Depression In Families Related to Major Mental Health Disorders

Major Mental Disorders and Depression

Depression in Families,Depression Is A Descriptive Term,What is Family,Genetic and Biological Research On Depression,Psychological Research In Depression,Family Response to Mental Depression.

Depression in Families

    Depression is a major mental health problem affecting 25 million Americans and their families. By 2020, depression will be the third leading cause of disability worldwide. 

    Most people suffering from depression live with their families, usually their spouses and children, and the negative impact of depression on families has been well-documented (Coyne et al., 1987; Keitner , Archambault, Ryan, & Miller, 2003; Lee, 2003; Miller et al., 1992). 

    Nursing has long viewed families- as a context for caring for the individual with depression, but only recently has focused on the whole family.

Depression Is A Descriptive Term

    Depression is a rather vague descriptive term with a broad and varied meaning ranging from normal sadness and disappointment to a severe incapacitating psychiatric illness. 

   William Styron (1990) describes in Darkness Visible the unsatisfactory descriptive nature of the term depression: "a noun with bland tonality and lacking any magisterial presence, used indifferently to describe the economic decline or rut in the ground, a true wimp of a word for such a major illness" (p. 37).

    Depression is a universal mood state with all people experiencing a lowered mood or transient feelings of sadness related to negative life events such as loss. For most, the feelings of sadness or disappointment resolve with time and normal functioning resumes. 

    In contrast, the symptoms associated with the psychiatric illness of depression can disrupt normal functioning, influence mortality and morbidity, and can cause a myriad of problems within the family (Badger, 1996a; Bluementhal et al., 2003; Cuijpers & Smit, 2002; Katon , 2003). 

    The psychiatric illness of major depressive disorder (MDD) is diagnosed if five out of the following nine symptoms are present for a minimum of 2 weeks most of the day, nearly every day: 

(a) depressed mood

(b) loss of interest or pleasure in all activities

(c) decrease or increase in appetite or significant weight change

(d) insomnia or hypersomnia

(e) psychomotor retardation or agitation

(f) fatigue or loss of energy

(g) feelings of worthlessness or excessive guilt

(h) difficulty concentrating or indecisiveness

(i) recurrent thoughts of death, recurrent suicide ideation or attempt (American Psychiatric Association (APA), 1994). 

    One of the five symptoms must be depressed mood or loss of interest or pleasure. Together, these symptoms cause significant functional impairment. In addition to MDD, depression is further classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (APA, 1994) into other diagnostic subtypes such as minor depression or dysthymia by signs and symptoms, onset, course, duration, and outcomes.

What is Family

    Family refers to any group that functions together to perform tasks related to survival, growth, safety, socialization, or health of the family. Family members can be related by marriage, birth, adoption, or can self identify themselves as family. 

    This definition is sufficiently broad to be inclusive of all types of families; however, it is recommended that researchers provide specific definitions of family appropriate to their research.

Genetic and Biological Research On Depression

    Genetic-biological research of depression in families includes genetic and biological marker studies ( Flaskerud , 2000; Viguera & Rothschild, 1996). The four research approaches to the genetics of mood are: 

(a) familial loading studies (eg, comparing families with depression to families without the disease)

(b) studies evaluating the inheritability of mood disorders (eg, twin studies)

(c ) studies of incidence of the risk for, but not yet ill from, mood disorders to determine biological or psychological antecedents

(d) in theory, studies using genetic probes to determine which relatives and which phenotypes are associated with the genetic contributions to mood disorders ( Suppes & Rush, 1996). 

    The results of the familial loading studies are clear whether the approach used is the "top-down" ( ie , studies of children with depressed parents) or the "bottom-up" approach ( ie , studies of relatives of depressed children ) ( Birmaher , Ryan, & Williamson, 1996; Jacobs & Johnson, 2001). 

    Children with depressed parents have a significantly greater risk of developing depressive disorders and other psychiatric disorders than do children with parents without depression (Buckwalter, Kerfooot , & Stolley , 1988; Peterson et al, 2003; Nomura, Wickramaratne , Warner, Mufson , & Meissman , 2002). 

    Biological marker studies have focused on growth hormone, serotonergic and other neurotransmitter receptors, sleep, and hypothalamic pituitary axis (Keltner, 2000; Viguera & Rothschild, 1996). 

    Despite evidence from genetic studies about the strong support for the genetic inheritance of depression, and the fact that abnormalities in biological markers persist throughout the life span, the relationship between genetic-biological predisposition and environment remains unclear.

Psychological Research In Depression

    Psychosocial research of depression in families has focused on communication, mar ital problems and dissatisfaction, expressed emotion, problem-solving, coping, and family functioning (Beach, Sandeen , & O'Leary, 1990; Biglan et al., 1985; Keitner , Miller, Epstein, Bishop, & Fruzzetti , 1987). 

    The evidence strongly supports that families who contain members with depression have greater impairment in all areas than matched control families, and then families whose members are diagnosed with alcohol dependence, adjustment disorders, schizophrenia, or bipolar disorders (Coyne et al., 1987; Keitner , Miller, & Ryan, 1993). 

    It is not surprising that depression has its most negative impact on families during acute depressive episodes (Miller et al., 1992), yet families with depressed members consistently experience more difficulties than matched control families even 1 year after initial treatment (Billings & Moos, 1985). 

    Family members) living with members with depression report greater health problems, with about 40% of adults being sufficiently distressed themselves to require therapeutic intervention (Coyne et al., 1987). 

    The majority of recent studies of families with members with depression have used primarily inpatient samples, have focused on women as the identified patient, have often excluded parents with depression, and have been quantitative in nature (Schwab, Stephenson, & Ice, 1993). 

    Few studies have used qualitative approaches to understand family members' perspectives and treatment needs. Badger (1996a) used a grounded theory method to describe the social psychological process of families living with members with depression. 

    The process, family transformations, refers to the cognitive and behavioral changes that occur within the family from the time the member initially exhibits symptoms through recovery and at. remission. 

    As family members moved through the three stages (acknowledging the strangers within, fighting the battle, gaining a new perspective), all members are transformed and family functioning forever altered.     

These results support findings from previous studies and provide perspectives of family members not normally included in depression research.

Family Response to Mental Depression 

    Despite identifying the multiple problems in these families, the role of the family in the treatment process has received less attention. Systematic family interventions have only begun to be developed and modeled after programs used with people with other psychiatric disorders and their families (Holder & Anderson, 1990; Kietner et al., 2003). 

    For example, Lee (2003) found that in mothers who participated in a program to improve maternal coping skills, these coping skills moderated between depression and negative life events, reducing the negative effects on children. 

    To date, few clinical trials have validated the effectiveness of these interventions. Families have identified the need for information about how to facilitate communication, decrease negative interactions, handle stigma, gain a new perspective, care for self and redesign their relationships (Badger, 1996b). 

    In theory, education, support and partnering could move family members more quickly through the stages to prevent depression from becoming a recurrent and chronic illness for the entire family. Future research should develop and test psychoeducational and support interventions with families. 

    Although a common concern with research with families remains the unit of analysis (individual, dyad, or family as a whole), research representing all perspectives is needed for nursing to more fully understand and treat depression in families.