Social Causes of Depression



Depression is one of the most prevalent psychological disorders. Depression can be caused by several factors, including interpersonal relationships. Interpersonal relationships are the relationship between individuals and the reactions and emotions of each individual expressed directly and discreetly to each other. Common interpersonal relationships include (a) within the family, such as between the parents and between parents and children; (b) the social environment where differences in ethnicity and social class come into play; and (c) interactions between genders across age groups for both females and males.



Many people suffer from depression at one point in their life. It is inevitable, the feeling of hopelessness, sorrow, or being alone. These are all common emotions associated with depression. For a select few, depression can be hard to overcome, and this is where depression becomes a disorder that requires active treatment. Those 'selected few' account for over 100 million people worldwide and result in 75% of all psychiatric hospitalizations. Yet the question remains, why did these people become depressed? How did they become depressed? One of the answers that lead to the cause of depression would be a person's interpersonal relationship with their surroundings and the people around them. There are many interpersonal instances that can have the ability to lead to the onset of depression, such as the family environment, the socialization setting, and the discrimination against gender in certain cultures and instances.



Family


One could argue that out of all the interpersonal cases that can contribute on the onset of a depressive disorder, the ambiance of a family has the most weight and impact on a depressed individual. In the case of spouses, the well being of one spouse will have a notable impact on the other spouse and on the welfare of their marriage. For example, in 30% of all marriage problems, there is one spouse that can be described as clinically depressed. The reason why a spouse might have a unipolar mood disorder could be due to their relationship being "characterized by friction, hostility, and a lack of affection".



Martial distress can also be caused by the impact of having a child. When a woman is pregnant, she can experience a whole range of emotions due to the changing of interpersonal relationship with husband and the building of a new relationship with the unborn child. For example, the building of a new interpersonal relationship with the child can be very tasking and become a major stressful life event that can cause a mood disorder to develop.



Aside from the martial distresses of spouses, the impact of depressed parents can have an effect on their children as well. In a study on the relation between depressed adolescences and depressed mothers, they found that the depressed children of depressed mothers had more negative interpersonal behavior as compared with depressed children of non-depressed mothers. This is reinforced when a study shows that the parents of depressed children are less warm and caring and more hostile than parents of non-depressed children. Because of this negative interpersonal relation between kids and their parents, children can develop a negative view of their family. This negative view can lead to the feeling of lack of control and having a high risk of conflict, rejection, and low self-esteem.



Cummings (1995) stated that any changes in a family environment due to parental depression increase the risk of developing a mood disorder in children. The result of this can be found as early as preschoolers and infants, due to the insecure attachment they develop with their parents. The emotional distress of children can also have an effect on their parents, causing depression that in turn will also affect the children, theoretically creating a never-ending cycle unless they seek treatment. Sometimes It is not the depressed parents that lead to the onset of depression in their children, but rather it is the change in the family environment that stems from the parents' depression that causes the children to become depressed. Some studies suggest that martial troubles are a better predicator for the onset of depression than the depression of the parents or the children themselves.



Experiencing depression while as a child or an adolescent can also lead to reoccurring slips as an adult. Depressed persons often perform poorly in marriage and relationship with family members and they also might respond negatively to others, which have the ability to create stressful life events, which as a result might drive the person further into depression. Depressed people are dependant on other people and constantly seek reassurance in such a way that drives people away. Hammen and Brennan (2001) found that 13% of the sons and 23.6 % of the daughters who were depressed had depressed mothers as compared to 3.9% of the sons and 15.9% of the daughters who were depressed lacked a depressed mother.



Many people believe that children and parents suffer differently from depression, but not so. Depressed children can be like depressed parents, expressing sadness, anger, shame, and self-directed hostility. Just like adults, depressed children tend to blame themselves for bad events and accredit the environment for good events--they do not give themselves credit when due. This is why oftentimes, children will feel guilty if their parents get divorced and they believe that they were at fault but realistically, it was the parents' martial distress that was the cause of the divorce, not the children's depressive mood disorder.



Socialization
As in the family environment, socialization is key to maintaining healthy relationship and feeling well deserved and part of someone's life. Depression can have an adverse effect on the social capacity of depressed persons, affecting their social functioning and ability to react and deal with stressful situations. Gotlib and Hammen (1992) discussed the social functioning of people with depressive disorders and found that people with the symptoms of depression are found to test low in social activities, close relationships, quality close relationships, family actives, and network contact, yet they test high in family arguments.



One major part in the development of mood disorders in a social setting would be how well one could deal with stressful events. Normally, this is called coping strategies and it allows a person to manage their troubles and not be overwhelmed. Oftentimes, people can become depressed when unable to deal with "drama" from their friends-especially in children. Depressed children reported significantly higher level of hopelessness, lower general self-esteem, and lower coping skills than non-depressed children. Their ability to be unable to cope with stress can lead to fewer and less adaptive coping techniques.



Social settings can also include one-on-one interactions and the rejection that occurs. In a study performed by Joiner, Alfano, and Metalsky (1992), they tested whether a depressed individual would have an affect on other people in one-on-one interactions and they found that affected people did have such an influence on other people. This influence could be described as responding negatively to their constant searching of reassurance and rejecting them, which in turn will "confirm" the affected person's belief that he or she is unworthy as a person.



A depressed individual can impact their social settings by exhibiting a lack of self-esteem, becoming more sensitive to the opinions of others, and more importantly (and interestly), become less physically active. This means that they will not want to go out, that they do not want to exert themselves. A prime example of this would be an athletic in school that becomes depressed. He does not want to participate in athletic activities because he is depressed, but his coach forces him to. As a result, he performs poorly, and his teammates heckle him for his poor performance. As an affected person, the athletic becomes overly sensitive to his teammates' heckling and his self-esteem plummets and he drops out of sports and begins to withdraw and fight with everybody he knows.



The social class can also have a subtle effect on depression. Brown and Harris (1978) reported that the females with children in the working class were more prone to depression than females with children in the middle class. This can be attributed to the working class mother having to leave home to work, having to leave her child alone. This interpersonal relation can cause excessive worry and guilt that the women is not being a good mother as compared to the middle class mom, who can afford to stay at home and take care of the children/her family.



Okazaki (1997) found that Asian Americans are more depressed in a social and academic setting because they have to face more pressure than their white American peers due to the fact that they are part of a visible minority that has different culture values than others. This interpersonal relationship between the two "cultures" can be defined as competitive and stressful due to the fact that in America, white people "have it made" while as other ethnic groups have to work twice as hard to get their foot in the door. This extreme indicator of stress can lead to the dejection of many ethnic groups because they might have failed at succeeding in a competitive environment.



Gender


There are a lot of interpersonal relations when it comes to gender, such as the discrimination against gender in an academic setting. This is very prominent in females, where girls can face increased expectations to conform to the standards set forth by society, to pursue feminine type activities and occupations. It appears that parents tend to have "lower expectations" for girls when it comes to school. As a result of that lowered expectations, parents tend to not push their daughters toward a high-profile job, instead attempting to make their daughter conform to the stereotype of society, like become a teacher or a nurse. In fact, in 1986-1987, women only garnered 15% of the bachelor's degrees awarded in engineering as compared to 76% and 84% for education and nursing, respectively.



Breaking the social norm can also lead to depression; the more intelligent a girl is, the more likely she is to become depressed. This positive correlation could be attributed to the more intelligent girls being able to out-perform the boys yet get punished for doing so. Being depressed as a female adolescent can have consequences in the long run in terms of social functioning, career, and enjoyment of life. Theoretically, if one were to be depressed in high school, then their grades would suffer. If their grades were to suffer, then their chances of entering a good college would dwindle. If they cannot enter a top-notch college, then they might not be able to get the career they want, and with that they would not be able to enjoy their job and feel like they have missed out on life.



The different experiences of each gender can also be the cause of a mood disorder. The experience can vary by the age of the children, adolescences, or adults. For example, after the age of 15, females are twice as likely to become depressed as compared with men and in another study of 11-year olds, only 2.5% males met the criteria for major depression while only 0.5% females met the criteria, however in a study of 14-16 year olds, 13% of the females met the criteria while 3% of the boys did. This abrupt rise of depressive disorders in females during the mid-to-late adolescence years can be attributed to the more concerns a girl has as compared to boys. These concerns and worries can range from their achievements or lack of, body dissatisfaction, sexual abuse, and low self-esteem.



This is reinforced when another study found that between the ages of 15-18, the prevalence of depression in girls will increase to twice the prevalence of boys (20.69 to 9.58) but will taper off during 18-21 years of age for both genders (15.05 and 6.58).



Do not be mistaken that females are the only gender that that can become depressed; a good number of males can develop a unipolar mood disorder. In the average lifetime, 49% of all males will experience a depressive episode (as compared with 63% of all females). Males will become sad and dejected for different reasons, such as intimate relationships. When an intimate relationship ends, males are more likely to become depressed at the loss than females. This could be attributed to the male's primal desire to have a mate so he will be able to continue his family name.



Depression has been around for a long time, spanning over thousands of years, dating back to the time of Saul I, yet even though Depression is a disorder that is hard to understand. Even with all the studies conducted, there is still not much to regarding the causes of depression. There are so many ways one would be able to become depressed, but the most common and most prevalent way thus far would be the interpersonal relationships of a person and their family, social lives, and the relationship between their gender and the discrimination they suffer at the hands of others. Perhaps a better understanding of those relationships can open up new avenues where new options for treatment can be conceived and new ways of interacting to people to create a equality amongst people where they will not feel depressed.



Main Causes of Depression

Some types of depression run in families, indicating that a biological vulnerability to depression can be inherited. This seems to be the case especially with bipolar disorder. Studies have been done of families in which members of each generation develop bipolar disorder. The investigators found that those with the illness have a somewhat different genetic makeup than those who do not become ill. However, the reverse is not true. That is, not everybody with the genetic makeup that causes vulnerability to bipolar disorder will develop the illness. Apparently, additional factors, possibly a stressful environment, are involved in its onset and protective factors are involved in its prevention.



Major depression also seems to occur in generation after generation in some families, although not as strongly as in bipolar I or II. Indeed, major depression can also occur in people who have no family history of depression.



An external event often seems to initiate an episode of depression. Thus, a serious loss, chronic illness, difficult relationship, financial problem, or any unwelcome change in life patterns can trigger a depressive episode. Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder.



Nothing in the universe is as complex and fascinating as the human brain. The over 100 chemicals that circulate in the brain are known as neurochemicals or neurotransmitters. Much of our research and knowledge, however, has focused on four of these neurochemical systems: norepinephrine, serotonin, dopamine, and acetylcholine. In the new millennium, after new discoveries are made, it is possible that these four neurochemicals will be viewed as the "black bile, yellow bile, phlegm, and blood" of the 20th century.
Different neuropsychiatric illnesses seem to be associated with an overabundance or a lack of some of these neurochemicals in certain parts of the brain. For example, a lack of dopamine at the base of the brain causes Parkinson's disease. Alzheimer dementia seems to be related to lower acetylcholine levels in the brain. The addictive disorders are under the influence of the neurochemical dopamine. That is to say, drugs and alcohol work by releasing dopamine in the brain. The dopamine causes euphoria, which is a pleasant sensation. Repeated use of drugs or alcohol, however, desensitizes the dopamine system, which means that the system gets used to the drugs and alcohol. Therefore, a person needs more drugs or alcohol to achieve the same high feeling. Thus, the addicted person takes more substance but feels less and less high.



The different types of schizophrenia are associated with an imbalance of dopamine (too much) and serotonin (poorly regulated) in certain areas of the brain. Finally, the depressive disorders appear to be associated with altered brain serotonin and norepinephrine systems. Both of these neurochemicals may be lower in depressed people. Please note that abnormalities of these neurochemicals are "associated with" instead of "caused by," because we really don't know whether low levels of neurochemicals in the brain cause depression or whether depression causes low levels of neurochemicals in the brain.



What we do know is certain medications that alter the levels of norepinephrine or serotonin can alleviate the symptoms of depression. Some medicines that affect both of these neurochemical systems appear to perform even better or faster. Other medications that treat depression primarily affect the other neurochemical systems. The most powerful treatment for depression, electroconvulsive therapy (ECT), is certainly not specific to any particular neurotransmitter system. Rather, ECT, by causing a seizure, produces a generalized brain activity that probably releases massive amounts of all of the neurochemicals.



Women are twice as likely to become depressed as men. However, scientists do not know the reason for this difference. Psychological factors also contribute to a person's vulnerability to depression. Thus, persistent deprivation in infancy, physical or sexual abuse, clusters of certain personality traits, and inadequate ways of coping (maladaptive coping mechanisms) all can increase the frequency and severity of depressive disorders, with or without inherited vulnerability.



The effect of maternal-fetal stress on depression is currently an exciting area of research. It seems that maternal stress during pregnancy can increase the chance that the child will be prone to depression as an adult, particularly if there is a genetic vulnerability. It is thought that the mother's circulating stress hormones can influence the development of the fetus' brain during pregnancy. This altered fetal brain development occurs in ways that predispose the child to the risk of depression as an adult. Further research is still necessary to clarify how this happens. Again, this situation shows the complex interaction between genetic vulnerability and environmental stress, in this case, the stress of the mother on the fetus.



What are the main factors that cause depression?
There are a number of factors that may increase the chance of depression, including the following:
  • Abuse. Past physical, sexual, or emotional abuse can cause depression later in life.

  • Certain medications. For example, some drugs used to treat high blood pressure, such as beta-blockers or reserpine, can increase your risk of depression.

  • Brain Chemistry Imbalance. Depression is believed to be caused by an imbalance in the neurotransmitters which are involved in mood regulation. Neurotransmitters are chemical substances which help different areas of the brain communicate with each other. When certain neurotransmitters are in short supply, this may lead to the symptoms we recognize as clinical depression.

  • Female Sex Hormones. It has been widely documented that women suffer from major depression about twice as often as men. Because the incidence of depressive disorders peaks during women's reproductive years, it is believed that hormonal risk factors may be to blame. Women are especially prone to depressive disorders during times when their hormones are in flux, such as around the time of their menstrual period, childbirth and perimenopause. In addition, a woman's depression risk declines after she goes through menopause.

  • Conflict. Depression may result from personal conflicts or disputes with family members or friends.

  • Death or a loss. Sadness or grief from the death or loss of a loved one, though natural, can also increase the risk of depression.

  • Genetics. A family history of depression may increase the risk. It’s thought that depression is passed genetically from one generation to the next. The exact way this happens, though, is not known.

  • Major events. Even good events such as starting a new job, graduating, or getting married can lead to depression. So can moving, losing a job or income, getting divorced, or retiring.

  • Other personal problems. Problems such as social isolation due to other mental illnesses or being cast out of a family or social group can lead to depression.

  • Physical conditions. Serious medical conditions like heart disease, cancer, and HIV can contribute to depression, partly because of the physical weakness and stress they bring on. Depression can make medical conditions worse, since it weakens the immune system and can make pain harder to bear. In some cases, depression can be caused by medications used to treat medical conditions.

  • Poor Nutrition. A poor diet can contribute to depression in several ways. A variety of vitamin and mineral deficiencies are known to cause symptoms of depression. Researchers have also found that diets either low in omega-3 fatty acids or with an imbalanced ratio of omega-6 to omega-3 are associated with increased rates of depression. In addition, diets high in sugar have been associated with depression.

  • Personality. People who have low self-esteem, who consistently view themselves and the world with pessimism or who are readily overwhelmed by stress, are prone to depression. Whether this represents a psychological predisposition or an early form of the illness is not clear.

  • Substance abuse. Nearly 30% of people with substance abuse problems also have major or clinical depression.



Sources and Additional Information:

Types of the Depression-Related Mood Disorders

Depression is a form of what is known as a mood or affective, disorder, because it is primarily concerned with a change in mood.



Depression is a very complex illness. No-one really knows for certain what causes depression, and everyone's experience of depression is different.



Depressive disorders come in different types, just as is the case with other illnesses such as heart disease. When a psychiatrist makes a diagnosis of a patient's depressive illness, he or she may use a number of terms--such as bipolar, clinical, endogenous, major, melancholic, seasonal affective or unipolar--to describe it. These labels confuse many people who don't understand that they can overlap. People with depressive illness may also receive more than one diagnosis since the illness is often linked with other problems, such as alcoholism or other substance abuses, eating disorders, or anxiety disorders.



Depression can also categorize in the following manner - (1) - Depression that is originating from a bad or disturbing event in your life and (2) - Depression which appears without apparent cause - the most common. The first type of depression is easier for you to tackle because the cause is known. The first step is to deal with the event that triggered your depression. It may have started as a result of a death, an accident, a divorce or any other type of setback. The second type of depression is more difficult to deal with as the source is unknown. It is the most common form of depression.



Getting proper help for different types of depression begins with a proper diagnosis. There are several different diagnoses for depression, mostly determined by the intensity of the symptoms, the duration of the symptoms, and the specific cause of the symptoms, if that is known.



For 20 percent to 35 percent of depressed people, a normal routine is all but impossible. Others have episodes of depression followed by feelings of well-being. Still others have episodes of terrible lows that alternate with inappropriate "highs." Here are some descriptions of the most common forms of depression.



Major Depression : Major depression is probably one of the most common forms of depression. You probably know a handful of people who suffer from it. The sufferer seems to walk around with the weight of the world on his or her shoulders. He or she seems disinterested in becoming involved in regular activities and seems convinced that he or she will always be in this hopeless state. There is a lack of interest in sexual activity and in appetite and a weight loss.



Atypical Depression : Atypical depression is a variation of depression that is slightly different from major depression. The sufferer is sometimes able to experience happiness and moments of elation. Symptoms of atypical depression include fatigue, oversleeping, overeating and weight gain. People who suffer from atypical depression believe that outside events control their mood (i.e. success, attention and praise). Episodes of atypical depression can last for months or a sufferer may live with it forever.



Psychotic Depression: Sufferers of psychotic depression begin to hear and see imaginary things - - sounds, voices and visuals that do not exist. These are referred to as hallucinations, which are generally more common with someone suffering from schizophrenia. The hallucinations are not "positive" like they are with a manic depressive. The sufferer of psychotic depression imagines frightening and negative sounds and images.



Dysthymia: Many people just walk around seeming depressed - - simply sad, blue or melancholic. They have been this way all of their lives. This is dysthymia - - a condition that people are not even aware of but just live with daily. They go through life feeling unimportant, dissatisfied, frightened and simply don't enjoy their lives. Medication is beneficial for this type of depression.



Manic Depression (also known as Bipolar Disorder): Manic depression can be defined as an emotional disorder characterized by changing mood shifts from depression to mania which can sometimes be quite rapid. People who suffer from manic depression have an extremely high rate of suicide.



Cyclothymic Disorder: Cyclothymia is a milder form of manic depression, characterized by hypomania (a mild form of mania) alternating with mild bouts of depression.



Unipolar Depression: This lowered mood may vary slightly throughout the day but the sufferer cannot usually be cheered up, and this is the major distinction between simply being unhappy and being clinically depressed. Unipolar depression is another name for the major depressive disorder. This term is used to distinguish it from depression which occurs within the context of of bipolar disorder, a disorder in which a person experiences alternating periods of depression and mania.



Post Partum Depression: Major depressive episode that occurs after having a baby. Depressive symptoms usually begin within four weeks of giving birth and can vary in intensity and duration.



Seasonal Affective Disorder (SAD): A type of depressive disorder which is characterized by episodes of major depression which reoccur at a specific time of the year (e.g. fall, winter). In the past two years, depressive periods occur at least two times without any episodes that occur at a different time.



Anxiety Depression: Not an official depression type (as defined by the DSM). However, anxiety often also occurs with depression. In this case, a depressed individual may also experience anxiety symptoms (e.g. panic attacks) or an anxiety disorder (e.g. PTSD, panic disorder, social phobia, generalized anxiety disorder).



Chronic Depression: Major depressive episode that lasts for at least two years.



Double Depression: Someone who has Dysthymia (chronic mild depression) and also experiences a major depressive episode (more severe depressive symptoms lasting at least two weeks). See above for definitions of these two categories of depression.



Endogenous Depression: Endogenous means from within the body. This type of depression is defined as feeling depressed for no apparent reason.



Situational Depression or Reactive Depression (also known as Adjustment Disorder with Depressed Mood): Depressive symptoms developing in response to a specific stressful situation or event (e.g. job loss, relationship ending). These symptoms occur within 3 months of the stressor and lasts no longer than 6 months after the stressor (or its consequences) has ended. Depression symptoms cause significant distress or impairs usual functioning (e.g. relationships, work, school) and do not meet the criteria for major depressive disorder.



Agitated Depression: Kind of major depressive disorder which is characterized by agitation such as physical and emotional restlessness, irritability and insomnia, which is the opposite of many depressed individuals who have low energy and feel slowed down physically and mentally.



Psychotic Depression: Major depressive episode with psychotic symptoms such as hallucinations (e.g. hearing voices), delusions (false beliefs).



Melancholic Depression (Sub-type of Major Depressive Disorder): Main features of this kind of depression include either a loss of pleasure in virtually all activities or mood does not temporarily improve in response to a positive event.



Catatonic Depression (Sub-type of Major Depressive Disorder): This type of depression is characterized by at least two of the following: Loss of voluntary movement and inability to react to one's environment; Excessive movement (purposeless and not in response to one's environment); Extreme resistance to instructions/suggestions or unable/unwilling to speak; Odd or inappropriate voluntary movements or postures (e.g. repetitive movements, bizarre mannerisms or facial expressions); Involuntarily repeating someone’s words or movements in a meaningless way.



Sources and Additional Information:

Rehabilitation Research Depression Questionnaire

Depression is often hard to recognize. Depression can express itself in more than a dozen ways and no two people will necessarily have the same kind of experiences of symptoms. Surprisingly, you don’t even have to be sad to be depressed! Because depression develops slowly, people just kind of slip into it.



 
One way to help determine if you need a formal evaluation is to take the Depression Questionnaire shown below. Examine each statement, and mark “T” if the statement applies to you and “F if it does not. When you have completed the questionnaire, give yourself one point for each “T” you chose. Scores totaling 1 to 5 indicate normal responses to everyday life. Scores from 6 to 10 indicate a moderate degree of depression that can affect health, functioning and outlook. Scores higher than 10 indicate a possible major depressive problem that is severely affecting daily life and health.



 If you score above 6, and definitely if you score above 10, you should make an appointment with your primary care provider, a psychologist or psychiatrist and discuss the problem. They can also make arrangements for tests to make sure you’re not suffering from something else (like an under-active thyroid or an infection). After that, treatment can be started and you can begin feeling better soon.



1. My daily life is not interesting (T or F).



2. It is hard for me to get started on my daily chores and activities (T or F).



3. I have been more unhappy than usual for at least a month (T or F).



4. I have been sleeping poorly for at least the last month (T or F).



5. I gain little pleasure from anything (T or F).



6. I feel listless, tired, or fatigued a lot of the time (T or F).



7. I have felt sad, down in the dumps, or blue much of the time during the last month (T or F).



8. My memory or thinking is not as good as usual (T or F).



9. I have been more easily irritated or frustrated lately (T or F).



10. I feel worse in the morning than in the afternoon (T or F).



11. I have cried or felt like crying more than twice during the last month (T or F).



12. I am definitely slowed down compared to my usual way of feeling (T or F).



13. The things that used to make me happy don’t do so anymore (T or F).



14. My appetite or digestion of food is worse than usual (T or F).



15. I frequently feel like I don’t care about anything anymore (T or F).



16. Life is really not worth living most of the time (T or F).



17. My outlook is more gloomy than usual (T or F).



18. I have stopped several of my usual activities (T or F).



19. I cry or feel saddened more easily than a few months ago (T or F).



20. I feel pretty hopeless about improving my life (T or F).



21. I seem to have lost the ability to have any fun (T or F).



22. I have regrets about the past that I think about often (T or F).





Total Number of True Answers:    ______

Physician Depression Questionnaire (PDQ-9)

This questionnaire consists of several statements. Read each statement carefully, then pick the number that best describes the way you have been feeling during the past two weeks, including today. See the Table below for interpreting your score.



Over the last 2 weeks, how often have you been bothered by any of the following problems?
                                                                                                                                   
  1. Little interest or pleasure in doing things.      

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Feeling down or depressed.

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Trouble falling or staying asleep, or sleeping too much.  

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Feeling tired or having little energy.

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Poor appetite or overeating.

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Feeling bad about yourself - or that you are a failure or have let yourself or your family down.

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Trouble concentrating on things, such as reading the newspaper or watching television.

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual.

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
  1. Thoughts that you would be better off dead or of hurting yourself in some way.

§         Not at All                                           0
§         Several Days                                      1
§         More than half the days                     2
§         Nearly every day                                3
                                                                                                                                   
Total Score
Interpreting PDQ-9 Scores:

This questionnaire estimates the overall severity of depression experienced by the patient according to the categories shown in the table below. If you scored in the 10-14 range, you should probably seek treatment. If you scored a 15 or higher, seeking treatment is strongly recommended.



Raw score     Range of severity                                             
0-5                  Not Present
5-9                  Minimal symptoms of depression reported
10-14              Moderate symptoms of depression reported
15-19              Moderately Severe symptoms of depression reported
20-27              Severe symptoms of depression reported



What is Depression?

The word "depression" causes much confusion. It is often used to describe when someone is feeling "low", "miserable", "in a mood", or having "got out of bed on the wrong side". However, doctors use the word in two different ways. They can use it to describe the symptom of a "low mood", or to refer to a specific illness, i.e. a "depressive disorder".



Officially, there are two definitions of the depression, reflecting the two approaches highlighted above:
  1. The condition of feeling sad or despondent.

  2. A psychiatric disorder characterized by an inability to concentrate, insomnia, loss of appetite, anhedonia, feelings of extreme sadness, guilt, helplessness and hopelessness, and thoughts of death. Also called clinical depression.

This confusion is made all the worse because it is often difficult to tell the difference between feeling gloomy and having a depressive illness. Doctors make a diagnosis of depression after assessing the severity of the low mood, other associated symptoms and the duration of the problem. 


Depression is very common. Almost anybody can develop the illness; it is certainly NOT a sign of weakness. Depression is also treatable. You may need to see a doctor, but there are things you can do yourself or things you can do to help somebody suffering from the illness. What you cannot do is 'PULL YOURSELF TOGETHER' - no matter whether this is what you think you should be able to do, or what other people tell you to do. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.



People who have experienced an episode of depression are at risk of developing another in the future. A small proportion may experience an episode of depression as part of a bipolar affective disorder (manic depression) that is characterized by episodes of both low and high moods.



As any illness, especially psychiatric disorder, depression affects not just the person, its personal life and professional activities, and influences its family and loved one as well. Therefore, understanding and accepting the disorder as a matter of fact is essential for all the family members. By applying unprofessional irresponsible pressure on the person, you can make matter much worse and let the “enemy inside” grow out of proportions and abilities to apply the adequate treatment. Note that prompt medical treatment might stop or even reverse the disease development, while lack of proper response might lead to the most severe health conditions.



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