Incidence of Depression in Australia
Depression is defined as a sudden affliction that is being experienced by almost everyone who is passing from certain complications in life. Depression is characterized by increase in the level of stress that leads to loss of close interpersonal relationships management along with alarming deceleration of the self-esteem. Depression is a common mental disorder and it manifests due to passivity, feelings of sudden failure, feeling of loss (family member or close friends) and a sense of helplessness in life or job and lack of mental support in the family or in the friend circle. The Oxford English Dictionary defines depression as “a mental condition characterized by severe feelings of hopelessness and inadequacy, typically accompanied by a lack of energy and interest in life”. Depression hampers the synchronization of the daily routine activities of a person like job, sleeping, eating or conversation with people (Irwig, 2012).
Depression, a form of mood disorder, occurs in 6.2% of the Australian population (Bennett & Shepherd, 2013). According to research, complex combination of genetic backup, psychological backup and surrounding environment factors play a major role in the generation of depression among the people (Khanam, &Bukhari, 2015). In majority of the cases, people suffering from depression experiences severe anxiety, making the overall scenario complicated (Sowislo, &Orth, 2013).
Epidemiological evidence suggests that out of the one million of depressed adults in Australia, women experiencing depression are significantly greater in numbers than that of men (Australian Bureau of Statistics, 2010) with varying prevalence rate. It can be a regarded as the significant cause behind the disability in the world (Bennett & Shepherd, 2013).Depression cast an adverse effect on both mental and physical health of a person. It is also assumedthat it contributesto an increase in the risk of comorbid chronic health conditions and increase the susceptibility of the life style diseases such as cardiovascular disease and Type 2 Diabetes mellitus. These diseases in turn further contribute to the complexity of the depression.
Women are more vulnerable towards going down inside severe depression in the time of childbirth. Almost 16 per cent of the first time mothers are affected by postpartum depression (Loxton et al, 2010). The level of postnatal depression becomes more severe if the mother is young (18 to 27 years of age). Moreover, the depression coping capacities among the women is hit hard due to several disturbing family issues. The issues include stereotypic gender roles, family problems and caring responsibilities. The higher rates of depression has also been observed among the indigenous group of the Australian women and other with chronic or fatal disease. Australian women who are suffering from skin problems and poor body image also pass on to depression. Older women on the other hand, are at the lower risk of developing depression. Therefore, it is the high time to expand the knowledge of depression among the women and at the same time, enhance the responsiveness of the health service towards the quality living of women (especially for the work group) who are at the risk of developing depression ((Bennett & Shepherd, 2013).
Incidence of Suicide in Australia
Suicide is the outcome of the deliberate act undertaken with an intention to end one’s life by own. According to the World Health Organization (2014), each year, 800,000 people loss their life from suicide. This private act of ending one’s life has a profound negative impact of the lives of the family members who are directly associated with the person committing suicide. In spite of high degree of socio-economic costs inflicted upon the affected individuals, associated family and the concerned communities management, suicide still remains an unexplored, misunderstood and under-researched reason of death. One of major driving force that compels a person on committing suicide is depression. It has been estimated that 50% of individuals who commit sufferfrom depressive illness (Cummins et al, 2015). Apart from depression, other major factors that are found responsible behind the suicidal attempts are severe anxiety, irritability, persistent insomnia, uncontrollable aggression, self-guilt, incurable illness, concomitant alcohol addiction and other biological crisis like pregnancy, adolescence and climacterium. Apart from personal disorders, several environmental factors also promote suicidal thoughts like broken family, previous family history, occupational and financial difficulty and loss of religious afflictions.
Australia records high occurrence of suicide. As per the statistical report published in the year of 2015, suicide rate of 12.6 per 100,000 in Australia (the data is highest in terms of comparison with the last 10 years data) (Statistics on Suicide in Australia, 2017). The estimated research suggests that at least 3027 deaths have occurred in Australia as a result of suicide this equates to more than 8 individual committing suicide per day in Australia. Unnatural death by means of suicide in males is at last three times greater than the females. However, in 2016-2017, the rate of suicides among the female residents of Australia is significantly higher than that of the males. Moreover, 30 people attempt to commit suicide each day (Statistics on Suicide in Australia, 2017) but remain unsuccessful.
Pregnancy is a special risk factor for suicide among the females and if the mother is young then the probability of attempting suicide increases. Women however, during the first year of childbirth and during the last trimester of pregnancy are at a low risk of committing suicide despite of their high psychiatric morbidity rate. The motherhood seems to shield a mother from committing suicide.
Suicide because of depression is also common among the college students in Australia. The main stressor of generating suicidal thoughts among the college students are high academic demands, financial pressures due to educational loan and disturbed family background like separation between parents, single parent or premature death of parents. A survey with undergraduate students demonstrated 44.3% students experience emotional complexities. This emotional complexity generates depression that directly affects their academic performance (Clifford, Doran & Tsey, 2013). National College Health Assessment Survey (2005) also reported similar results. According to the report, the students are undergoing such a extreme depression that it became extremely problematic for them to study diligently during the semesters and they opted to end their life via committing suicide (Delfabbro et al., 2013).
One of the most important factors that have contributed to Elizabeth’s mental condition and health risk is postpartum depression (PPD). PPD affects 10 to 20% of the mother following the child birth. Some of the risk factors that make a mother more susceptible towards the PPD are lack of social support or social life, negative life events and a family history of depression (O'hara& McCabe, 2013). Elizabeth has a family history of depression. Her mother experienced anxiety and depression during her first pregnancy, which required anti-depressant medication and mental health in-patient care after suicidal behaviours. Prior to pregnancy, Elizabeth and her husband Craig used to have a trending social life. They used to visit pubs with their friends during every weekend. They even used to travel internationally for two holidays. However, after Elizabeth got pregnant and her husband Craig got a new truck driving job, their weekly routine of social hangover got hampered. This lack of social quotient in life is further decelerated as Elizabeth is on maternity since one month before delivery. She is finding this isolation from the work and colleagues extremely difficult. Moreover, the rental company contacted Elizabeth several days ago stating that the house owners of their rented apartment may terminate their rental agreement in two months as they want to live there themselves. This advanced notice of sudden loss of home casted negative impact on the young mother, Elizabeth.
The second most important factors that have contributed to Elizabeth’s mental condition and health risk are the occurrence of high blood pressure. High blood pressure level is linked with faster decline in the specific cognitive domains. Significant high blood pressure rate leads to faster deterioration of the neuropsychological condition leading to depression. Moreover, high blood pressure is directly proportional with hypertension and the latter is again dependent on the current family equilibrium. Elizabeth is only 21 years old, too young to be a mother. Moreover, her husband is also young (22 years old) and they had a courtship only 18 months before they decided to live-in and now they are parents of 2 weeks old baby. Now, such a young age means lack of real time experience and thus generation the root of hypertension. Elizabeth is sad because her baby was suffering from breathing problems since birth, she has been threatened by the tenant to leave their rented apartment and there is no mental support from her husband as he is mostly busy with his new job. All these ignite the embryo of hypertension, leading to depression (Goldstein, Levey&Steenland, 2013).
Ethical principle of beneficence addresses the concept that the action of nurses should promote something good, something that is best for the patient care. Ethical principle for non-maleficence states that nurses must not harm patient. In both the cases, nurses must ensure that they must act strictly for the mental and physical benefit for Elizabeth.
The urgent mental risk of Elizabeth is she can commit suicide out of sheer depression as Elizabeth informed the once she walked to the chemist shop for buying baby formulae milk she bought two packets of pain killers with the intension to overdose.
Cognitive Behavioural Therapy (CBT)
CBT is based on patient’s thought, the mind set he or she is nurturing at that very phase of life along with other physical sensation like hallucination, headache, tremor, increased in heart beat, anxiety and palpitation. The concept of CBT is based on the fact that there lies a strong interconnection between the emotional thoughts both in subconscious and in conscious mind. These complex interconnection at times leads to the generation of negative thoughts, trapping patients in a vicious cycle (Jones et al., 2012). CBT first breaks the principal mental illness into small sub parts. While doing so, it becomes easier of the nurses or the psychologist to council the patients. In case of Elizabeth CBT will start via breaking her postpartum depression into several small fragments, like lack of social life, long leave from job, lack of quality time with the partner, threat in social security and previous family history of depression. However, CBT gives importance to the current problems and does not give preference in focusing on the past issues. This practical approach generates less stress over the patient as they are not forced to recollect their past horrifying memory and hence, helping them to cure easily (Hofmann et al., 2012).
Mini mental state examination tool is a questionnaire that consists of 30 questions, which helps to measure the cognitive stage of the patients. This is mainly used to assess the condition of the patients, who are suffering from mental health illness. The patient, Elizabeth is suffering from PPN. She needs the appropriate care with the medical treatment. The assessment tool can help to assess the severity as well as the progression of the cognitive impairment. Before taking any approach to the treatment, the condition of the patient needs to be assessed. The assessed information needs to be documented. This documented information can help in the treatment to check the difference of the cognitive stage of the patient (Arevalo-Rodriguez et al., 2015).
A mental health problem from which Elizabeth is supposedly suffering from is PPD. PPD or postnatal depression is a type of mood disorder which occurs after child birth and are mostly prevalent in women.
Promotion of breast feeding as breastfeeding is found to reduce the suicidal thoughts and depression (Figueiredo, Canário& Field, 2014). Nursing triggers the release of the oxytocin hormone, which promotes nurturing and mental relaxation. Oxytocin helps the inflated uterus to contract after delivery and reduce the rate of internal postpartum bleeding. Moreover, high concentration of oxytocin in blood lowers the blood pressure and thus reducing stress. Apart of stress relieving benefits, breastfeeding also helps the newborn child to develop a connection with his or her mother via skin-to-skin contact happening during breast feeding (Ahn& Corwin, 2015).
It is also known as insight-oriented or psychoanalytic therapy (Driessen et al., 2013). This therapy examines the complexities of interpersonal relationships. In case of Elizabeth it will analyze her relationship with her mother, husband and her child. Via the wavelength and the magnitude of the inter-personal relationship the therapy will eventually study the factors that have lead to the change her thoughts or behavior. In one word, it can be described as traditional “talk therapy”. In this therapy, the nurse will try to understand Elizabeth’s difficulties in the context of who she is as an individual. The therapy will look inside the family background, history of upbringing and current scenario into consideration.
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