Omega-3 fatty acids are increasingly recognised as playing an important role in human brain development and mental health. The polyunsaturated fatty acids (PUFAs) include omega-3 and omega-6 fats which are essential fatty acids (EFAs), consumed via the diet. Omega-3 fatty acids are particularly abundant in fish oils. The omega-3 fatty acids are being focused on for their role in depression, the main types being docosahexaenoic acid (DHA), which is abundant in neural tissue, and also eicosapentaenoic acid (EPA) which is biologically very active. There is an emerging literature in relation to omega-3 fatty acid blood levels in depression and the effects of treatment with omega-3. Strong epidemiological evidence has also been published indicating an association between a population's fish intake and depression rates. A specific research focus on omega-3 as a treatment for depression in the perinatal period is also starting to emerge. The importance of this particular area is enhanced by the knowledge that omega-3 depletion occurs during the perinatal period due to fetal diversion for neurodevelopment. In view of the lay public promotion of omega-3 and its appeal to women as a 'natural therapy', there is a need to scientifically evaluate its effectiveness to treat depression in the perinatal period. It is also important to investigate omega-3 as an alternative to antidepressants given the ongoing uncertainties regarding their safety in pregnancy. In this thesis a literature review presents current research relating to this field. This is followed by a description of the methodology and results for the two trials conducted. The results of the double-blind randomised placebo controlled trial of omega-3 as a treatment for depression in the perinatal period were essentially negative. However this result is limited by the small sample size in the study and therefore it may be unwise to interpret the result as conclusive. The case-control study confirmed the hypothesis that omega-3 levels were more depleted in depressed women compared to non-depressed women. A discussion of the results and trial limitations then follows in the thesis. It is concluded that further larger studies are warranted in this area.

Research Doctorate - Doctor of Philosphy (PhD) / A large body of population- and treatment-based evidence exists to indicate depression and alcohol/other drug (AOD) use are highly prevalent on a global scale, and co-occur with considerable frequency. Despite this evidence, significant gaps exist in treatment research and clinical services, as people with co-occurring depression and AOD use problems have typically been excluded from randomised controlled treatment trials, and also face many individual- and service-level barriers to accessing treatment. Consequently, a well-defined and adequately tested treatment strategy does not currently exist for people experiencing the complexities of concurrent depression and AOD use problems. A small body of evidence exists to suggest that co-occurring mental and AOD use disorders (“comorbidity”) leads to poorer treatment outcomes, increased risk of relapse, higher levels of problematic symptomatology, and poorer quality of life. However, little consistent information is currently available to suggest what additional impact comorbid depression and AOD misuse produces relative to the experience of a “single” condition (such as depression or AOD misuse in isolation). Studies 1 and 2 attempted to address this important gap in knowledge by examining the presenting characteristics of 246 people with AOD use problems, according to the presence of comorbid depressive symptoms. One hundred and thirty seven participants were drawn from AOD treatment services, and a further 109 were referred via mental health services and also met criteria for a psychotic disorder. Results indicated that the presence of depression was associated with a significantly higher severity of psychiatric symptoms and personality disorder, significantly decreased social and occupational functioning and significantly reduced quality of life. Current depression was also associated with a significant increase in the experience of cravings and self-reported dependence on amphetamines. These difficulties were over and above the already high rates of disability and distress reported by each sample as a whole. Furthermore, treatment for mental health problems was rare among the AOD treatment participants, as was AOD treatment among the mental health sample. This is despite the presence of moderate to severe levels of depression and AOD use reported by each sample. In particular, Studies 1 and 2 highlight the vulnerabilities for people with comorbid mental health and AOD use problems who present to treatment in the mental health or AOD use settings, and in particular how depression significantly increases the disability and other challenges experienced by these people. These results provide a strong rationale for the development of an appropriate treatment protocol for depression and AOD use comorbidity. No clear treatment model or evidence-based approach exists to suggest how depression and AOD use comorbidity is best managed. When people with this comorbidity do manage to access clinical treatment services, they typically receive treatment targeted at one aspect of their presentation (e.g. depression-focussed or AOD-focussed treatment). Yet, it is not known whether a singular focus of treatment is effective in producing sustainable change in the outcomes of people with comorbid problems, nor whether failure to treat all components of the comorbid presentation confers a worse outcome. Studies 3 and 4 reported on two randomised controlled clinical trials of psychologicaltreatment for AOD use problems among a sample of 246 people with AOD use problems, drawn from AOD treatment services (n=137) or mental health services (n=109). In doing so, these studies provide some of the first available data on these issues. Participants were categorised according to the presence of comorbid depression (as per Studies 1 and 2) and response to treatment was analysed over a six- to 12-month follow-up period. In spite of high levels of current depressive symptoms at entry to the studies, and equally hazardous use thresholds of a range of substance, people enrolled in Studies 3 and 4 reported some gains via their experiences with these single-focussed treatments. Attendance and retention rates were higher than reported in previous research, and the presence of depression did not adversely influence the motivation of project participants to change their current AOD use patterns. A treatment effect was generally not detected among the Study 3 and 4 participants, regardless of the presence of depression, with those receiving an assessment-only control treatment in both studies reporting similar patterns of change in outcome. Regardless of the magnitude of change reported by all study participants, people with depression reported significantly higher levels of depression, poly-drug use, amphetamine dependence, hazardous use of a range of substances, HIV risk taking and criminal activity and lower levels of functioning and self-concept across the follow-up assessment period. These residual symptoms were present at sufficiently high levels of severity to increase the risk of relapse to AOD use and continued morbidity. These results suggested the potential value of targeting depression in the context of comorbid AOD use problems. One previous study has examined the impact of an adjunctive psychological treatment of depression for people hospitalised for alcohol use disorder. Results indicated that people who received the additional depression treatment reported significantly greater improvements on depression- and alcohol-related outcomes over the short-term relative to people receiving a relaxation-only control treatment. These improvements were suggested to be enhanced if treatment had integrated depression- and alcohol-related approaches into the one treatment program. In the first study of its kind, Study 5 developed and evaluated the efficacy of an integrated psychological treatment program for comorbid depression and AOD use problems. Sixty-seven participants received integrated treatment delivered by a therapist, computer-delivered integrated treatment or a brief intervention (control) treatment delivered by a therapist. Depression scores, daily use of alcohol and cannabis, hazardous use of a range of substance and poly-drug use fell significantly over a 12-month follow-up period across the integrated treatments and brief intervention (control) conditions. The small sample size of Study 5 meant that very few treatment effects were detected at a statistically significant level, however important reductions in key outcomes for depression, AOD use, quality of life and general functioning were noted for people in the integrated treatment relative to controls over a 12-month period. The magnitude of change in Study 5 across these domains was comparable with the only other study of psychological treatment of depression and alcohol-use disorders described above. The integrated treatment in Study 5 was associated with higher levels of improvement in depression, alcohol use and cannabis use (where present) than did the AOD-focussed treatment examined in Studies 3 and 4. The results further suggest that a brief intervention targeting both depression and AOD drug use problems is associated with reductions in key outcomes in the short-term, withintegrated, lengthier psychological treatment potentially associated with longer-term changes on the same outcomes. No previous study has directly compared the outcomes for people completing psychological treatment delivered via a computer program with those completing treatment with a ‘live’ clinician over an extended follow-up period of 12-months. Given the barriers people with comorbid depression and AOD use problems face in accessing available treatment services, the consideration of alternative modes of delivery of evidence-based treatment to this group is timely. Study 6 expanded on the Study 5 results by presenting further analysis of the performance of the computer-delivered version of the integrated treatment relative to the clinician-delivered equivalent, matched for content. Given the small sample size of participants, Study 6 devised a four-point criterion which, if satisfied, would suggest that the computer-delivered and clinician-delivered integrated treatments were approximately equal. Based on these criteria, the results indicated that the outcome profiles for people engaged in the computer-delivered treatment were equivalent to those reported by people involved in clinician-delivered therapy over a 12¬month follow-up period. Additionally, computer-delivered integrated treatment was associated with similar rates of improvement as the therapist-equivalent on depression scores, risky drinking patterns, hazardous use of substances, poly-drug use, levels of daily cannabis use, suicidality, treatment retention and therapeutic alliance. This result requires further replication to test these assumptions, however it is promising that a treatment requiring an average of 12-minutes face-to-face of “generic” clinician time per weekproduces a similar pattern of improvement to a treatment requiring an average of 60 minutes of face-to-face specialist psychologist input over the same time period. Studies 1-6 resulted in the development of a menu of treatment options for people with depression and AOD use comorbidity, with each treatment approach providing evidence for at least some benefit among the study participants. While encouraging, these results again raise the issue of how treatment may be incorporated into existing services (mental health, AOD use, primary care, etc.), which typically remain segregated, with little opportunity for collaboration and cross-fertilisation of skills and expertise between service settings. Chapter 7 discusses a new model of treatment for comorbid depression and AOD use problems that incorporates the results of Studies 1-6, and involves a stepped care approach to developing a treatment plan tailored to the specific needs and levels of distress experienced by people with depression and AOD use comorbidity. The stepped care model of treatment could be incorporated into existing service settings and structures, with the potential for computer-based therapy to provide access to specialised treatment for depression and AOD use comorbidity that might otherwise be unavailable. As a result, stepped care treatment could foster earlier engagement with treatment services and encourage motivation and optimism among people with comorbid depression and AOD use problems. These are important issues for service development and delivery of appropriate treatments to this underserved population.

Depression is poorly recognised, under-assessed and under-treated in patients receiving palliative care for a life-limiting illness. There are barriers to assessment and diagnosis, and limited access to specialist clinicians who might assist in these complex assessments and who could provide options for treatment. The three studies presented, using different research methodologies, and using both qualitative and quantitative analysis, seek to clarify these issues and to provide some solutions. A questionnaire was sent to all Palliative Care Services (PCS) in Australia. Questions included what part specialist psychological clinicians played in multi-disciplinary team meetings and in the treatment or coordination of patient care. Very few PCS used a valid screening instrument for psychological distress and very few had regular support from a psychiatrist or psychologist. Many did not have access to social work support. There are two competing issues with regard to recognising and assessing depression in palliative populations. A rapid reliable screen that points to a likely problem would be useful, but also there is a need to understand something of the patient experience of depression. In the second study, the one- and two-item screening instruments widely used in palliative care are examined and limitations that have been found in other settings are confirmed. A new novel screening tool is developed from this data and tested empirically. This algorithm is short, has good psychometric properties and is validated for an Australian palliative care population. Depending on the response pattern it is possible to identify that a particular patient has significant symptoms of depression by asking between one and four questions. Professional carer and patient acceptability of the questions is high. The understanding of the experience and symptom profile of depression in Australian palliative care patients is addressed in the third study. Patients and family carers were recruited prospectively from palliative care and oncology ambulatory clinics of two teaching hospitals in an Australian capital city. The Geriatric Depression Scale (GDS) was administered to the patient and the Collateral Source version of this instrument was asked of the carer. A subset of this sample completed the measures twice. The results using this 30-item scale were then compared with all the known previously published short versions of this scale. Two short forms met as many psychometric criteria as the longer forms. None of the versions of the GDS showed sufficiently high correlations between carer-completed and patient-completed forms. The frequency of symptoms was also assessed. Patients more frequently reported fatigue and anhedonia than depressed affect. Despite many screening instruments being available for depression, their use is limited in Palliative Care Services. Although these studies have validated several options for Australian palliative care patients, the issues behind the low uptake rates for screening have not been resolved. The final chapter of this thesis constructs known and potential barriers into a logical structure and then offers some solutions to improve access to mental health professionals by considering service models and applying this theory to the problem of depression and its assessment in palliative care populations.

Thesis (Ph. D.)--State University of New York at Binghamton, Decker School of Nursing, 2006. / Includes bibliographical references.

Zugl.: München, Universiẗat, Diss., 2007.

<p>Syftet med studien var att undersöka vilka strategier sjuksköterskor använder sig av för att upptäcka depression bland ungdomar i åldrarna 13-19 år, samt vilka strategier de använder sig av i mötet med dessa. Ett annat syfte var att undersöka hur sjuksköterskor upplever mötet med deprimerade ungdomar i åldrarna 13-19 år. Metoden<strong> </strong>var att intervjua 6 sjuksköterskor inom skola och barn och ungdomspsykiatrin. Intervjuerna genomfördes under hösten 2007. Intervjuerna spelades in på band och transkriberades ordagrant. Materialet analyserades och meningsbärande enheter plockades ut samt delades in kategorier, resultatet blev fyra huvudkategorier samt tio subkategorier. Resultatet visade på att alla skolsköterskor som intervjuades hade ett samarbete med kuratorer, rektorer och lärare för att upptäcka ungdomar som befann sig i riskzonen för depression. Dessa ansåg dessutom att hög frånvaro från skolan kan bindas till fysisk och psykisk ohälsa. Samtliga sjuksköterskor i studien använde sig av någon form av frågeformulär för att upptäcka depression. Alla sjuksköterskor var överrens om att det är viktigt att behandlingen planeras i samarbete med ungdomen. Alla sjuksköterskor i studien ansåg att det är mycket viktigt att informera ungdomarna om hur långt deras tystnadsplikt sträcker sig. Alla var även överrens om vikten att försöka involvera ungdomarnas föräldrar. Sjuksköterskorna i studien upplevde alla att de ibland tar jobbet med sig hem, dock har de med tiden blivit bättre på att distansera sig från arbetet.</p> / <p>The aim of this study was to examine which strategies nurses use to detect depression among adolescences in the ages 13 to19 and which strategies they use when meeting depressed adolescents. Another aim of this study was to examine the nurses' experience from that meeting. The method used was interviews with six school and psychiatric nurses. The interviews were recorded on tape and transcribed verbatim. Meaning units were extracted and the material was put into categories, which resulted in four main categories and ten subcategories. The result showed that all of the school nurses who participated in the study had cooperation with counsellors, principals and teachers to discover adolescence who where at risk of depression. Furthermore the nurses reckoned that a high amount of absence from school could be signs of physical or mental illness. The participants in this study used some form of questionnaire to detect depression. In addition all of the nurses agreed on the importance of planning the treatment together with the adolescence. Moreover the nurses in the study believed in the importance of informing the adolescence of their professional confidentiality and how far it reaches. Additionally every nurse who participated in this study agreed on the importance of involving the parents of the adolescences. The nurses in the current study experienced that they sometimes brought their work home with them, however distance oneself from work has become easier over time.</p>

<p>Syftet med föreliggande empiriska studie var att undersöka och beskriva i vilken omfattning individer behandlade med hemodialys rapporterar symtom på depression. Författarna ville även redogöra för den utsträckning antidepressiva läkemedel ordinerats samt om det existerade några könsskillnader i depressionssymtom och i ordinerad antidepressiv behandling. Studien baserades på ett bekvämlighetsurval från 11 geografiskt spridda dialysenheter i Sverige. Urvalet bestod av 222 patienter som mötte inklusionskriterierna (behärska svenska språket tillräckligt bra för att förstå frågorna i enkäten, genomgått hemodialys behandling i minst 6 månader samt vara 18 år fyllda) varav 141 patienter fullföljde undersökningen. Dessa 141 deltagare fick fylla i den förkortade versionen av CES-D formuläret, ett självskattnings instrument där den egna mentala hälsan skattas. Resultatet visade att drygt en tredjedel av hemodialyspatienterna hade depressionssymtom och endast 12 patienter av 50 med depressionssymtom var ordinerade antidepressiv behandling. Emellertid visade inte föreliggande studie några signifikanta könsskillnader gällande depressionssymtom eller i ordinerad farmakologisk behandling. Författarna drar slutsatsen att depression är vanligt bland hemodialyspatienter. Därför är det viktigt att utbilda både vårdgivare och närstående för att de ska kunna se tecken på depressionssymtom i ett tidigt skede, eftersom rätt behandling kan öka dessa patienters livskvalitet och samtidigt vara kostnadsbesparande för sjukvården</p> / <p>The aim of the present empirical study was to investigate and describe in which extent individuals treated with hemodialysis reported symptoms of depression. The authors also wanted to describe in which extent antidepressant medicine was prescribed. Also if there existed any differences between males and females in depressive symptoms and if there was any divergence in treatment with anti depressive medicals. The study was based on a convenience sample from 11 geographical spread dialys units in Sweden. The sample consisted of 222 patients whom fulfilled the inclusion criterias (they had to have a good knowledge of the Swedish language so they could understand the questionnaire, at least six months of dialysis treatment experience and be at least 18 years old) of whom 141 carried out the study. These 141 participants filled out the short version of the CES-D form, a self report form where the mental health was estimated. The result showed that one third of the hemodialysis patients had symptoms of depression and only 12 patients of 50 had treatment with antidepressant medicine. However the study did not show any significant differences between male and female regarding depressive state and treatment with anti depressive medicine. The authors conclude that depressive symptoms are common among hemodialysis patients. That is why it is important to educate nurses and relatives so they can learn how to see signs of depressive symptoms as early as possible. Right treatment could then increase hemodialysis patients quality of life and also save money for the hospitals.</p>

<p>Postnatal depression (PND) is a condition which affects about 8-15% of recent parents. The cause of PND is unknown but several underlying factors have been purposed through different studies. This descriptive literature review aims to illuminate the parent’s situation when the mother is affected with PND. In search of literature, the databases Medline (via PubMed), Academic Search Elite, Cinahl, PsycINFO, PsycARTICLES and SweMed+ were used. Fourteen articles were finally included in this study. The result of the chosen articles, both from the woman’s and the men’s perspective, could be divided into three categories; thoughts and feelings about the own situation, thoughts and feelings surrounding the partner and the baby and thoughts and feelings about the perception of support. The women felt that the expectations they had of motherhood, before the baby was born, was not matched by later experiences and they perceived themselves as bad mothers. They also found it hard to talk about their feelings with both their partner and with people outside the family, thinking that no one would understand. The men felt as though they, due to their partner’s condition, had lost control of life and that there, for them, was no organized help or support available.</p> / <p>Postnatal depression (PND) är ett tillstånd som drabbar ca 8-15% av nyblivna föräldrar. Orsaken till PND är inte känd men flera troliga bakomliggande faktorer har föreslagits genom olika studier. Föreliggande beskrivande litteraturstudie syftar till att belysa föräldrarnas situation när modern drabbats av PND. Vid sökning av litteratur användes databaserna Medline (via Pubmed), Academic Search Elite, Cinahl, PsycINFO, PsycARTICLES och SweMed+. Fjorton artiklar inkluderades slutligen i studien. Resultatet av valda artiklar kunde, både ur kvinnans och ur mannens perspektiv, delas in i tre kategorier; tankar och känslor om sin egen situation, tankar och känslor omkring partnern och barnet samt tankar och känslor om upplevelsen av stöd. Kvinnorna upplevde att de förväntningar de haft på moderskapet före barnets födelse inte överensstämde med den senare erfarenheten och de uppfattade sig själva som dåliga mammor. De upplevde det även svårt att tala om sina känslor, både med partnern och med personer utanför familjen, i tron att ingen skulle förstå. Männen upplevde att de, i och med partnerns tillstånd, förlorade kontrollen över livet och att det, för dem, inte fanns organiserad hjälp eller stöd att få.</p>

Depression hos äldre har blivit ett stort hälsoproblem. Idag är depression den vanligaste psykiatriska sjukdomen bland äldre. Om en depression inte identifieras kan den leda till allvarliga konsekvenser. En av sjuksköterskans uppgifter kan vara att identifiera depression hos äldre personer. Syftet med denna litteratur studien var att ta reda på sjuksköterskans svårigheter och möjligheter i att identifiera depression hos äldre. Den valda metoden var en kvalitativ litteraturstudie och gjordes enligt Friberg (2001). Den kunskap som framkom om sjuksköterskan kategoriserades i svårigheter att identifiera depression och möjligheter i att upptäcka depressionen. Resultatet av studien visar att sjusköterskor har svårigheter i att identifiera depression hos äldre, men det finns möjligheter att förbättra en identifiering. När den äldre deprimerade maskerar sina depressiva symtom i somatiska sjukdomar, kan sjuksköterskan få svårigheter att identifiera depressionen. Det kan också finnas attityder hos sjuksköterskor, att människan blir deprimerad på äldre dagar. Detta kan leda till att depressionen inte identifieras. Genom att använda sig av kommunikation, GeriatricDepression Scale (GDS), kunskap från närstående och utbildning ökar sjuksköterskans möjligheter att identifiera en depression och därmed minska lidandet för den äldre. Slutsatsen som dras är att det behövs mer utbildning för sjuksköterskor i att kunna identifiera depression hos den äldre personen. / Depression in elderly people has become a big health problem. Today, depression is the most common psychiatric illness amongst elderly. If depression is not identified, it can lead to serious consequences. One of the nurse’s duties could be identify depression in elderly people. The purpose of this literary study was to find the nurse’s difficulties and possibilities in identifying depression in elderly. The chosen method was a qualitative literary study and was carried out according to Friberg (2001). That knowledge that emerged about the nurses was categorised in difficulties in identifying depression and possibilities of discovering this. The result of the study shows that nurses have difficulties in identifying depression in elderly, but there are possibilities to improve an identification. When the depressed elderly disguises the depressive symptoms in somatic illnesses, the nurse may have difficulties in identifying the depression. There may also be the attitude of the nurses, that depression is part of the aging process. This may lead to that depression is not identified. By using communication, the Geriatric Depression Scale (GDS), information from people close to the patient and education, the nurse’s possibilities in identifying a depression are increased and can thereby reduce the suffering of the elderly. The conclusion is that nurses need more education to be able to identify depression in eldery.

Depression är en psykisk sjukdom, som karaktiseras av bland annat nedstämdhet och sömnstörningar. Allt fler i Sverige riskerar att under sin livstid drabbas av någon form av depression. Sjuksköterskors attityder gentemot vuxna patienter med depression, har stor betydelse för tillfrisknandet. Syftet var att beskriva sjuksköterskors kunskap och attityd till vuxna personer med depression. Studien har genomförts som en deskriptiv litteraturstudie, där 15 artiklar har granskats av författarna för att inkluderas i studien. Resultatet visade att depression uppfattades olika av sjuksköterskorna som deltog i studierna, då vissa ansåg att det inte var en sjukdom. Några sjuksköterskor ansåg det givande att vårda dessa patienter vilket speglade av sig positivt på attityden. Andra hade uppfattningen att de inte skulle kunna tänka sig att bo i samma grannskap som någon med denna problematik, samt att de var svåra att tala med. Detta tillsammans med kunskapsbrist ledde till negativa attityder. Slutsatsen av denna studie var att den kunskapsbrist som rådde inom detta område, ledde till att adekvat vård av dessa patienter blev begränsat och därför önskas mer forskning och utbildning inom området för att stärka självförtroendet och öka kunskapen hos sjuksköterskan. / Depression is a mental illness, which is characterized by including depressed mood and sleep disorders. More and more people in Sweden might sometime in their lifetime be affected by some form of depression. Nurses' attitudes towards adult patients with depression are important for recovery. The aim of this study was to describe nurses' knowledge and attitude to adults with depression. The study was conducted as a descriptive literature review, in which 15 articles were reviewed by the authors to be included in the study. The results showed that depression was perceived differently by the nurses who participated in the studies, when some thought that it was not a disease. Some nurses felt it rewarding to care for these patients as reflected by their positive attitude. Others believed that they could not imagine living in the same neighborhood as someone with this problem, and that these people were difficult to talk to. This, together with lack of knowledge led to negative attitudes. The conclusion of this study was that the skills shortages in this area, leading to adequate care of these patients were limited. Therefore, it requires more research and education in the field of strengthening confidence and increasing knowledge among nurses.