Problem 1: depression part 1
What is depression?
World Health Organization. (2017). Depression and other common mental disorders: global health
estimates (No. WHO/MSD/MER/2017.2). World Health Organization.
Facts
The global number of people with depression was estimated to be bigger than 300 million in 2015.
Depressive disorders impact the mood or feelings of affected persons. Symptoms range in terms of
severity (mild to severe) and duration (months to years). 4.4% of the world’s population suffers from
depression. The number of people with common mental disorders is going up, especially in lower-
income countries. The risk of becoming depressed is increased by poverty, unemployment, life events
such as the death of a loved one or a relationship break-up, physical illness and problems caused by
alcohol and drugs.
Definitions
Depressive disorders are characterized by sadness, loss of interest or pleasure, feelings of guilty or low
self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration. Depression can
be long-lasting or recurrent, substantially impairing an individual’s ability to function. Depression can
lead to suicide. Depressive disorders include two main sub-categories:
• Major depressive disorder/depressive episode: this involves symptoms such as a depressed
mood, loss of interest and enjoyment and decreased energy. A depressive episode can be
categorized as mild, moderate or severe.
• Dysthymia: a persistent or chronic form of mild depression. The symptoms are similar to a
depressive episode, but tend to be less intense and last longer.
Prevalence
- The global population with depression in 2015 is 4.4%. It is more common among females
(5.1%) than males (3.6%).
- Prevalence varies by WHO region, 2.6% in Western Pacific region and 5.9% in African region.
- Prevalence varies by age, peaking in older adulthood (above 7.5% among females aged 55-74
years, and above 5.5% among males). Depression also occurs in children and adolescents under
15, but at a lower level than older groups.
- The total number of people with depression is 322 million. Half of these people live in the
South-East Asia region and Western Pacific region, reflecting the relatively larger populations of
those two regions.
- The number of people living with depressed increased by 18.4% between 2005 and 2015, this
reflects the growth in the population and the increase in the age groups at which depression is
more prevalent.
,Estimates of health loss
Years Lived with Disability (YLD): multiplying the prevalence of these disorders by the average level of
disability associated with them
Disability-Adjusted Life Years (DALYs): YLDs are added to Years of Life Lost (YLL) to compute DALYs,
which are the key metric to assess the Global Burden of Disease (GBD).
In the case of depression and anxiety disorders, no YLL are attributed directly to these disorders in GBD
analyses, thus estimated of YLD are represent total estimated DALYs for these conditions. Depression,
however, is a major contributor to suicide.
Depressive disorders led to a total of over 50 million Years Lived with Disability (YLD) in 2015. More
than 80% occurred in low- and middle income countries. Depressive disorders are ranked as the single
largest contributor to non-fatal health loss (7.5% of all YLD).
Psychological theories and psychological treatment of depression
Abramson, L.Y., Alloy, L.B., Hankin, B.L. et al. (2002). Cognitive vulnerability-stress models of depression
in self-regulatory and psychological context. In: L.H. Gotlib & C. Hammens (Eds.). Handbook of
depression (pp. 269-294). New York: Guilford Press.
Beck and Seligman came with cognitive theories on depression due to (possibly) several reasons
(important for the test!):
• The rise of information-processing approaches in general and the study of social cognition,
which provided a basic science foundation for a cognitive approach to depression
• Basic researchers demonstrated that cognitive processes mediate emotional reactions, with the
specific contents of thought producing specific emotional reactions (threat and dangers leads to
anxiety).
• Many researchers did not like the psychoanalytic approach to depression anymore, because it
seemed untestable. Cognitive theories were testable.
• Many psychologists questioned the adequacy of purely behavioural accounts of various
psychological phenomena.
Two cognitive theories of depression: hopelessness theory and Beck’s theory
According to the hopelessness theory and Beck’s theory, the meaning or interpretation that people
give to their experiences influences whether they become depressed and whether they will suffer
repeated, severe or long episodes of duration.
Hopelessness theory (Abramson et al., 1989)
,According to this theory, the expectation that desired outcomes will not occur and that aversive
outcomes will occur and that one cannot change this situation (hopelessness) is a cause of depressive
symptoms, especially hopelessness depression (HD). Symptoms of HD are sadness, suicidality, low
energy, sleep disturbance, poor concentration etc.
Negative life events are starters for people to become hopeless. Not all people become depressed
when confronted with negative life events, according to hopelessness theory three kinds of inferences
that people may make when confronted with negative events contribute to the development of
hopelessness (causal attributions, inferred consequences and inferred characteristics of the self).
Hopelessness and in turn depressive symptoms are likely to occur when negative life events are (1)
attributed to stable (persisting over time) and global (affects many areas in life) causes and viewed as
important, (2) viewed as likely to lead to other negative consequences and (3) implies that the person
is unworthy or deficient.
Example: a student fails a test, she is likely to become depressed when she believes that the failure (1)
was due to her low intelligence, (2) will prevent her from getting into medical school and (3) means
that she is worthless.
Informational cues in the situation (consensus, consistency and distinctiveness information) and
individual differences in cognitive style, influence the content of people’s inferences about cause,
consequence and self. Someone who exhibits a general style to attribute negative events to stable and
global causes, believes further negative consequences and unworthiness, should be more likely to
make depressive inferences.
Cognitive vulnerability-stress component: negative cognitive styles are the cognitive vulnerability and
negative life events the stress. If there aren’t negative life events, people exhibiting depressive
inferential styles should not be more likely to develop hopelessness than people not exhibiting this
style.
Factors that moderate the cognitive vulnerability-stress component: social support buffers against
depression when people experience stressful events, people may provide adaptive inferential feedback
that promotes benign , rather than depressive inferences about the causes, consequences and
meaning of negative events.
Beck’s theory
This theory is similar to the hopelessness theory. In this theory, maladaptive self-schemata containing
dysfunctional attitudes involving themes of loss, inadequacy, failure and worthlessness constitute the
cognitive vulnerability for depression. Dysfunctional attitudes often involve the theme that one’s
, happiness and worth depend on being perfect or on other people’s approval. An example is “I am
nothing if a person I love doesn’t love me”. When these self-schemata are activated by the occurrence
of negative life events (stress), they generate specific negative cognitions (automatic thoughts) that tae
the form of overly pessimistic views of oneself, one’s world and one’s future (the negative cognitive
triad) that in turn lead to sadness and the other symptoms of depression. In the absence of negative
events, the depressogenic self-schemata remain latent, less accessible and do not directly lead to
automatic thoughts. Beck said that this cognitive vulnerability-stress model applies to only some forms
of depression, particularly nonendogenous, unipolar depressions.
In Beck’s (1983, 1987) theory, individual differences in the value people place on different kinds of
experiences influence whether or not particular negative events will activate the cognitive vulnerability
(depressogenic self-schemata) for depression. People who value social relationships high, will be likely
to become depressed when they experience social rejection.
Comparison of the Hopelessness Theory and Beck Theory (very important for the test!)
Similarities:
- Both theories emphasize the role of cognition in the origin and maintenance of depression.
- Both theories contain a cognitive vulnerability hypothesis in which negative cognitive patterns
increase people’s vulnerability to depression when they experience negative life events in
congruent or highly valued content domains.
- Both theories propose a mediating sequence of negative inferences that influence whether or
not negative events will lead to depressive symptoms.
- Both theories recognize the heterogeneity of depression and either explicitly (hopelessness
theory) or implicitly (Beck’s theory) propose the existence of a cognitively mediated subtype of
depression. This subtype may exist in nonclinical populations as well.
Differences:
- In the hopelessness theory, inferences about cause, consequences and self are examples of
cognitive products. Depressive and nondepressive cognition differ in content (stable, global vs
unstable, specific causal attributions for negative events) but not in process. In contrast, Beck’s
theory emphasized that depressive and nondepressive cognition differs not only in content, but
also in process. Beck suggested that the inference process is schema-driven among depressives
and data-driven among nondepressives.
- Although both theories emphasized that depressed people’s inferences are negative, Beck
further proposed that depressed people’s inferences are unwarranted given current
information. Specifically, Beck suggested that depressed individuals ignore positive situational
