Symptoms and Theory Application to Depression in Young Adulthood

Symptoms and Theory Application to Depression in Young Adulthood

Order Description

Continue to use the case study of Megan to further develop your understanding of the impact of depression on young adults.

1.two paragraph, identify four or more psycho-social factors that may be contributing to Megan’s depression. Psycho-social factors are often characterized as
situational (environment, relational, circumstance, related to an event) or contextual (cohort, gender, race, ethnicity, sexual orientation, discrimination,
socioeconomic status, and culture). Please identify if the factors you selected from the Megan case would be considered situational or contextual variables. Note:
Sometimes in the literature, psycho-social factors may be referred to as psycho-social stressors. Try not to confuse psycho-social stressors with symptoms of
depression like you would see in the DSM.

2. three paragraphs, apply theory to the case of Megan to help explain her depression. Choose either cognitive theory of depression or interpersonal theory of
depression covered in your readings this week to more deeply understand how Megan’s depression may have evolved.

3.In a sentence or two that concludes Megan case study, make one or two suggestions of something you think would help Megan’s depression




•Common mental health disorder in adulthood; sometimes co-exists with anxiety

•Major depressive disorder affects about 3% of adults; subthreshold, or other minor or clinically relevant depression are more common, especially among older adults

•Younger adults at higher risk, as well


Defining Depression


What do we mean by depression?


A cluster of symptoms in four domains:

•Affective (mood)





Common Signs of Depression


Affective Signs or Symptoms


•Tearfulness, guarded, distracted expression

•Irritability, short temper

•Lack of reactivity — quality of mood

•Not enjoying happy times or usual interests

•Non-variability of mood, flat affect

•Co-morbid anxiety common — panic or generalized worry


Behavioral Signs

•Changes in typical behavior

•Passive and intentional isolation


•Lower activity level than is typical for the individual

•Less self-care

•Saying less than usual


•Crying, sighing, looking pained



Cognitive Aspects



Negative thinking about the self and the situation are a hallmark of depression. Often this thinking is distorted:


•Pessimism about possibilities; hopelessness



•Lack of motivation



•Judging self and actions harshly, feeling worthless



•Lack of self-confidence



•Thoughts of ending pain, going to sleep, or death



•Suicidal ideation or planning



•Excessive worry about mental abilities, memory or concentration problems



•Memory or concentration problems



•Guilt and regret about real or exaggerated wrong-doings



Somatic Aspects of Depression


•Fatigue; psychomotor retardation

•Poor appetite, weight loss (or for some: binge eating, excess substance use/alcohol abuse)

•Insomnia; possible excess daytime sleeping

•Increase in headaches, back aches or digestive distress


Medical Conditions that Mimic or Co-exist with Depression


•Chronic pain, back pain, arthritis

•Parkinson’s disease

•Multiple sclerosis

•Congestive heart failure

•Thyroid problems

•Poor nutrition


Inactivity due to illness can exacerbate mood disorders.


Course of a Depressive Episode


Most depressions develop over a period of a few weeks, gradually worsening. Most of the time, there is a life stressor that triggers the onset, but may be unknown to
the person.


Impact of Depression on Development.

•Make it harder for individual to complete developmental tasks

•Difficult to create a sense of identity/esteem when feeling poorly about self

•Difficult to make life choices and practice human agency

•Stigma of depression


Caution: Confusing Depression and Grief

People experiencing loss or trauma may experience depression or depressive symptoms in the course of their recovery from their grief experience. But we need to be
cautions and consider the context of the person and situation as well as the impact it is having on the individual so we do not pathologize a grief reaction.


Theories to Explain Depression


Diathesis-Stress Model


•Diathesis is a predisposition, or vulnerability, whether constitutional or biological or psychological.

•Stress combined with that predisposition leads to the disorder.

•People find change difficult — transitions or developmental stages when change occurs can challenge individuals and families.


Biological Vulnerabilities


•Genetic predisposition—family members with depression or bipolar disorder.

•Possible reasons, female gender:

?Hormonal fluctuations

?Power and violence issues (victimization)

?Restricted occupational mobility/economic deprivation

?Styles of relating and thinking; stress reactivity

•Physical illness or disabling conditions

•Events that threaten bodily integrity


Psychological Vulnerabilities


•Early major losses or multiple losses

•Severe childhood deprivations (physical, emotional)

•Traumatic events at vulnerable life stages

•Rumination as a way of coping: obsessive thinking, passive coping style

•Internalizing style—blaming self


Social Vulnerabilities


•Social isolation, loneliness

•Loss of significant relationship

•Chronic lack of control of environment

•Chronic stress, difficult social environment

•Family chaos, drug/alcohol abuse

•History of parental neglect


Interpersonal Theories of Depression


Relationship of depression to:•Attachment interruptions or insecure or resistant attachments in early life

•Current or recent interpersonal disputes

•Disappointments or losses of something or someone important


Current experiences bring about repeats of early life experiences/representations of self or others that may be out of awareness (unconscious).



Cognitive Theory


•Depression originates from negative value judgments:

?Maladaptive thinking about the self and others; cognitive distortions

?Most of these: negative and self-blaming thoughts

?Hopelessness, exaggerated pessimism

?Harsh self-evaluations and expectations


•Cognitive structures, or “cognitive schemata,” are set ways of thinking that date from early experiences and are re-interpreted at various stages—deeper beliefs that
become activated and sometimes are very rigid



•Negative bias against the self; self-referential thinking—personalizing failure



?Preoccupation with self-blaming and self-worthlessness



?Arbitrary inference: making worst case assumptions about others’ opinions or motives



Two Treatment Models


Interpersonal Psychotherapy (IPT)


(Harry Stack Sullivan, 1953; Klerman & Weissman, 1984)

•Focus is on current social relationships, using early life material only as it manifests itself in the here and now

•12-16 weekly sessions, structured

•Manuals exist to outline the strategies



•Therapist is active and supportive



•Areas of focus for IPT:






?Interpersonal disputes



?Role transitions




?Interpersonal deficits



•The therapist encourages adaptive behaviors; encourages working out disputes, mourning, etc.



Cognitive-Behavioral Therapy (CBT)


•Structured, usually short-term, but can be one or more years (individual and group methods)

•Introduce behavioral assignments to increase pleasurable activities (The “B” in CBT)

•Patient and therapist monitor thinking to identify automatic thoughts and eventually, the beliefs operating just below the automatic thoughts

•Distorted cognitions are challenged, evaluated and alternative views are considered

•“Cognitive restructuring” works to change cognitive schemas that aren’t functional, or are “depressogenic”—that are overly rigid, harsh, self-deprecating or

•These dysfunctional schemata are replaced with positive, realistic beliefs

•The client is asked to act “as if” these beliefs are not true—try out the restructured cognitions



Megan Case Study


Megan is a 26-year-old, married female with a 2-year-old son. Megan is white and her husband, Marcus, is African-American. They married when she was seven months
pregnant. Megan and her husband each have an associate’s degree. They have been living with his family (mom, grandmother, and two younger siblings) in a third-floor
room with the baby, Javier.


Megan and Marcus have had increasingly severe relationship problems for several years. Megan wanted to wait to get married until after Javier was born and she could
“do it right”—but Marcus and his family wanted to just have a simple wedding and move on. He is working part-time in a hospital as a phlebotomist (drawing blood) and
hopes to get hired full-time. Megan works second shift as an LPN. When neither of them is home, Javier is cared for by Marcus’s grandmother, who is 72. Although the
couple does not see one another too often during the week, when they are together they argue a lot.


Megan has been having headaches and backaches. She gained more than 60 pounds when she was pregnant and has lost only a few pounds of her “baby weight”. Her old
clothes don’t fit. When she is not working, she usually lies on the bed in their room with the TV on, snacking, while Javier plays. Sometimes she falls asleep. She
finds she is impatient with Javier a lot. She has never hit him, but she tunes him out and lets him cry more than she thinks a parent should. She has been sleeping
poorly at night and feels overwhelmed by her marital difficulties, financial problems, and pressures at work. She often ruminates about “why I can’t handle these
things.” She sometimes thinks about dying, though she would not do anything to harm herself or Javier.


She does not have much interest in her friends, in her former activities, in sex with Marcus, or in much of anything. She is tired all the time, she has trouble
concentrating at home and work. She feels numb, or when she has to go out, she feels ashamed of how she looks and her current situation.


Megan’s feelings of depression and anxiety started during her pregnancy when she moved from her parents’ home to her new in-laws’ house. She stated that she often
feels uncomfortable, homesick and trapped. She has no car. Her parents do not like the fact that she moved in with Marcus’s family. But they were not welcoming of
Marcus and Javier into their home so she felt she had no other good option. Megan’s mood reportedly improves when she talks with her best friend from high school or
her sister. Unfortunately, both of them live out of state, and most of their contact is on Facebook or text.


Megan is the elder of two children. Her parents are both in the healthcare field. Her father is a successful pharmaceutical sales person and her mother is a nurse
manager. Megan got involved with a crowd that partied a lot in high school, and for a while she smoked marijuana and even took some of her parents’ pain-killers. She
has been drug-free for about five years but still drinks occasionally. Megan had so-so grades in high school, so her possibilities for college were limited. She was
involved in the choir and the theater and had dreams of being an actress all through high school. After she graduated, she auditioned for plays and other acting jobs
while she worked at a coffee shop, but after three years, her parents did not think she could make a living at acting and offered to support her while she attended
school for something that would earn her more consistent income. She met Marcus in class at the community college she attended for her LPN.


Megan describes her family and Marcus’s family as very different. Her family is small, and they have few relatives locally. Her parents were always very busy with work
and are comfortable financially. Marcus’s family struggles financially, though his mom is now working as a government administrative assistant and doing well. There
are many relatives in and out of the home.


Marcus is also interested in theater and music, so they have that in common, but he seems more content now to do his job and be with his family. He is not too
ambitious for the future. Megan went to school for her LPN because she wanted to please her parents and she was getting tired of working for tips at the coffee shop,
but she does not like her work or feel fulfilled by it. She also does not love being a mom. That is, she loves Javier, but she thinks she is not a very good mother to
him. She tends to be very self-critical and to worry about everything she’s not doing. Megan thinks Marcus is a great dad, but she is not sure what he should be doing
as a husband and she certainly does not feel much like a wife. She did not feel ready to have a baby or to get married, and now in her depressed state, she feels


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