Kaitlyn Rutigliano Nursing 616 C: Living with Mental Illness University of New Hampshire December 4, 2013
Major Depressive Disorder 2
Issue Major Depressive Disorder (MDD) is one of the leading psychological illnesses among teens and young adults. Over the past ten years, MDD has significantly increased in individuals ages 19-24. Although this is a common mental health disorder, researchers are beginning to take a closer look as to why this MDD has become such a phenomenon in the younger population. Many studies have been conducted to identify potential causes of rising MDD rates in young adults. Researchers are investigating many factors that may be contributing to this increase such as environmental toxins, extreme life stressors and neurological imbalances (Zarate, 2010). In addition, researchers are also looking into the onset of depressive symptoms and the etiology of this disorder. This paper will discuss the major concerns with MDD and how young adults are the most at risk. Identifying Decision Mental health is a critical area of health care that is often neglected in hospitals and out- patient facilities. Due to economical hardships, budget cuts are implemented in these care settings; unfortunately, mental health units are often the first to be terminated. Without professional help, many individuals with mental illnesses suffer tremendously, especially young adults. Young adults, ages 19-24, are highly vulnerable to mental disorders due to the maturation of the brain. The neurological transition between adolescence to adulthood puts both physical and mental stress on the body. Brain development is occurring rapidly during this stage of life and researchers are noticing neurotransmitter imbalances as one of the major playmakers in major depressive disorder in young adults. In addition to neurological imbalances, researchers are also paying close attention to environmental and lifestyle stressors in relation to MDD. Major Depressive Disorder 3
This topic tends to be over looked; meanwhile it is one of the leading mental disorders in young individuals. Major Depressive Disorder is a debilitating mental illness that can lead to death, most commonly through suicide, if left untreated for an extensive period of time (Chueng, 2007). Health care professionals need to be aware of the importance of early diagnosis and proper treatment. This disorder can manifest as early as childhood and health care professionals should be held accountable for recognizing major objective and subjective symptoms patients may be experiencing. Assessing the Research The resources gathered for this research paper were found through the University of New Hampshires interlibrary databases. Databases used included CINAHL and PsycINFO and provided the student with the most helpful articles to support the topic of young adults and major depressive disorder. During the initial stages of research, the student was mainly focused on the broad topic of MDD rather than a specific population. This propelled the student to look into areas where MDD was most problematic: young adults. Using Boolean search terms such as and and or, allowed the student to find the most scholarly articles related to the topic of interest. Key words used included young adult(s) and depression, college student(s) and depression, mental health and young adult(s). In addition to using Boolean search terms and categorical keywords, the student narrowed the search further to articles that were less than 10 years old and provided full-text studies. These limitations enhanced the students ability to find more evidence-based resources. Logical Argument As discussed earlier in this paper, major depressive disorder (MDD) is one of the most common mental health illnesses seen in young adults. However, the issue that revolves around Major Depressive Disorder 4
this population is that health care professionals are failing to recognize and treat the signs and symptoms of MDD. The first article entitled, Mental Health Service Use Among Adolescents and Young Adults with Major Depressive Disorder and Suicidality was a quantitative study that addresses the need for mental health services and how physicians are not considering the signs and symptoms of MDD in their young adult patients. In this study, researchers found that 42% of young adults (out of 619 participants with depression, between the ages of 15 24) did not use any mental health services. In addition out of the participants, aged 19-24 with suicidal ideations, 48% could not access mental services (Chueng,2007). Depending on health care plans, many individuals require referrals from primary care physicians to seek out-patient treatment, mainly psychiatric care. However, if physicians are not taking the necessary action to help their patients and recognizing major depressive symptoms, than conditions persistently become worse. Another component related to MDD is the biochemical neurotransmitter receptor function in the hypothalamus. Psychological Stress and Vulnerability for Major Depressive Disorder: Cortisol, Brain Structure, Function, and Cognitive Processing in Young Adults is a quantitative study that discusses how the stress can lead to hypothalamic changes within the cerebral cortex leading to MDD. The hypothalamic-pituitary-adrenal (HPA) axis is a major site in the brain that controls and regulates stress. When stress levels exceed the capabilities of the body to naturally regulate, neurological imbalances result. Researchers conducted a study on healthy young adults who did not have significant indicators of MDD (Dedovic, 2013). The participants of the study were exposed to stressful situations and brain activity was monitored. The researchers discovered that young adults were more susceptible to depressive-like symptoms when presented with extreme cases of stress compared to other age groups. The HPA function decreased in these participants which allowed for the researchers to conclude that stress directly relates to MDD. Major Depressive Disorder 5
An article entitled Predictors of First Lifetime Onset of Major Depressive Disorder in Young Adulthood was a mixed-method study that addressed how MDD is most frequently detected in young adulthood. The study goes on to explain that many individuals who exhibit depressive tendencies experience their first onset in their 20s. Researchers discovered that young adults were most at risk for developing MDD due to genetics, past abuse history that resurfaced and psychosocial variable (Klein, 2013). Findings were conducted through self-evaluation surveys which addressed indicative measures of potential MDD. Prefrontal White Matter Abnormalities in Young Adult with Major Depressive Disorder: A Diffusion Tensor Imaging Study was a quantitative study that discussed how neurological malformations directly correlated with MDD seen in young adults. Researchers compared the measurements of prefrontal matter of healthy young adults against individuals with MDD. The study concluded that those participants with MDD had significantly lower fractional anisotropy (FA) values in prefrontal white matter (Li, 2007). With a decreased FA, the brain does not work at an optimal level and produces neurological imbalances such as MDD, which was seen in these participants. This study provided a scientific approach to how MDD can be dependent on the functionality of major sectors of the brain. The fifth article reviewed was entitled Does Emotion Predict the Course of Major Depressive Disorder? was a qualitative study that addressed the etiological components of MDD. Researchers wanted to gain a better understanding of whether or not emotions played a significant role in the manifestation of MDD. The results showed that a persons mindset and attitude toward life was a profound indicator of MDD severity. Participants who showed a positive regard toward oneself was less likely to experience severe cases of depression. Major Depressive Disorder 6
However, those who had a negative attitude towards self were more likely to exhibit worse cases of depression. The researchers concluded that many of the participants who experienced more severe cases of depression exhibited behaviors such as neuroticism and social isolation (Morris, 2009). This study focused more on participants outlook and behavior rather than the neurological aspect of MDD. The sixth article that was used, Prevention of Recurrence of Major Depression Among Emerging Adults by a Group Cognitive-Behavioral/Interpersonal Intervention, discussed the increasing prevalence of depression relapse and the importance of relapse prevention. This qualitative study directed research towards the young adult population. Studies have shown that individuals who experience depression in adolescence were 50% more likely to experience recurrence of with first two years of adulthood. Researchers conducted this study on college students who had a history of adolescent depression. In order to find the most effective method of prevention, the researchers tested the use of cognitive-behavioral and interpersonal therapy over a two year span. The result showed that students who received these therapeutic modalities cut their risk for depression relapse in half compared to those who did not receive the treatment (Sheets, 2013). The study helped support the effectiveness of cognitive therapy and the treatment of MDD. The Course of Depressive Symptoms in Men From Early Adolescence to Young Adulthood: Identifying Latent Trajectories and Early Predictors was the seventh article reviewed for this research paper. The study looked at the MDD trajectory and how it changed from adolescence to adulthood. Males from ages 15-24 were interviewed and researchers found that the psychiatric trajectory of MDD was based on specific effects of childhood, parental, provisional, and individual risk factor (Stoolmiller, 2005). This study demonstrated that the male pattern of MDD Major Depressive Disorder 7
was not dependent on one sole purpose, but rather a collection of factors. In addition, symptoms that presented in adolescent appeared to stay consistent as the individual entered young adulthood. Psychiatric Disorders in Young Adults: Depression Assessment and Treatment was the final article that was reviewed. This study discussed the rise in MDD prevalence in young adults and the causes of this significant increase. Researchers found that young adults who participated in their study were more likely to experience high rates of relapse, vestigial symptoms, cognitive and functional declination, psychosocial disability, and an overall decrease in personal well- being (Zarate, 2010). The study was directed towards understanding the pathophysiology of MDD and ways to decrease the need for lifelong medication. The study concluded that factors such as brain chemistry, social factors and genetics were major triggers for MDD onset and severity. Critical Approach All of the studies used in this research paper were peer-reviewed and evidence-based cases. However, each article has different strengths and weaknesses. The first article used, Mental Health Service Use Among Adolescents and Young Adults with Major Depressive Disorder and Suicidality, was a concise and systematic study that provided statistical evidence of the consequences of not seeking psychiatric treatment. One of the limitations to this article was that it did not demonstrate specific mental health treatment that would be most beneficial for patients with MDD. The second article, Psychological Stress and Vulnerability for Major Depressive Disorder: Cortisol, Brain Structure, Function, and Cognitive Processing in Young Adults was informative and brought forth a different approach to MDD. The main limitation to this study was that it was difficult to interpret due to the science-heavy vocabulary. An advanced reading level would be necessary to Major Depressive Disorder 8
fully comprehend the literature used. The third article used, Predictors of First Lifetime Onset of Major Depressive Disorder in Young Adulthood was a very interesting article that demonstrated how adult onset was not the only indicators of MDD. The researchers showed that MDD patients exhibit various depressive-symptoms that physicians and family members often overlook. The research was methodical and easy to understand. The fourth study, Prefrontal White Matter Abnormalities in Young Adult with Major Depressive Disorder: A Diffusion Tensor Imaging Study was a profound study that greatly supported the neurological imbalances associated with MDD. The main limitation for this article was that it was taken from a small sample; therefore not accounting for the general population. The fifth study, Does Emotion Predict the Course of Major Depressive Disorder? had many limitations such as the findings not taking into account the course of MDD, lack of measurement of MDD trajectory and only using published articles that supported researchers theory causing bias. The sixth article, Prevention of Recurrence of Major Depression Among Emerging Adults by a Group Cognitive-Behavioral/Interpersonal Intervention provided a thorough analysis of how MDD can resurface in individuals who had previous episodes. The most significant limitation was that all the participants were aware of their psychiatric history and were self- selected samples. The seventh article, The Course of Depressive Symptoms in Men From Early Adolescence to Young Adulthood: Identifying Latent Trajectories and Early Predictors was one of the weaker articles because it was solely focused on males and did not take into consideration the severity of symptoms and how long the participant had been suffering from MDD. Looking back, the student may have rejected this article due to its strict population. The eighth article used, Psychiatric Disorders in Young Adults: Depression Assessment and Treatment was the most beneficial article that provided imperative information regarding MDD. The only limitation Major Depressive Disorder 9
was that range of assessment and treatment mechanisms were focused on traditional methods of care. Implication for Nursing Practice After reviewing all eight articles, major depressive disorder in young adults is a complicated psychiatric illness. Each article identified and discussed the many factors that determine the etiology and trajectory of MDD. Young adults are most vulnerable due to the neurological transition from adolescence to adulthood due to the stress that the body is under chemically. There is a major deficient in health care knowledge of adult onset of MDD as one can tell from the articles above. Nurses and physicians need to be more aware of this mental disorder and advocate for their patients. Educational courses and seminars should be implemented in health care settings; this is issue is not being taken serious and more individuals are suffering each year due to the lack of help and understanding. Health care professionals, especially nurses, should know the most common signs and symptoms of depression as well as the not so common ones such as waking up earlier than normal or body rashes similar to eczema. In addition, treatment options need to be re-evaluated for effectiveness in clinical practice. For example researchers have found Wellbutrin, a commonly used anti-depressant medication, to actually be a very poor remedy for MDD patients. The health care system is grossly infatuated with medicinal methods of treatment; however, alternative methods need to be considered. Holistic healing such as restorative yoga, light therapy, acupuncture, consuming foods high in Vitamin D, Folate and Omega 3 fatty acids, and herbal supplements such as St. Johns Wort have all been proven methods of treating MDD. Although these methods are available, patients rarely know about alternative mechanisms. Major Depressive Disorder 10
Nurses must promote both alternative and traditional treatment option; ultimately, it is the patients choice of which avenue they wish to take.
Major Depressive Disorder 11
References Cheung, A. H., & Dewa, C. S. (2007). Mental health service use among adolescents and young adults with major depressive disorder and suicidality. The Canadian Journal Of Psychiatry / La Revue Canadienne De Psychiatrie, 52(4), 228-232. Dedovic, K. (2012). Psychological stress and vulnerability for major depressive disorder: Cortisol, brain structure, function, and cognitive processing in young adults. Dissertation Abstracts International, 72, Klein, D. N., Glenn, C. R., Kosty, D. B., Seeley, J. R., Rohde, P., & Lewinsohn, P. M. (2013). Predictors of first lifetime onset of major depressive disorder in young adulthood. Journal Of Abnormal Psychology, 122(1), 1-6. doi:10.1037/a0029567 Li, L., Ma, N., Li, Z., Tan, L., Liu, J., Gong, G., & ... Xu, L. (2007). Prefrontal white matter abnormalities in young adult with major depressive disorder: A diffusion tensor imaging study. Brain Research, 1168124-128. doi:10.1016/j.brainres.2007.06.094 Morris, B. H., Bylsma, L. M., & Rottenberg, J. (2009). Does emotion predict the course of major depressive disorder? A review of prospective studies. British Journal Of Clinical Psychology, 48(3), 255-273. doi:10.1348/014466508X396549 Sheets, E. S., Craighead, L., Brosse, A. L., Hauser, M., Madsen, J. W., & Craighead, W. (2013). Major Depressive Disorder 12
Prevention of recurrence of major depression among emerging adults by a group cognitive-behavioral/interpersonal intervention. Journal Of Affective Disorders,147(1-3), 425-430. doi:10.1016/j.jad.2012.08.036 Stoolmiller, M., Kim, H. K., & Capaldi, D. M. (2005). The Course of Depressive Symptoms in Men From Early Adolescence to Young Adulthood: Identifying Latent Trajectories and Early Predictors. Journal Of Abnormal Psychology, 114(3), 331-345. doi:10.1037/0021- 843X.114.3.331 Zarate, C. r. (2010). Psychiatric disorders in young adults: Depression assessment and treatment. In J. E. Grant, M. N. Potenza (Eds.) , Young adult mental health (pp. 206-230). New York, NY US: Oxford University Press.