Depression and Bipolar Disorder In Nursing and Mental Health Psycho Education
What Mental Health Psycho Education
Mental health is the latest field of health practice to incorporate patient education, called in this field, “psychoeducation.” It follows earlier fields, beginning with diabetes, cardiovascular, and then respiratory diseases and arthritis in establishing the need for education, programs, and public campaigns to deliver it, a body of research that supports and directs it, and eventually measurement instruments and standards of practice.
As noted in earlier, the major fields of health practice have moved through all but the last two steps on this continuum, although none has yet made effective education available to all who need it.
Since mental health is at the earliest stages of the continuum of incorporation of patient education into its practice, it represents a case study of the logic and organizational actions that accompany this transition.
Mental health's use of the term “psychoeducation” reflects an effort to incorporate educational interventions into its dominant psychotherapeutic treatment modality. The nature of the disorders (disturbed thought processes) no doubt led people to conclude that patients could not learn to care for themselves, and a past tradition of complete provider dominance meant patients did not have rights to learn information and skills.
The earliest educational target was compliance with physician-prescribed treatment, believed to be especially important in those cases in which medication was administered for controlling symptoms and avoiding relapse. Most development of psycho education occurs by disease entities such as depression and bipolar disease, schizophrenia, dementia, and eating disorders and is driven by significant social need.
The number of individuals suffering from these
disorders is immense, causing significant disability and economic loss. The
hope is to understand those areas in which psycho education can provide benefit
by itself or in combination with other therapies. Discussion of patient
preparation for self management of these disorders. may be found in Redman
(2004).
Depression and Psycho Education In Nursing
A meta analysis of 69 programs to decrease depression found those using educational methods showing an effect size of 27 and those not using educational methods an effect size of 14. The overall effect size for all interventions was 22, which represents an 11% improvement of the experimental group over the control. Programs with larger effect sizes use multiple component interventions including competence enhancement techniques and 60 to 90 minute sessions.
Given the large population of individuals suffering from
depression, effect sizes of this magnitude could make a large difference if
implemented widely (Jane Llopis, Hosman, Jenkins, & Anderson, 2003). A
further summary of 25 articles found a substantial and significant relationship
between depression and noncompliance with treatment regimen; the association
between anxiety and non compliance was variable and overall nonsignificant
(DiMatteo, Lepper, & Croghan, 2000).
Psycho educationally oriented treatments lend themselves well to self administration. Bibliotherapy is widely used for depression, showing an effect size of 83 (large). The effect size is similar to self administered treatments for anxiety, although they usually incorporate checkins with a clinic or a degree of observation (Mains & Scogin, 2003).
There are very
few data to suggest patients for whom self administered treatments may be best
suited. While few of the numerous self help books have been empirically tested,
those used in clinical trials showed an average effect size roughly equal to
that in psychotherapy trials (McKendree Smith, Floyd, & Scogin, 2003).
A psychoeducational group for those who screened positively for possible postnatal depression (PND) reduced the level of depressive symptoms in comparison with a group in routine primary care.
The intervention included educational information about PND strategies for coping with difficult childcare and eliciting social support, use of cognitive behavioral techniques to deal with women's erroneous cognitions about motherhood and to provide strategies for coping with anxiety, and instructions on the use of relaxation.
While the effect was maintained 6 months after the group had ended, some women continued to show evidence of depressive symptomatology (Honey, Bennett, & Morgan, 2002). While only a single small study, this work is typical in mixing educational interventions with those from other theoretical origins.
Since 13% of childbearing women will experience an episode of minor or major depression, it is important to know whether these findings can be widely generalized.
Societal level solutions dealing with isolation and stress in new mothers are generally not identified: instead, women are to be helped to develop the cognitive and emotional stamina for them to endure what may be fair, untenable, or even threatening situations (Lloyd & Hawe , 2003).
Bipolar Disorder and Health Issues
Bipolar patients are at risk for relapse even when undergoing optimal pharmacotherapy. Two examples of randomized controlled trials of psycho educational interventions showed similar decreases in depression and longer relapse free intervals. Colom et al. (2003) provided fully compliant, complex bipolar patients with standard psycho therapeutic care and for the experimental group psycho education in groups of 8 12 and for the control noneducational meetings.
Twenty sessions of 90 minutes focused on content and on exercises to develop illness awareness, treatment compliance, early detection of prodromal symptoms and relapse, and lifestyle regularity. At the end of the follow-up period, 36% of the control group and 8% of the treatment group had been hospitalized (significantly different at .01).
Likewise, Miklowitz, George, Richards, Simoneau, and Suddath (2003) provided psycho education to bipolar patients who were also receiving pharmacotherapy, and to their families. This randomized controlled trial provided family focused psycho education in 21 sessions over 9 months following an episode of bipolar illness, and to the control group crisis management.
The psycho educational
treatment taught about the disorder and provided communication enhancement
training and problem solving skills. Again, the experimental group had longer
relapse free intervals and less depression during the 2nd year follow up.
Similar effects were found in four of five controlled trials of
caregiver training for dementia. Such training was found effective in
decreasing behavioral problems in the patients and in delaying
institutionalization (Teri, 1999).
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