Exam 6: Understanding Mood, Anxiety, and Personality Disorders

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Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems may become chronic, thereby leading to substantial impairments in an individual's ability to take care of his or her everyday responsibilities. The factors that predispose an individual to depression can be broken down into demographic, social, and psychosocial factors and seasonal, geographic, and dietary factors.
Depression has been found to be approximately two times more common among women than men in almost all epidemiological studies on the prevalence and incidence of unipolar major depression. This gender difference unravels in early adulthood, becomes most pronounced in people between the ages of 30 and 45, and continues to persist in the elderly population. Among people younger than 45 years, depressive disorders show much higher lifetime prevalence. However, the age of onset differs between familial and nonfamilial cases.
The average age of onset of recurrent unipolar major depressive episode falls between the ages of 30 and 35 years, whereas single-episode major depression that often lacks a family history of mood disorders usually begins some years later. Because it is a frequent and highly recurrent illness, the probability of recurrence of major depressive disorder does not decrease with age.
It is well accepted that cultural differences may color the clinical presentation of depression, often leading to unreliable statistics in prevalence studies performed by standard methodology. Recent research has found that, after controlling for demographic factors, Asian Americans and Hispanic Americans have a significantly lower lifetime prevalence of unipolar depressive disorders.
Marital status and mood disorders have a very complicated relationship. For instance, being single, divorced, or separated can be both a risk factor for depression and the outcome of undesirable life events set into motion by depressive disorders. Major depressive disorders are most frequent among divorced, separated, or widowed individuals. Single females have lower rates of depression than married women, but for men the opposite holds true. The risk of a major depressive episode is quite high among recently widowed individuals across all ages but particularly so for the elderly.
Despite being well documented, the relationship between depressive symptoms and low social class is only supported by a weak correlation. Individuals with lower socioeconomic status consistently have lower levels of education, income, and living conditions, coupled with higher rates of unemployment. Just as in the case of marital status and mood disorder, there is a possibility that cause and effect may be reversed here. Mood disorder could easily lead to unemployment, divorce, or low income, resulting in a downward slide on the social ladder.
Two of the most important psychosocial factors that can have a major role in influencing and precipitating depressive episodes are social stressors and social support. Social stressors have been well documented as risk factors for mood disorders. The type of a stressor (acute versus chronic, positive life event versus negative life event, etc.) can play an important role in influencing and precipitating depressive disorders. In the genesis of mood disorders, chronic stressors (e.g., physical disability or difficult marital situation) play a more significant role than acute stressors. That said, the strongest predisposing factor is an accumulation of stressful negative life events. More important than an event is the subjective perception of that event by the individual. Acute positive events can also precipitate major depression.
Social support can help improve coping and temper the occurrence of psychosocial stressors or their unpleasant outcomes. Research has consistently shown that living alone, having low socioeconomic status, and being unemployed are important risk factors for mood disorders. A weak or nonexistent social support system can also be considered a major risk factor.
Depression can be seen across all age groups and in all populations. However, there are certain population groups that deserve special mention, either because the manifestations of depressive illnesses in these populations have unique features or because the prognosis of depression in those groups is more guarded.