Syfte: Syftet med studien var att undersöka hur vanligt det är med stress och depression efter genomgången hjärtinfarkt. Vidare planeras att undersöka samband mellan stress och depression samt också eventuella skillnader mellan könen för hur stress och depression upplevs efter genomgången hjärtinfarkt. Metod: Patienter som varit inlagda för hjärtinfarkt vid Akademiska sjukhuset i Uppsala inkluderas i studien. Patienterna skall ha genomgått hjärtinfarkt och/eller PCI och/eller CABG. De tre enkäterna Vardagslivets stress, Känsloläge samt MADRS användes. Frekvenser och korrelationer beräknades med IBM SPSS Statistics version 19. Tillstånd för studien söktes hos klinikchef. Resultat: Antalet patienter i studien är 18. Förekomsten av självskattad depression efter hjärtinfarkt uppmättes till 6%. Självskattad stress varierade mellan patienterna, dock skattade 33%, höga nivåer av stress. Skillnader i hur kvinnor och män upplever stress och depression efter genomgången hjärtinfarkt kunde inte bestämmas i denna studie. Ett signifikant svagt samband mellan stress och depression visades dock (r = 0,52, p= 0,029). Slutsats: Patienter med nyligen genomgången hjärtinfarkt kan uppleva depression i efterförloppet. Att behandla depressionen kan ge ökad livskvalitet. / Objective: The aim of this study was to investigate the frequency of depression and stress after a myocardial infarction. Other aims were to study the relationship between stress and depression and also differences between the sexes in their experience of stress and depression after a myocardial infarction. Method: Patients being hospitalized at Akademiska sjukhuset in Uppsala, Sweden were included in the study. Patients with a myocardial infarction and/or coronary angioplasty and/or coronary bypass surgery were included. Three questionnaires The Everyday Life Stress Scale, The Depressive Mood Scale and MADRS where used. Frequencies and correlations were calculated using IBM SPSS Statistics version 19. Permission for the study was sought from the clinic manager. Result: 18 participants were included in the study. The frequency of self estimated depression after a myocardial infarction was 6%. The frequency of self estimated stress varied throughout the population but 33% estimated their stress as high. Differences in stress and depression between women and men could not be determined in this study. A weak significant correlation between stress and depression was however shown (r = 0,52, p= 0,029). Conclusion: Patients who have gone through a myocardial infarction can experience depression afterwards. Treating depression can improve quality of life.

Bakgrund: Depression är en komplicerad sjukdom som kan medföra allvarliga problem. Symtom på depression kan variera, några av de vanligaste förekommande symtomen för en ungdom är irritation, håglöshet, trötthet, koncentrationssvårigheter och skuldkänslor. Detta kan medföra att skolarbetet påverkas negativt och hela livssituationen. Skolsköterskan har en viktig roll i arbetet för att främja den psykiska hälsan. Syfte: Syftet var att belysa skolsköterskors erfarenheter av att stödja ungdomar i åldern 13-19 år med depression. Metod: Åtta intervjuer genomfördes med skolsköterskor verksamma i grundskola och gymnasieskola. Studien genomfördes i två län och i fem kommuner. Data analyserades med manifest kvalitativ innehållsanalys med induktiv ansats. Resultat: Ur analysen av datamaterialet framkom fyra kategorier, öppenhet för elevens behov, bygga upp elevens självbild, samordna insatser och känsla av otillräcklighet. Kategorier belyses med underkategorier och citat. Konklusion: Resultatet visar att skolsköterskor har en öppenhet mot elever med depression och förtroende utgör grunden för ett gott samarbete med eleven. Resultatet kan bidra till att utveckla och förbättra skolsköterskors möjligheter att ge stöd till deprimerade elever. Det kan även utgöra en grund för fortsatt diskussion om hur skolsköterskans arbetssituation bör förbättras för att ge mer resurser till deprimerade elever. / Background: Depression is a complex disorder that can cause serious problems. Symptoms of depression can vary, some of the most common symptoms of a youth is irritability, listlessness, fatigue, difficulty concentrating and feelings of guilt. This may mean that school is adversely affected and the whole life situation. The school nurse has an important role in promoting mental health. Aim: The aim was to highlight the school nurses' experience of supporting young people aged 13-19 years with depression. Method: Eight interviews were conducted with nurses working in primary and secondary education. The study was conducted in two counties and five municipalities. Data were analyzed with manifest content analysis with an inductive approach. Results: From the analysis of the data revealed four categories, openness to student needs, build the student's self-image, coordinate actions and feelings of inadequacy. Categories illuminated with sub-categories and quotes. Conclusion: The results show that nurses have an openness to students with depression and confidence is the basis for a good working relationship with the student. The results can help to develop and improve school nurses' ability to provide support for depressed students. It can also provide a basis for further discussion on how the school nurse's work situation should be improved to provide more resources for depressed students.

Postpartum depression is a debilitating condition that has been researched in different populations. A surge in prevalence has been noted in non-western cultures and extremely high prevalence has been recorded in some South African studies. There is a dearth of literature on prevalence or experiences of postpartum depression in South African Indian women. AIMS: This study sought to understand the causes and experiences of South African Indian women potentially suffering from postpartum depression with a view to making recommendations for prevention and care of postpartum depression. METHOD: Low-income South African Indian women were screened for postpartum depression at primary health care clinics at two locations in KwaZulu-Natal. The Edinburgh Postnatal Depression Scale was used to screen women for postpartum depression. A semi-structured interview was then carried out to determine eight women’s levels of coping. These included individual, interpersonal, community, societal and cultural coping mechanisms and support systems. RESULTS: In line with other studies on postpartum depression, the study revealed that interpersonal issues, abusive relationships, economic hardships and a lack of adequate social support precipitated or aggravated depressive feelings in the postpartum period. CONCLUSION: A number of recommendations for prevention and treatment of postpartum depression were identified and include Routine Screening, Psycho-education, Interpersonal Therapy, Task-shifting to Community Health Workers to aid in prevention and treatment and increased maternity and paternity leave. / Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Durban, 2010.

No description available.

Bakgrund: Depression är ett växande problem som orsakar stort lidande hos befolkningen i form av nedstämdhet, isolering och sjukskrivningar samt uppskattas bli det största hälsoproblemet i världen. Tidigare forskning belyser depression i samband med annan sjukdom. Därav behövs ökad kunskap om människor som lever med egentlig depression. Syfte: Syftet med studien var att belysa människors upplevelser av att leva med depression Metod: En litteraturöversikt baserad på tio kvalitativa artiklar som analyserades i enlighet med Friberg (2012). Funna nyckelord dokumenterades och användes för skapande av teman. Resultat: Tre övergripande teman kunde identifieras, varav ett av temana innehöll två subteman. Ovisshet om sin situation belyser ett stadium före människans vetskap om sin sjukdom. Stigmatisering innefattar två subteman där samhället och anhörigas påverkan samt människans självstigmatisering bidrar till en negativ påverkan i människans livskvalitet. Personlig utveckling belyser hur människorna kan finna styrka och självinsikt både under och efter en genomgången depression. Diskussion: Diskussionen belyser människors upplevelse av depression utifrån Rosemarie Rizzo Parse’s Human becoming teori där fokus riktades på sjuksköterskans omvårdnad. / Background: Depression is a growing problem that causes great suffering among the population in the form of dysphoria, isolation and sick leave, and is expected to be the biggest health problem in the world. Previous research highlights depression associated with other disease. Hence the need for increased knowledge of people living with major depression. Aim: The purpose of this study was to examine people’s experiences of living with depression Method: A literature review based on ten qualitative articles that were analyzed in accordance with Friberg (2012). Found keywords were documented and used for creating themes. Results: Three main themes were identified, of which one of the themes contained two subthemes. Uncertainty about their situation highlights a stage before the person’s knowledge of their disease. Stigma includes two subthemes where society and relatives influence and the person’s self-stigma contributes to a negative impact on the quality of the person’s life. Personal growth highlights how people can find strength and self-perception, both during and after a depressive episode. Discussions: The discussion highlights people’s experience of depression from the perspective of Rosemarie Rizzo Parses’ Human becoming theory, where the focus was directed at the nurse’s care.

No description available.

No description available.

Regulatorische T-Zellen (Tregs, CD4+CD25hi-Tregs) haben u. a. die Aufgabe, die Immunantwort sowie die Zytokinfreisetzung zu steuern, um die Immuntoleranz gegenüber körpereigenen Antigenen aufrecht zu erhalten. Es wurde beschrieben, dass depressive Patienten eine erniedrigte Konzentration von Tregs aufweisen. Da es Hinweise darauf gibt, dass Zytokine wie Interleukin (IL)-1IL-6 und Interferon (IFN)-eine Rolle in der Pathophysiologie der Depression spielen, und dass sich die Konzentrationen dieser Zytokine während antidepressiver Therapie ändern, untersuchten wir Veränderungen der Produktion von IL-1IL-6 und IFN- und Veränderungen der Konzentration von CD4+CD25hi-Tregs während antidepressiver Therapie. Wir gewannen dazu das Blut von 16 Patienten mit depressiver Störung in der ersten und sechsten Woche nach stationärer Aufnahme, indem wir die Plasmakonzentrationen von IL-1bestimmten. Ferner wurde die Produktion von IL-1, IL-6 und IFN-in einem Vollblut-Assay unter immunologischer Stimulation mit Lipopolysaccharid (LPS) oder Newcastle Disease Virus (NDV) in-vitro gemessen. Die Lymphozyten wurden differenziert und CD4+CD25hi-Tregs mittels Durchflusszytometrie bestimmt. Der psychopathologische Status wurde mit der Hamilton-Depressionsskala (HAMD-21) erfasst. Der HAMD-21-Score, die IL-1-Plasmakonzentrationen sowie die LPS-induzierte IL1-- und IL-6-Produktion waren nach sechs Wochen antidepressiver Behandlung signifikant gegenüber der Baseline erniedrigt. Dagegen stieg der Anteil der CD4+CD25hi-Tregs unter den Lymphozyten von 2,74% ± 0,88 (Mittelwert ± Standardabweichung) auf 3,54% ± 1,21 signifikant (p = 0,007) an. Es fand sich keine signifikante Änderung der NDV-induzierten IFN--Produktion. Der Anstieg der CD4+CD25hi-Tregs während antidepressiver Therapie könnte mit dem Abfall der Zytokinproduktion und der psychopathologischen Verbesserung der Patienten in einem kausalen Zusammenhang stehen.

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.