Bakgrund:  Ungdomar som utvecklar depression i tonåren har en ökad risk att utveckla kroniska psykiska sjukdomar i vuxen ålder. Depression karaktäriseras av nedstämdhet och kan visa sig på flertalet sätt beroende på vilken ålder personen befinner sig i. Ungdomstiden och framförallt puberteten är präglad av psykiska, fysiska och kroppsliga omställningar som kan påverka personens mående. Syfte: Belysa barn och ungdomars erfarenhet av depression i åldrarna 12-25 år. Metod: Kvalitativ litteraturstudie. Resultat: Resultatet kategoriserades i fyra teman: copingmekanismer, stigmatisering, behov av stöd och emotionell smärta. Resultatet visade att hos ungdomar som utsätts för icke hanterbara krav och familjeproblematik kunde det generera i psykisk ohälsa och leda till depression. Slutsats: Att utvecklas från att vara tonåring till att bli vuxen kan medföra en känslomässig storm och en psykisk påfrestning för den enskilde och dennes omgivning. Ungdomar söker sällan hjälp i tid. Klinisk betydelse: Litteraturstudien kan bidra med hur hälso- och sjukvårdspersonal bättre kan bemöta barn och ungdomar med depression samt förhindra att sjukdomsprocessen blir längre och orsakar ett större lidande för den drabbade. Nyckelord: depression, erfarenhet, kvalitativ forskning, ungdomar / Background: Young people who suffer from depression in adolescence are at increased risk of developing chronic mental disorders in adulthood. The period of youth and particularly adolescence is characterized by mental, physical and bodily changes that may affect the person's mood. Depression is characterized by depressed mood and can appear in several different ways depending on the people’s age. Aim: Illustrate children's and young people's (aged 12-25 years) experience of depression. Method: Qualitative literature review. Results: The results were categorized into four themes: coping, stigmatization, support needs and emotional pain. The results showed that adolescents who are exposed to non-manageable demands, family problems could generate in mental illness and lead to depression. Conclusion: To evolve from being a teenager to being an adult can cause an emotional storm and psychological distress for the individual and his surroundings. Young people rarely seek help in time. Clinical significance: The literature study can contribute to how health professionals can better respond to children and adolescents with depression and prevent for disease process to become longer and causing greater suffering for the afflicted. Keywords: adolescent, depression, experience, qualitative research

By 2020 depression is predicted to be the second most frequent cause of disability worldwide. Research suggests that existing methods of treatment are ineffective for many resulting in a large number of chronic, treatment resistant courses (termed refractory depression [RD]). Further evidence suggests that up to 60% of individuals with RD have a co-morbid Personality Disorder (PD), namely Clusters A and C. As such, it has been proposed that individuals with RD fail to respond to existing treatment interventions because these treatments fail to address maladaptive personality styles (i.e., overcontrol tendencies) that may complicate treatment. This project aimed to test this novel assertion by examining whether individuals with RD exhibit higher levels of overcontrol (e.g., skills deficits in the expression and experience of emotion, in forming close relationships and in receptivity and openness) compared to individuals with current, but not chronic, depression and a normal control group. A total of 180 individuals were recruited and based on eligibility criteria were allocated to the following groups: RD, n = 56; acute, non-chronically depressed (ANCD), n = 61; normal control (NC), n = 63. Participants completed a series of self-report questionnaires and as a whole, between group analyses supported study predictions; individuals with RD displayed significantly higher levels of overcontrol compared to both the ANCD and NC groups. More specifically, individuals with RD demonstrated significantly more difficulties with interpersonal relationships and expressing emotions, a significantly greater need for structure and significantly higher levels of maladaptive perfectionism compared to controls. This study forms part of a large multi-centre randomised controlled trial (RCT; REFRAMED) that is designed to study the efficacy of a novel treatment intervention - Radically Open-Dialectical Behaviour Therapy – for individuals with RD.

Depressionssjukdomar är en ökande sjukdomsbörda som idag omfattar 340 miljonermänniskor världen över och beräknas till att vara den näst största år 2020.Upplevelsen av fenomenet depression beskrivs som en emotionell kamp kopplad tillomvärldens tyckande och där utanförskap, nedstämdhet och skam är dominerandekänslor i personens liv. Sjuksköterskans vårdprofession utgör ett viktigt stöd i och hosomvårdnadsarbetet kring personer med depression och vars kompetens möjliggör eneffektiv och positiv vårdtid. Syftet med studien utgick från att belysa sjuksköterskorsomvårdnadsåtgärder kring personer med depression i slutenvård. En litteraturstudiegenomfördes och resultatet baseras på elva vetenskapliga artiklar. Efter analys avartiklarna framkom tre distinkta teman: utbildning som omvårdnadsåtgärd, socialtstöd som omvårdnadsåtgärd och självstärkande omvårdnadsåtgärder. I resultatetpåvisades det att utbildning hos sjuksköterskor avgjorde kvalitén på insattaomvårdnadsåtgärder samt att det i sin tur genererade kunskap och förståelse omkringfenomenet depression hos patienterna. Härifrån kunde förståelsen och vetskapen omsjukdomsbilden tjäna som avlastning och ett tillfälle till återhämtning och ro. Vidarekunde detta lugn användas som tillfälle att återbygga relationer. Framtida forskninginom området bör fokusera på att göra omvårdnaden till en tvärvetenskaplig disciplin,speciellt rörande psykosociala sjukdomar, så som depression. / Depression is an increasing benefactor to the worldwide burden of disease with about340 million being affected and estimates to be the second major benefactor by 2020.The experience of depression is described as an emotional struggle related to worldlyopinions which symptomizes in three dominant feelings such as alienation, dejectionand shame. The nursing profession constitutes a crucial element of support in andduring healthcare work with patients diagnosed with depression. The purpose of thisstudy was to highlight nurses’ caring measures for inpatients with depression. Themethod was a literary overview and the result constitutes of eleven articles. Theanalysis of said result composed of three distinct themes; education as a caringmeasure, social support as a caring measure and self-reinforcing caring measures.Education of both nurses and patients improved the experienced care and generated amore equal relationship. The social support strengthened the patients’ confidence andserved as relief which generated an opportunity for recovery and peace. Lastly theself-reinforcing measures were a non-dramatic way to deal with the depression anddepended solely on the person’s perspective. Future research need to focus on makingthe nursing profession more interdisciplinary in regards to psychosociologicaldiseases, such as depression.

published_or_final_version / Nursing Studies / Master / Master of Nursing

Barn som lider av depression är ovanligt men i tonåren ökar sjukdomen markant. Primärvården blir ofta den första vårdkontakten. Vårdpersonal inom primärvården känner inte alltid till symtomen för depression hos ungdomar. Om tonåringar inte får hjälp med sin depression kan det leda till sämre livskvalitet och försämrad prestation i skolan. Syftet med studien är att undersöka hur primärvården kan identifiera depression hos ungdomar. Studien är en deskriptiv litteraturstudie med syfte att granska litteratur i det valda ämnet. Resultatet visar att screening för att identifiera ungdomsdepression inom primärvården är att rekommendera. Samtal är ytterligare en metod att identifiera depression. Besöket i primärvården skapar ett bra tillfälle att samtala med tonåringen om mental hälsa och depression. Om inte screening används finns det många tecken på depression hos ungdomar som primärvården kan observera. Det finns dessutom både skillnader och likheter mellan depressionstecknen hos pojkar och flickor i tonåren. / Children who suffer from depression are uncommon, but in adolescence the disease increases remarkably. Primary care is often the first health care contact. Health professionals in primary care do not always know the symptoms of depression in adolescence. If teens do not get help with their depression it can lead to lower quality of life and poorer performance in school. The aim of this study is to examine how primary care can identify depression in adolescents. The studay is a descriptive literature review aimed to examine the literature in the chosen subject. The results show that screening to identify youth depression in primary care is recommended. Conversation is an additional method to identify depression. The visit to primary care creates a good opportunity to talk with the teenager about mental health and depression. If no screening is used, there are many signs of depression in adolescents that primary care can observe. There are both similarities and differences between depression signs in boys and girls in their teens.

Aims: To examine the efficacy of CBT for late-life depression in older adults with co-morbid physical illness and to review what has been revealed by meta-analytic studies with regards moderators of treatment in psychological approaches for late-life depression. Method: Systematic literature search and meta-analysis of randomised controlled trials (RCT) evaluating CBT for depression in older adults with co-morbid physical illness and systematic review of meta-analyses examining psychological therapies for late-life depression. Results: Nine papers met inclusion criteria for meta-analysis. CBT was superior to waiting list and treatment as usual control conditions, showing a statistically significant pooled standardised mean difference (SMD) of 0.63 (95 per cent CI, 0.29 to 0.97, p = 0.0003). This was largely maintained at follow up (SMD 0.5, 95 per cent CI, 0.08 to 0.92). Sensitivity analysis showed individual CBT yielded a large, statistically significant summary effect size of 0.80 (95 per cent CI, 0.45 to 1.16), but that group CBT did not show statistical superiority over controls. Clinician-rated measures of depression yielded larger effect sizes, with a SMD of 1.57 (95 per cent CI, 0.56 to 2.59, p = 0.002) as compared with patientrated measures: 1.03 (95 per cent CI, 0.75 to 1.31, p = 0.0001). Fourteen meta-analyses met inclusion criteria for systematic review. More recent publication was significantly correlated with increased reporting quality and reduced analysis of moderating factors. Duration of treatment, treatment setting and gender of participants showed no moderating impact on outcome. Depression severity, participant age, treatment modality, and study quality showed no consistent relationship with outcomes. Active or placebo controls were associated with reduced effect sizes when compared with no treatment or waiting list controls. Patient-rated outcome measures were associated with reduced effect sizes as compared with clinician-rated measures. Conclusions: When compared with treatment as usual and waiting list controls Individual CBT is effective in reducing depressive symptoms for depressed older adults with an underlying physical illness. Meta-analytic studies of late-life depression show variable results regarding moderators of treatment efficacy. More high quality studies examining the effectiveness of psychological therapies are needed with clinically representative older populations, particularly, the older-old and those with co-morbid physical illnesses.

In later life, adverse life events, disability, health problems, inadequate social support, and personality traits hypothesized to be important risk factors for depression. Sample included 35 older (65-84) physical rehabilitation patients in a large metropolitan hospital. Statistical analysis included Pearson Product Moment correlations and multiple regression results. Perceived physical health, instrumental ADLs, life satisfaction, extraversion, and conscientiousness are inversely related to depressive symptom severity; neuroticism is positively related to depressive symptom severity. Regression models predicted depressive symptom severity, PANAS negative effect and PANAS positive affect. Neuroticism, insrumental ADLs, and age are significant predictors of depressive symptom severity; neuroticism and age are signficant predictors of PANAS negative affect, while extraversion is a significant predictor of PANAS positive affect. Personality factors, level of functioning, and age are important factors relating to mood. Limitations of this study include: small sample size with special characteristics (high level of SES); incomplete personal and family history of psychiatric problems; and lack of clinical comparison sample.

Over the past twenty years the number of children identified with learning disabilities has risen drastically. In addition, 26 - 40% of these children also experience depression. While cognitive functioning has been demonstrated to be associated with depression, it is unclear whether the mood, vegetative, or cognitive symptoms of depression predict particular cognitive processes and vice versa. The purpose of this study was to determine which particular cognitive processes were associated with specific depressive symptoms and depression as a whole. Structural equation modeling (SEM) was conducted to test a model which examined how three cognitive processing factors (verbal & visual reasoning, and attention/working memory) were associated with three depressive symptom factors (disturbances in mood, vegetative, and cognitive functioning). The data for SEM came from a large data set of children with learning disabilities (n=227). Model fit results supported the proposed model, and a significant association was found between the attention/working memory factor and the depression symptom factor reflecting disturbances in cognitive functioning. Less robust relationships were observed between verbal reasoning and cognitive depressive symptoms and an approach toward the conventional level of significance was noted between visual reasoning and cognitive depressive symptoms. Using a sub-sample of original participants who were re-evaluated 20-25 years later (n=40), longitudinal analyses were conducted to determine the predictive power of cognitive functioning and depression over time. There was some indication for the predictive power of visual reasoning performance in childhood on mood symptoms of depression in adulthood. The most robust association at both time 1 and time 2 was between attention/working memory performance and cognitive symptoms of depression. However, the association appeared to be time specific and not predictive.

Bakgrund: Depression är en psykisk sjukdom som går i skov och är annorlunda från person till person i hur länge det håller i sig och hur pass allvarligt depressionen anses vara. För varje nytt skov en person får så ökas risken för framtida skov som kan bli allt mer allvarligare och därmed svårare att återhämta sig från. Då depression är en vanlig sjukdom som blir allt vanligare så finns det ingenstans inom vården där en sköterska inte kommer att möta dessa människor.   Syfte: Syftet med föreliggande arbete var att beskriva hur sjuksköterskor upplever att vårda människor som har depression samt beskriva vilka undersökningsgrupper som finns i de valda artiklarna.   Design: En beskrivande litteraturstudie.   Resultat: Sjuksköterskor kände sig säkra i att känna igen depressionssymtom, men ändå förblev många depressionstillstånd odiagnostiserade och obehandlade. Frustration kring sjukdomen och dess behandling uppstod då det inte fanns tid eller rätt kunskap för att kunna hantera det. Viljan att lära sig mer och vara lyhörda för patienternas behov fanns vilket hänvisade till ett behov av att ha en bra relation mellan sjuksköterskan och patienten. Det var en tydlig dominans av kvinnor i de 10 utvalda artiklarna. Det fanns allt från nyanställda sköterskor till sjuksköterskor som arbetat i flera år även om de flesta av deltagarna i de olika studierna var i medelåldern.   Slutsats: Sjuksköterskor upplever frustration och maktlöshet när de vårdar människor med depression vilket leder till känslan av stigmatisering och dåliga relationer mellan vården och patienten. Viljan att bli bättre på att känna igen depression och kunna vara ett stöd för människorna med sjukdomen finns hos sköterskorna, men bristen på tid, kunskap och kommunikation gör att sjuksköterskor känner att de inte kan hantera patienterna och blir otrygga i sin arbetsroll som vårdare. / Background: Depression is a mental illness that relapses and is different from person to person in how long it lasts and how serious the depression is considered. For each new relapse a person has the risk of future relapses increased which can become more serious and more difficult to recover from. Considering that depression is a common disorder that is becoming more common, there is no place in health care where a nurse will not meet these people.   Aim: To describe how nurses experience caring for people who have depression. The aim is also to describe the study groups of the selected articles.   Design: A descriptive study of literature.   Findings: Nurses felt confident in recognizing symptoms of depression, but many depressions remained undiagnosed and untreated. Frustration towards the disease and its treatment were experienced since there was no time or the right knowledge to be able to handle depressed patients. The desire to learn more and be empathetic to the needs of patients was present which supported the need for a good relationship between the nurse and the patient. There was a dominance of women in the 10 selected articles. Everything from newly hired nurses to nurses who've worked for several years participated although most of them were middle-aged.   Conclusion: Nurses are experiencing frustration and powerlessness when they care for people with depression, which leads to the feeling of stigmatization and poor relationships between nurse and patient. The desire to become better at recognizing depression and be a support for people with the disease exists, but the lack of time, knowledge and communication makes nurses feel insecure in their role as caregivers.

Eine depressive Erkrankung kann sich mit unterschiedlicher Geschwindigkeit innerhalb weniger Stunden oder über Monate hinweg ausbilden. Zur Erfassung dieses bisher wenig untersuchten klinischen Merkmals wurde das Onset of Depression Inventory (ODI), ein standardisiertes klinisches Interview, entwickelt. Die vorliegende Studie prüfte die Test-Retest-Reliabilität des Onset of Depression Inventory und betrachtete die Frage nach dem optimalen Zeitpunkt der Durchführung des Interviews im Krankheitsverlauf. Es konnte gezeigt werden, dass die Patientenangaben zur Geschwindigkeit des Depressionsbeginns über den Beobachtungszeitraum zwischen zwei Untersuchungszeitpunkten stabil sind und auf hohem Niveau signifikant korrelieren. Im Weiteren zeigte sich keine Beeinflussung der Angaben zur Geschwindigkeit des Depressionsbeginns durch die Schwere der depressiven Symptomatik. Die hohe Übereinstimmung der Patientenangaben resultiert in einer hohen Test-Retest-Reliabilität und spricht für die Verlässlichkeit der mit dem ODI erhobenen Daten. Damit ist mit dem ODI ein geeignetes Instrument für die reliable Erfassung der Geschwindigkeit des Depressionsbeginns gegeben, was gleichermaßen für die klinische Arbeit als auch für wissenschaftliche Zwecke anwendbar ist und vor allem im klinischen Kontext eine frühe Differenzierung zwischen Unipolarer Depression und Bipolarer Affektiver Störung ermöglicht.