefs), and paranoia (wrongly believing that others are trying to harm you). |
|
Peripartum Depression |
Among women who experience major depression in the weeks and months immediately after childbirth. Approximately 1 in 10 men also experience depression in the peripartum period. |
|
Premenstrual Dysphoric Disorder (PMDD) |
Among women at the start of their period where they experience: mood swings, irritability, anxiety, trouble concentrating, fatigue, change in appetite, change in sleep patterns, and feelings of being overwhelmed. |
|
Situational Depression |
This is a depressed mood when having trouble managing a stressful life event such as death in the family, a divorce, or losing a job. Doctors also call it “stress response syndrome.” |
|
Atypical Depression |
Contrary to the persistent sadness of typical depression. It is a “specifier” that describes a pattern of depressive symptoms. Positive event can temporarily improve your mood. Symptoms of atypical depression include: increased appetite, sleeping more than usual, feeling of heaviness in one’s arms and legs, and oversensitivity to criticism. |
|
Treatment Resistant Depression |
It related to about 1/3 of people who fail to respond to depression treatment. The failure may be due to other conditions. |
Depression would also be characterized experiences of five or more of the symptoms, lasting for most of the day, nearly every day, for a period of two weeks or longer (ADAA, 2016). The following insertion sheds more light:
Five of the following features should be present most of the day, or nearly every day, for two weeks, representing a change of functioning (must include 1 or 2) [for one to be diagnosed as being clinically depressed]:
- Depressed mood (feeling sad, empty, hopeless, tearful) nearly every day, for most of the day; 2. Marked loss of interest or pleasure in all or almost all activities;
- Significant weight loss or gain (more than 5% change in 1 month) or an increase or decrease in appetite nearly every day;
- Insomnia or hypersomnia nearly every day;
- Observable psychomotor agitation or retardation;
- Fatigue or loss of energy nearly every day;
- Feelings of worthlessness or inappropriate or excessive guilt (not merely self-reproach about being sick);
- Diminished ability to think or concentrate, or indecisiveness, either by subjective account or observed by others;
- Recurrent thoughts of death (not just fear of dying), suicidal ideation, a suicide attempt, or a specific plan for committing suicide (Outhoff, 2019, p. 15, adapted from American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 5th Ed, May 2013); Cleare et al., 2015).
Table 4: Five Factor Model by Tackett (2006, p. 586).
Personality differs from temperament in that the latter refers to “traits or characteristics that are biological in nature and appear very early in life” (Tackett, 2006, p. 584). Temperaments are therefore, observable in infancy and toddlerhood (Frick, 2004), and becomes a subset of personality. Personality on the other hand, develops as children progress cognitively and emotionally pegged on their interactions with the environment (Tackett, 2006). It involves ways in which persons learn to respond to experiences in more complex ways (Caspi, 2000; Shiver & Caspi, 2003). It is therefore, influenced by nature, nurture (upbringing), roles played (Kopytoff, 2005), gender (Oyewumi, 2005) and even culture (Calhoun, Gerteis, Moody, Plaff, & Virk, 2009). Personality is one’s identity; sameness with oneself over a time (Kiingati, 2019).
Table 5 gives each model, what it is, and what it says about the relationship between MDD and Personality.
|
Model |
What it entails |
Relationship between MDD & personality |
|
Stress-Vulnerability model i.e., stressful triggers influence symptomatic episodes; neuroticism sets in motion processes that lead to common mental disorders |
It states that “genetic or biological predisposition to certain mental disorders exists and psychological and social factors can increase the likelihood of symptomatic episodes. (Journeypure Clarksville, 2019)”. “Biological vulnerability and stress—are influenced by … factors (alcohol & drug use, medication use, coping skills, social support, & meaningful activities), [and] people have some control over (Behavioural Health Evolution, 2008, p. 2). It is a predisposition model: having a causal/etiological role (Clark, 2005; Ormel et al., 2013). |
Personality features predispose a person to MDD i.e., high levels of neuroticism (an expansive personality trait dimension showing the degree to which a person experiences the world as distressing, threatening, and unsafe (Watson & Casillas, 2003)), tend towards high levels of MDD development |
|
Pathoplasty model (also called pathoplastic model) i.e. personality influences somatic episodes |
This model influences the manifestation of a later disorder rather than having a causal role (Clark, 2005). It helps shape the environment in such a way that a disorder is sustained (Clark, Watson & Mineka, 1994). In so doing, it becomes an exacerbating model in which a personality factor worsens a manifestation (Tackett, 2006). For it to be viable, it has to be assessed before the onset of a disorder, throughout the process and at the end. This makes it complicated (Tackett, 2006). |
Personality affects the onset, severity and course of the MDD, including response to treatment i.e. high levels of neuroticism result in greater level of severity, chronicity of the MDD and to the more negative response to treatment. |
|
Complication/ Scar model i.e. multiple depressive disorders permanently influence personality (neuroticism). |
This model holds the premise that the development of psychopathology (especially of Axis 1 disorders: mood, anxiety, disruptive behaviour, substance use disorders (Crawford, Cohen, First, Skodol, Johnson, Kasen, 2008)) changes an individual’s premorbid (attributes preceding the occurrence of a disease or disorder) personality. A comprehensive list of the five axes and related disorders, refer to Substance Abuse & Mental Health Services Administration. DSM-IV to DSM-5 Changes: Overview. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. https://www.ncbi.nlm.nih.gov/books/NBK519711/. |
When multiple depressive disorders occur, an individual’s neuroticism increases (Tackett, 2006). MDD has a permanent effect on personality change. |
|
State model i.e. multiple depressive disorders temporarily influence personality (neuroticism). |
Sharing its position with the Scar model, it states that neuroticism is shaped by common mental disorders. However, while in the Scar model the episode of the common disorder model has permanent effect, in the State model, the effect is temporarl; is there at a time and state, then disappears (Ormel, et al., 2013) |
MDD has a temporal effect on personality change. |
|
Spectrum model i.e. personality & psychopathology are in a continuum |
The model “states that personality traits and manifestations of psychopathology lie on a continuum (or, continua) such that the relationship between personality and psychopathology is dimensional. A[n]… example of this model is the “schizophrenia spectrum” of disorders: Schizophrenia, Schizotypal Personality Disorder, and Paranoid Personality Disorder, which are often described as differing manifestations of a common etiology (Tackett, 2006, p. 588). Also refer to Nicolson et al., (2003). |
There is a continuum involving pathological processes: mild-moderate-severe and this continuum is also present with personality i.e. (i) Normative personality-normal process (ii) Psychopathology-pathological process |
|
Common cause/ Shared cause/ Liability/ Factor model i.e. personality and psychopathology (MDD) have similar causal influences. |
The model predicts that “depression and personality are distinct entities, but share common etiopathogenetic mechanisms. However, there are no causal influences between both entities in this specific model…[i.e.] patients frequently present with depression and personality dysfunction, because both problems have the same or similar causal influences, but a patient’s depression is not caused by his or her personality problems” (Bahn, Herpertz & Krause, 2018, p. 3). MDD and BPD will often present together (p. 4). Hence, “patients suffering from BPD will often present with depression, because the personality dysfunctions in functional domains underlying BPD elevates the risk for depressive symptoms (e.g., interpersonal rejection sensitivity outpatients at risk for depressive reactions to real or perceived abandonment)” (p.8). |
Shared etiological factors give rise to both personality and MDD… In that line, neuroticism and common mental disorders share the same genetic and environmental determinants (Ormel et al., 2013, p. 687). |
Depression and Suicide
Suicide is a world concern, rated among the 20 top leading causes of death (WHO, 2019); rated higher than malaria, breast cancer, or war and homicide. In Africa, Necho, Tsehay, & Zenebe (2021) give the following statistics: (i) suicidal ideation: 7.8% – 42%; (ii) suicidal attempt: 1.3% – 20.1%. They also note that 1.8% of world’s global disease burden is linked to suicide, and that 85% of world’s suicides are in low- and middle-income countries.
A police report in Kenya, shows that in 2021, Kenya had reported 480 suicide-caused deaths in three months (April-July), with the youngest being 9 years and the oldest 76 years (Wainaina, 2021). This was a sudden increase from 2019 report that had 196 suicide caused deaths. Additional information was that from 2015 to 2018, 1442 attempted suicide cases had also been reported. These alarming records, show a concern in relation to suicide. Among the major causes of suicide, are AIDS, depression, stigma, and poor social support. As for additional information on the relationship between depressive disorders and suicide, the University of Saskatchewan (student wellness center) (2020), states that depressed moods contribute to thoughts of suicide. They continue to state that 15 % of those with chronic depression end their lives by suicide.
This is also supported by statements by the Government of Canada (2020), and Mood Disorders Society of Canada (2019). Founded on these realizations, this paper addresses depressive disorders, shedding light on the role of psychosocial interventions. In addressing the related variables, the paper starts by giving the factors signaling suicide. This sheds light on preventive measures that significant others may observe in relation to one moving towards depression.
Conclusion
This paper has discussed depressive conditions, giving the definitions, as well as prevalence. It has also addressed the aspects of distribution of depressive disorders as per age and gender. The subsequent sections have looked at types of depressive disorders as well as contributors to the disorders. This is followed by the effects as well as the needed interventions. In the end three issues have been discussed. The first gives the barriers that hinder the interventions. Also there are two discussions on depressive disorders and stress, as well as and suicide. This paper has attempted to unearth depression with an aim to shedding light on the disorders. Throughout the discussion, literature has been cited to inform the discussion. Also, the case of Hen, has also been used to address the processes, that appertain to the depressive disorders. As its final quest, the paper proposes a psychosocial self-test kit on one’s vulnerability towards depressive disorders.
