ABSTRACT “DEPRESSION IS A MEDICAL CONDITION”: EXPLORING THE MEDICALIZATION OF DEPRESSION ON SSRI WEBSITES Sociologists of medicine have become increasingly interested in mental health over the last two decades (Pilgrim and Rogers, 2005). Known as the “common cold” of mental illness, depression affects millions around the globe. The social understanding of depression has been shaped by a phenomenon known as medicalization, where an unusual behavior or state of being is labeled illness or disorder or disease, and addressed through rationalized medical intervention. The medicalization of depression is particularly evident on SSRI websites. SSRIs (Selective Serotonin Reuptake Inhibitors) are a popular class of antidepressants used to treat depression. Pharmaceutical companies who manufacture these medications now advertise their products on the Internet, an increasingly popular source for health information. This thesis is a critical, empirical investigation of the medicalization of depression on SSRI websites. Five major research questions guide this study. First, how is depression portrayed on the websites? Second, what are the means used to construct this portrayal? Third, who is the apparent target audience? Fourth, what assumptions are made about this audience? Finally, what is absent from or silent in the websites? These questions are answered using an analytical framework called Critical Discourse Analysis (CDA). This framework is both a theoretical orientation and a methodological process (Fairclough, 1992). This study reveals that medicalization has a strong impact on the portrayal of depression on the websites, and is the major perspective from which the issue is approached. The depressed person is seen to be affected by depression in a variety of ways, including being ill with a medical condition and at risk for further difficulty if treatment is not handled properly. A variety of means are used to construct the portrayal of depression, including structural means such as interactional controls, linguistic means such as word choices and meanings, and visual means such as the use of diagrams and caricatures. Embedded in the text are a number of indicators which highlight some apparent assumptions about the targeted audience, such as insurance coverage and general literacy. Absences or silences in the texts include a failure to discuss the prevention of depression. The most significant finding concerns “the symptom/side-effect” problem; this dilemma highlights the lack of clarity around definitions of recovery and mental health as well as the purpose of taking medications. It also reveals that, while the application of the medicalized perspective to depression is certainly useful given the efficacy of antidepressant drugs for many people, it is not infallible and requires careful critical consideration.

Abstract Cognitive theories of emotional disorders predict that individuals suffering from an emotional disorder exhibit increased interference for stimuli that are idiosyncratic to their disorder (Williams, Mathews, & MacLeod, 1996). However, due to inconsistent results, there is debate as to whether attention disrupting effects for negative information occur in depression. Suitability of experimental stimuli employed to elicit attentional biases is a commonly cited limitation that may have contributed to these inconsistencies. The present investigation was designed to examine the influence of rumination on the operation of attentional biases in depression using a digit-parity task. Depressed and never-depressed participants were required to make a speeded judgement about the parity of two digits flanking a to-be-ignored centrally presented word. Depressed individuals displayed longer digit-parity response times for depression-relevant words relative to never-depressed individuals. Furthermore, depressed individuals displayed the longest digit-parity response times for word stimuli relevant to the idiosyncratic content of their ruminative thoughts. These findings highlight the importance of studying the idiosyncratic content of each depressed individuals ruminative themes when investigating attentional biases within this population.

Pregnancy is often portrayed as a happy time for the woman and her family. In reality, many women struggle with negative emotions and moods that can have deleterious effects on the mother, the fetus, and the growing family. Depression is an increasing, worldwide problem, with women in their childbearing years and those of low socioeconomic status the most vulnerable. <p>This study explores depression, as determined by the Edinburgh Postnatal Depression Scale (EPDS), in a high-risk sample of pregnant women enrolled in two prenatal programs in Saskatoon, Saskatchewan, Canada. A prevention and population health approach has been used to identify potential determinants and implications of antenatal depression. The data analyzed in this study were from the first cross-sectional portion of a longitudinal, epidemiological study of depression in pregnancy into the postpartum. Women were invited to participate in the study at their first prenatal visit. Data were collected by program staff. <p>The prevalence of depression in this sample of 402 high-risk women was 29.5%, which is similar to other studies of inner-city, low income, and minority women elsewhere in the world. In the final model, antenatal depression was associated with a history of depression, moods going up and down, current smoking status, high levels of stressors, and social support.<p>Factor analysis of the EPDS revealed three underlying factors: Anxiety, Depression, and Self-harm thoughts. The anxiety factor explained most of the variance in the overall EPDS scores in this sample of women. A history of problems with mood fluctuations was significantly associated with anxiety and depression subscales and self-harm. Significantly more women aged 21 and under experienced anxiety, and more Aboriginal women experienced depressive symptoms and self-harm thoughts. Twenty percent of women reported self-harm thoughts in the preceding seven days. Depressed, Aboriginal, and single women, and women who use alcohol were most at risk for self-harm thoughts. <p>The level of depressive symptoms in this sample of women represents a significant public and mental health problem in women already challenged by inequities in their life circumstances. We need to develop public health policy that will support screening and identification of women with depression. Interventions at the primary, secondary, and tertiary levels of prevention can help to improve the health of women struggling with antenatal depression, promote the optimal intrauterine environment for their unborn children, and reduce the intergenerational transmission of depression.

Objective: The aim of this study was to study the prevalence of depression among patients with arrhythmia, and to investigate if there was any gender difference in the study population regarding depression. Furthermore, differences considering depressive symptoms between patients with arrhythmia and the general population were to be investigated. Method: The self-rating scale MADRS-S was distributed during two weeks to 24 patients with arrhythmia. Twenty-one patients completed the study. Results: 28.5 % of the participants showed symptoms of some level of depression. No one was considered as severe depressed. No significant difference was seen between genders. Comparison between participants and the general population was not possible to investigate. Conclusion: The results of this study show that depressive symptoms appears in 28.5 % of the patients with arrhythmia. More research is needed regarding gender differences and differences between this patient group and the general population in this subject. / Syfte: Syftet med föreliggande studie var att kartlägga förekomst av depression bland patienter med arytmiproblem på en vårdavdelning, samt att se om det förelåg någon skillnad mellan män och kvinnor i studiepopulationen gällande depression. Vidare avsågs även skillnader gällande depression mellan studiepopulationen och normalbefolkningen att undersökas. Metod: Självskattningsformuläret MADRS-S delades ut under två veckor  till 24 patienter med arytmi på en kardiologisk vårdavdelning. Tjugoen patienter fullföljde studien. Resultat: 28,5 % av deltagarna uppvisade symtom på någon grad av depression. Ingen av deltagarna ansågs dock ha svår depression. Ingen signifikant skillnad kunde ses mellan könen. Jämförelse mellan studiepopulationen och normalbefolkningen gällande depression gick inte att utföra. Slutsats: Resultatet av denna studie visar att depressiva symtom förekommer hos 28,5 % av patienter med arytmi på avdelning. Mer forskning behövs gällande skillnad mellan män och kvinnor samt mellan studiepopulationen och normalbefolkningen i denna fråga.

Depression är idag ett av de största folkhälsoproblemen. Antalet insjuknade i depression ökar ständigt. Ungefär 25 % av alla kvinnor och 15 % av alla män beräknas någon gång få en depression som kräver behandling. Som sjuksköterskor kommer vi i vården att möta patienter med depression och för att kunna ge en så adekvat vård som möjligt behövs kunskap om hur patienten upplever sin situation och vården som erhålls. Ges inte rätt och passande behandling finns risk för försämring. Syftet med studien var att belysa patienters upplevelse av vård vid depression. Studien utfördes som en litteraturstudie där elva kvalitativa artiklar valdes ut till att ingå i resultatet. Resultatet påvisade att patienterna upplevde stöd som en betydelsefull faktor i vården. I de fall där patienterna mötte personal som var oförstående upplevde patienterna sig kränkta och hade svårare att acceptera sjukdomen och ta till sig behandlingen. Patienterna ansåg att en anpassad och tillräcklig information var av stor vikt för att kunna hantera sin depression. Information innebar även att patienten kunde vara delaktig i beslutsprocessen och ta kontroll över situationen. Vidare forskning inom området hade varit önskvärd för att kunna utveckla vårdarbetet och för att kunna möta patienterna på bästa sätt.

The purpose of this thesis was to investigate how spirituality and religion could serve as a protective factor for depressed elderly (65 and older) who are victims of abuse. The review was carried out using scientific articles found through searches of various scientific databases with no limitation date.   Results found no studies which investigated that relationship across developed countries and especially not in the European context. However, the review gave some indications that spirituality might serve as an asset for depressed elderly. In addition the study found that professionals working with abused elderly should encourage them to be involved in spiritual actions and discussions. Studies on what role spirituality can influence and improve coping strategies across abused elderly are urgently needed in order to improve interventions aimed to curb the ever growing problem of elderly abuse.

Sammanfattning Syfte: Att utifrån litteratur beskriva hur patienter som drabbats av Poststroke Depression (PSD) upplever sin livskvalitet. Design: Beskrivande litteraturstudie. Metod: Litteratur söktes i databaserna PubMed och CINAHL, som publicerats mellan 2002-2012. Resultatet baseras på 13 vetenskapliga artiklar.   Resultat: Livskvalitet kan ses ur två dimensioner, psykiskt och fysiskt. Då livet förändras inom dessa dimensioner efter en stroke, kan detta påverka hur individen upplever sin livskvalitet. Patienter som drabbas av PSD kan uppleva en sämre livskvalitet, då de kan uppleva minskad fysisk aktivitet, liksom nedsatt funktionsförmåga och minskad självständighet i utförandet av aktiviteter i dagliga livet (ADL). Minskningen av aktivitetsnivån kan innebära att individen mer sällan deltar i sociala aktiviteter och/eller fritidsaktiviteter, vilket kan resultera i en form av isolering. Kommunikationsnedsättningar är en annan aspekt som kan leda till att individen undviker deltagande i aktiviteter då denne kan uppleva begränsningar i vardaglig kommunikation. Upplevelsen att ha reducerat socialt liv visar på starka samband med upplevelsen av sämre livskvalitet. Socialt stöd från exempelvis vårdpersonal, har däremot visat sig bidra till förhöjd upplevelse av livskvalitet. Slutsats: PSD leder ofta till att individer upplever sämre livskvalitet, inom både den psykiska och fysiska dimensionen. Det är viktigt att sjuksköterskan exempelvis, informerar patienten om rehabiliteringens betydelse samt ger individspecifik omvårdnad utifrån dennes intressen. / Abstract Aim: The aim was to, through literature describe how patients, who are suffering from Poststroke Depression (PSD) experience their quality of life (QOL). Design: A descriptive literature study. Method: Literature published during the period 2002-2012 were searched in the databases PubMed and CINAHL. The litetature study is based on 13 scientific articles.  Results: QOL can be approached in two dimensions, mentally and physically. When life changes within these dimensions after stroke, this can affect how individuals experience their QOL. Patients who developes PSD can experience a poorer QOL, since these patients could experience reduced physical activity, as well as reduced mobility and decreased independence in performing activities of daily living (ADL). This decrease in activity level may lead to, that the individuals are less likely to participate in social activities and/or sparetime activities, which can result in a form of isolation. Communication reductions are another aspect that can lead to that these individuals avoid participating in activities, since they may experience limitations in daily communication. The experience of having reduced social life shows a strong connection to the experience of poorer QOL. Social support from health professionals, for example, has been shown to contribute to an increased experience of QOL. Conclusion: Patients suffering from PSD often experience poorer QOL, in both the mental and the physical dimension. A matter of great importance is that nursing is performed after the patient’s personal needs and interests and that patientes are given proper information about the inpact of rehabilitation and its effects on the recovery phase.

Previous literature has shown that depression is the most common major emotional result following a stroke. Although the prevalence and severity of this issue have been well documented, limited research has been done to identify the evolution of post-stroke depressive symptoms in the acute phase following a stroke. During this period of time, the patient is faced with a number of significant changes from his / her previous level of functioning. These issues can include loss of physical functioning, loss of independence, changes in living arrangements, and an increased reliance on the support and care of others. The purpose of the current study was to examine fluctuations in depressive symptoms as each participant progressed through rehabilitation and discharge, and to gather qualitative information pertaining to the contributing factors that could play a role in this issue. A sample of nine participants between the ages of 50 and 85 was obtained from a regional rehabilitation unit. Data and clinical information were collected using an intensive case study design. Participants were asked to complete the Geriatric Depression Scale (GDS) at three-day intervals while on the rehabilitation unit and following discharge. This information was interpreted in the context of qualitative information gathered through reports from the participant, his or her significant other / family member, nursing and professional staff members on the rehabilitation unit, and patient records. Other analyses performed included an examination of the interactions between performance and motivation during the rehabilitation process and role of discharge site in the development and course of depressive symptoms. When examined as a whole, the information collected across all nine participants would suggest that following discharge there was a statistically significant increase in the level of post-stroke depressive symptoms. While the individuals were on the rehabilitation unit, the depressive symptoms decreased significantly and this trend continued following discharge, but the slope was not as significant as that which was observed on the rehabilitation unit. The results also suggested that there is a significant difference between the progression of depressive symptoms between groups separated based on discharge site.

Although researchers are now able to assess reliably the variable of existential meaning, quality longitudinal investigations of meaning's relationship with specific clinical variables are scarce. The author conceptualizes existential meaning as a composite of personal, spiritual, and implicit meaning. These latter three variables are, respectively, the experience of one's particular life as having purpose and coherence, experiencing a transcendent or spiritual presence from which one derives a sense of unique purpose, and manifesting attitudes and behavior that are normatively valued. Utilizing a sample of 395 male and female undergraduates and employing the framework subscale of the Life Regard Index-Revised (LRI-R-framework), the Spiritual Meaning Scale (SMS), and the Personal Meaning Profile (PMP) to measure personal, spiritual, and implicit meaning, respectively, the author explored existential meaning's relationship over time with depressive symptoms (as measured with the Beck Depression Inventory-II, depression scale of the Depression Anxiety Stress Scales, and depression scale of the Personality Assessment Inventory) and hope (as measured with the Herth Hope Scale, the Adult State Hope Scale, and the Beck Hopelessness Scale). A latent cross-lagged panel analysis of the relationship between meaning and depression over 2 one-month time periods indicated that meaning exerted unidirectional influence on depression, with decreases in meaning leading to increases in depressive symptoms. Additionally, hierarchical regression analysis showed that individuals with low levels of existential meaning were more likely than those with higher meaning levels to experience increased symptoms of depression in response to increased stress levels. Because the newly developed SMS (appended to this paper) was the only meaning measure exhibiting sufficient discriminant validity with regard to hope, only the SMS was entered in cross-lagged panel analysis measuring its relationship to hope over the 2 one-month periods of time, with results indicating that spiritual meaning and hope reciprocally influence one another. Existential meaning seems appropriately conceptualized as a construct consisting of personal, spiritual, and implicit components. Because this construct can be assessed reliably and may play a role in the etiology and alleviation of depressive symptoms, the author calls for increased research within clinical settings on methods for optimizing individuals' levels of existential meaning.

As the average age of the population in the United States gets older each year, the problem of depression has been recognized as a chronic problem that affects the quality of life and mental health of many of our nation's elderly. Widowed females, who represent the largest segment of older adults, are particularly at risk for suffering from depression in their elder years. One of the primary difficulties in treating depression in this population is lack of understanding of the factors that contribute to its etiology, in the context of an environment which restricts development of social relationships and limits resources for treatment of depression symptoms. This study examined the reported levels of interpersonal intimacy, depression and the personality characteristics of introversion or extroversion, and examined the relationship between the three factors. Results indicated that, with this study sample (N=99), 23.2% of the sample met cut-off scores indicating depression. Overall, the participants reported being satisfied with their current level of intimacy in relationships; however those who also reported being depressed were less likely to be satisfied. Likewise, those participants who were depressed were more likely to be in the introvert group of personality characteristics. There was no significant relationship established between satisfaction with intimacy and the personality traits. The study showed that the variables examined, including some demographic variables, were correlated, but more work and a larger sample is needed to allow the variables to be used for the purpose of prediction of depression or satisfaction with intimacy in this population.