Older Adult Mental Health: Symptoms, Risks, Treatments for Depression

Geriatric Depression: Symptoms, Risk Factors and Treatments

Neese, B. (2016). Social Work Helper. Retrieved from: https://www.socialworkhelper.com/2016/08/15/geriatric-depression-symptoms-risk-factors-treatments/

Around 7 million of the nation’s 39 million adults ages 65 years and older are affected by depression, according to the Centers for Disease Control and Prevention (CDC). Although a majority of older adults are not depressed, they have an increased risk of developing depression, which is a persistent sad, anxious or empty feeling, or a feeling of hopelessness and pessimism.

Unfortunately, depression in older adults is often not recognized or treated. Symptoms may be mistaken for natural reactions to illness or life changes that occur during aging. Geriatric depression is associated with an increased risk of suicide, decreased physical, cognitive and social functioning, and greater self-neglect, reports the Annual Review of Clinical Psychology.

Due to its consequences, geriatric depression is regarded as a major public health problem. On a more positive note, the CDC says that it is “fairly easy to detect” and “highly treatable.”

Symptoms

Depression can cause feelings of sadness or anxiety that last for weeks at a time. Additionally, a wide range of other symptoms may be present.

• Feelings of hopelessness, pessimism, guilt, worthlessness and helplessness
• Irritability and restlessness
• Loss of interest in activities once pleasurable
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Sleeping difficulties or irregular sleeping patterns
• Overeating or appetite loss
• Thoughts of suicide
• Persistent aches or pains that do not get better, despite treatment

Depressed individuals over the age of 65 are less likely than younger individuals to exhibit dysphoria, which is a state of unease or general dissatisfaction with life, a study in the Journal of Gerontology found. Older individuals with depression are more likely than younger individuals to experience sleep disturbance, fatigue, psychomotor retardation, loss of interest in living and hopelessness, according to Psychological Medicine.

Additionally, older depressed individuals commonly complain of poor memory and concentration. The Archives of General Psychiatry found that patients with late-life depression had slower cognitive processing speed and performed poorer in all cognitive domains.

Risk Factors

“Non-genetic biological risk factors for depression are particularly important in old age,” says the Annual Review of Clinical Psychology. Several factors have been associated with late-age depression.

• Endocrine dysregulation, bone loss and certain medications (beta blockers, central nervous system medications, hormones, anti-Parkinson agents, certain cancer medications and others) may cause late-life depression.
• Around 20 to 25 percent of heart disease patients experience major depression, and another 20 to 25 percent experience symptoms of depression not meeting criteria for major depressive disorder, according to Biological Psychiatry.
• Dementia may be a risk factor for depression, but diabetes is not. Rather, the evidence suggests that depression is a risk factor for diabetes.
• Stroke patients have the highest rates of major depression (20 to 25 percent) among other neurological disorders. Rates are intermediate (15 to 20 percent) for Parkinson’s disease compared to Alzheimer’s disease (10 to 15 percent).
• Anxiety disorder and sleep disturbance are also risk factors for depression among older adults.

Social risk factors for depression, though less important in old age, can become more significant in very old age when individuals face greater losses and fewer resources. As with other ages,Psychology and Aging found that late-life depression is linked to the number of stressful life events experienced. Also, troubled relationships can explain depressed older individuals, including spousal depression, marital conflict and perceived family criticism. In The Journals of Gerontology, financial trouble is one of the most common stressful life events experienced by older adults.

Treatment and Prevention

In a review of evidence-based therapies for depression in older adults, Clinical Psychology: Science and Practice named the following as beneficial: behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy and reminiscence therapy. A behavioral treatment plan for depression in nursing homes was successful in Clinical Case Studies. It found a strong increase in positive affect and activity level after a 10-session program for increasing pleasant activities was administered. In the Journal of Mental Health and Aging, a meta-analysis found that psychotherapeutic interventions changed self-rated depression and other measures of psychological well-being in older adults by about one half standard deviation and clinician-rated depression by more than one standard deviation.

In 2007, an expert panel recommended home- or clinic-based depression care management (DCM) along with cognitive behavioral therapy for older adults with depression, the American Journal of Preventive Medicine reports. DCM uses a team approach with a trained social worker, nurse or other practitioner alongside a primary care provider who prescribes treatments in consultation with a psychiatrist. Clinical trials link DCM to a reduction in depression symptoms, higher remission rates and improvements in health-related quality of life, reports the CDC.

Prevention efforts are often directed to those who are at an increased risk of disorder. The American Journal of Psychiatry found that treating all patients with subsyndromal depressive symptoms could prevent 24.6 percent of new depression onsets in that period. In Aging & Mental Health, cognitive behavioral therapy demonstrated significant benefits in the prevention of depression in nursing home residents. Treatment of insomnia and other sleep disturbance is a valuable opportunity to prevent depression in older adults, given the highly effective nature of cognitive behavioral treatments for insomnia in this age group. The American Journal of Geriatric Psychiatry identified that individual educational interventions for subjects with chronic illness, individual therapy for at-risk bereaved older adults, cognitive-behavioral interventions to reduce negative thinking and life review were interventions with the most empirical support. Programs to reduce social isolation may also help prevent depression in older adults.

Helping Seniors in the Community

Human services professionals can join healthcare professionals and families to provide support for older adults who have or are at risk for depression. From clinics and nursing homes to homeless shelters, a variety of environments exist where individuals are particularly at risk for developing depression. Professionals trained to work with older adults and lead initiatives in the community can make a difference.

Southeastern University offers an online B.S. in Human Services and an online M.A. in Human Services to positively impact seniors. Both programs equip graduates with the knowledge and skills needed to work in and lead human service environments. The master’s program offers a gerontology specialization, and both degree options take place in a convenient online format.

Domestic Violence Exposure in Childhood Leads to Increased Suicide Risk in Adulthood

The Childhood Incidents That Increase Later Suicide Risk

Exposure to domestic violence, abuse cast a long shadow, study finds
Retrieved from: https://consumer.healthday.com/public-health-information-30/domestic-violence-news-207/what-incidents-in-childhood-increase-suicide-odds-711825.html

MONDAY, June 13, 2016 (HealthDay News) — Adults who witnessed parental domestic violence in childhood are at increased risk for suicide attempts, a new study finds.

“When domestic violence is chronic in a home, there is a risk of long-term negative outcomes for the children, even when the children themselves are not abused,” said study lead author Esme Fuller-Thomson. She is a professor with the University of Toronto’s Faculty of Social Work.

The researchers examined data from more than 22,500 Canadian adults. They found that about 17 percent of those exposed to chronic parental domestic violence (more than 10 times before age 16) had attempted suicide, compared with roughly 2 percent of those not exposed to parental domestic violence.

“We had expected that the association between chronic parental domestic violence and later suicide attempts would be explained by childhood sexual or physical abuse, or by mental illness and substance abuse,” Fuller-Thomson said in a university news release. “However, even when we took these factors into account, those exposed to chronic parental domestic violence still had more than twice the odds of having attempted suicide.”

These chaotic home environments cast a long shadow, she added.

“Social workers and health professionals must continue to work vigilantly to prevent domestic violence and to support survivors of this abuse and their children,” Fuller-Thomson said.

The study also found that adults who were maltreated during their childhood were more likely to have attempted suicide. Almost 17 percent of those who’d been sexually abused and more than 12 percent of physically abused children were later found to have made at least one suicide attempt, said study co-author Reshma Dhrodia, a recent Master of Social Work graduate.

The researchers also found that a history of major depressive disorder, anxiety disorders, substance abuse and/or chronic pain was associated with significantly higher odds of a suicide attempt.

The study was published online June 9 in the journal Child: Care, Health and Development.

More information

The American Academy of Child and Adolescent Psychiatry outlines how to help children exposed to domestic violence.

Trauma-informed care and practice resources for adults

Trauma-Informed Care and Practice 

To provide trauma-informed care to children, youth, and families involved with child welfare, professionals must understand the impact of trauma on child development and learn how to effectively minimize its effects without causing additional trauma (Child Welfare Information Gateway).

Below are resources that are helpful to support the development of trauma-informed practices and provide helpers with opportunities to develop enhanced knowledge and skills in supporting adults coping with trauma. I will be providing a separate post for trauma-related resources for children and youth.

Canada

Trauma-informed Practice Guide (2013). Retrieved from: http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf

• The Trauma-Informed Practice (TIP) Guide and TIP Organizational Checklist are intended to support the translation of trauma-informed principles into practice. Included are concrete strategies to guide the professional work of practitioners assisting clients with mental health and substance use (MHSU) concerns in British Columbia. 

Authors: Emily Arthur, Amanda Seymour, Michelle Dartnall, Paula Beltgens, Nancy Poole, Diane Smylie, Naomi North, and Rose Schmidt

Initial draft authors: Cristine Urquhart and Fran Jasiura of Change Talk Associates
British Columbia Centre of Excellence for Women’s Health; BC Ministry of Health, Mental Health and Substance Use Branch; and Vancouver Island Health Authority, Youth and Family Substance Use Services, 2013.

Trauma-informed Toolkit (2014). Canadian Centre on Substance Abuse. Retrieved from: http://www.ccsa.ca/Resource%20Library/CCSA-Trauma-informed-Care-Toolkit-2014-en.pdf

Trauma-informed: The Trauma Toolkit Second Edition (2013). Klinic Community Health Centre (Manitoba). Retrieved from: http://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf

• A resource for service organizations and providers to deliver services that are trauma-informed

Trauma-informed Approaches in Addictions Treatment (2010). Retrieved from: http://bccewh.bc.ca/wp-content/uploads/2014/02/2010_GenderingNatFrameworkTraumaInformed.pdf

• A discussion guide to gendering the National Framework for Action to Reduce the Harms Associated with Alcohol and Other Drugs and Substances in Canada. Identifies Canadian examples of promising practices in action. Lists discussion questions on providing integrated approaches.

Authors: British Columbia Centre of Excellence for Women’s Health (BCCEWH) in partnership with the Canadian Centre on Substance Abuse (CCSA) and the Universities of Saskatchewan and South Australia, 2010.

United States

National Center for Trauma-Informed Care

Seeking Safety: A Treatment Manual for PTSD and Substance Abuse 

• Website offers the book Seeking Safety as well as a wide variety of articles about treatment and implementation (primarily photocopies of journal articles). Website: http://www.treatment-innovations.org/seeking-safety.html

Student Loan Debt & Mental Health Impacts

Schools look to address mental health impact of rising student debt

By Aleksandra Sagan (May 30, 2016). The Canadian Press/The Globe and Mail. Retrieved from: http://www.theglobeandmail.com/globe-investor/personal-finance/genymoney/post-secondary-schools-look-to-address-mental-health-impact-of-rising-student-debt/article30200722/

Many of this year’s new post-secondary graduates have left the academic world carrying tens of thousands of dollars in debt. Meantime, those heading to college and university this fall will soon contend with steep tuition rates that often result in a similar burden.

While schools attempt to lessen the load by offering financial aid, average student debt appears to be climbing. So some institutions are also responding by beefing up their mental health services to help students cope with life in the red.

“We’re worried about one type of debt — student debt — and we want to know how to pay it off as quickly as possible,” said Dillon Collet, who is about to enter his final year at the University of Toronto’s faculty of law and sat on the dean’s advisory committee on financial aid.

The committee organized a financial aid workshop that discussed the psychology of debt. It was well-attended, Collet said, with about 60 students in the room and a lineup outside.

The committee’s student representatives also pushed to have tuition fees — and their connection to student stress — to be discussed at the faculty council’s meeting each year, Collet said.

“A lot of students suffer silently.”

Estimates suggest average student debt in Canada is past the $25,000 mark.

In 2013-14, graduates finished school with an average of $12,480 in federal loan debt, according to numbers from the Canada Student Loans Program.

However, that figure doesn’t include provincial or private loans. An Ontario student graduating from a four-year university program, for example, shouldered an average of $22,207 in provincial debt in 2012-2013. That makes for a total debtload of more than $34,000 if they also borrowed the average sum from the federal government.

The Canadian University Survey Consortium surveyed more than 18,000 graduating university students from 36 Canadian universities for its 2015 annual report. The average debt-ridden student owed $26,819.

Such a debt load can have an impact on a student or graduate’s mental health, though only a small amount of published research exists on the apparent link.

A 2015 journal paper analyzed data from a U.S. Bureau of Labour Statistics survey of more than 8,000 youth in the United States — where tuition fees are significantly higher than in Canada — to determine if debtload and psychological well-being were connected.

“Students who took out more student loans were more likely to report poor mental health in early adulthood,” said one of the paper’s authors, Katrina M. Walsemann, an associate professor at the University of South Carolina.

Canadian experts have also noticed a link, even though Canadian students don’t generally go into as much debt as their American cohorts.

Jillian Yeung Do, York University’s director of student financial services, witnessed it while working with a student. While she couldn’t provide much detail for privacy reasons, she said she became really concerned about a student.

“After that encounter, I decided that it would be a good idea to — for myself, personally, and as well for the entire team — to be trained in having these conversations with students,” she said.

The university’s health educator taught the financial services staff how to identify students in distress, listen to them and provide proper referrals. York University also plans to launch a new financial literacy campaign soon, she said.

The University of Toronto’s faculty of law staff, including its financial aid workers, will also have training on mental health issues next month, said Alexis Archbold, the assistant dean of the JD (juris doctor) program. She’s also the chair of the dean’s advisory committee on mental health and wellness, formed this past academic year.

Archbold and the committee spent the year listening to students’ primary concerns. Unsurprisingly for a professional program, she said, high tuition and the anxiety of the corresponding debtload emerged as one of the common themes.

The school’s new academic, personal and wellness co-ordinator will work with Archbold this summer to develop a wellness strategy, she said.

The committee will continue to hear from students on how to improve the strategy, which seems to fall in line with at least some of what the students want.

“We want a platform in which we can engage with the faculty and the administration,” said Collett, “and we can really talk about the nuts and bolts.”

HeadsUpGuys: Support and Help for Men Experiencing Depression

HeadsUpGuys

Men Get Depressed

It’s not a sign of weakness, it’s a fact. Guys get depressed. Depression affects 840,000 men every year in Canada, and is the second leading cause of disability worldwide.

There are many misconceptions about depression that make it difficult for men to talk to others and take charge of their health.

Check out the site to read about Myths and Reality of coping with depression. Find out about Symptoms, a Self-check tool, learn more about triggers and risk factors. 

Depression Can be Treated

Ignoring or hiding the pain of depression only makes things worse. This site will provide you with tips and tools, information about professional services, and stories of success that show you how depression can be overcome.

It starts with you recognizing depression and then making important changes in your life to overcome it. It takes courage. It takes strength. It takes work. But know that it can be done.

Take the next step in your recovery and learn more about what men’s depression looks like.

You Are Not Alone

Live life to the fullest

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