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Abstract
The problem of depression is associated with the matters of inheritance, external factors as well as the ability of a person to cope with stress. Stressful factors are closely linked with the possibility of influencing the emotional condition of a person. As a rule, depression may develop regardless of the ethnic background of a person, however, some researchers claim that some ethnic groups are more subjected to depression. The paper aims to explain the key points of depression as a problem, define its background as well as study questions associated with its origin, curing, and avoiding.
Key Points
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Depression is a common problem
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The primary care setting is more commonly used for the initial diagnosis and treatment of depression than mental health settings.
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Routine screening for depression in primary care settings is less than optimal
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As a result, diagnosing and treating depression in primary care settings could be improved
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Improving the frequency of depression screening in primary care would improve the quality of life for many patients by leading to more timely treatment.
Background Knowledge
Major depression is one of the most commonly encountered conditions in primary care affecting approximately 8% of patients (Andrews, 2001). Almost one out of every five people that visit primary healthcare facilities require medical intervention for depression. Anyone may experience depression, and important concern is that up to 3.5% of depressed people commit suicide. Furthermore, up to 60% of those patients who committed suicide were reported to have severe depression. Although depression can be episodic, approximately 12% of patients who experience depression will have a chronic, unremitting course (World Mental Health Survey Consortium, 2004). Recurrent episodes of depression are harder to cure. Although depression is one of the most common disorders encountered in primary care, many providers fail to routinely screen and treat depression. If more evidence-based care were provided, a significant decline in the rate of disability for patients with depression would ensue (Sanderson et al., 2007).
Diagnosing depression can be challenging for primary care practitioners because many of the symptoms (e.g. fatigue, constipation, sleep disturbance) are common to other illnesses. A variety of symptoms point to depression including sadness, lack of interest in pleasurable activities, acute changes in weight, insomnia, fatigue, and psychomotor agitation. Feelings of guilt or regret, helplessness, hopelessness, and self-hatred also are associated with depression (Frerichs, Aneshensel, 2005). As a rule, primary care providers aim not to aggravate depression symptoms, therefore, their questions may remind of difficult situations and feelings that patients may experience. (Jason, 2005) As for the patients, their apathy may be the largest barrier for therapists, as it prevents patients from defining the actual problem.
Several studies ( Rosenberg, 2002; Pignone et.al. 2002; Eglinton Medical PC, 2010; Cooper, 2002) are dedicated to understanding the nature of depression. Some researchers reveal the racial/ethnic identity of depression as an important factor in the prevalence of depression. (Ellison & Verma, 2003). Hurt (2007), noted that Hispanics of low socioeconomic status and low education level had a higher incidence of depression in comparison with other ethnic groups. However, their psychosocial and emotional stress factors were more complicated in comparison with stress factors of white people. This is explained by the socio-economic status of Hispanics (Hurt, 2007)
Schnittker (2005) emphasizes that the ethnicity of depression is a myth, while depression affects people regardless of their position, job, color of skin, education, religion, etc. Nevertheless, Jason (2005) defined some cultural factors of the problem as risk factors for depression within Hispanics. Additionally, studies by Noh & Kasper (2003); Karlsen & Nazroo (2002) helplessness and alienation from the rest of the world are regarded as the general factors of depression, though research by Romando, (2005) documented the etiology of depression, and he also emphasized the hypothesis that immigrant groups have higher depression rates in comparison with Americans. Keen (2002) and Andrews (2001), in their turn, stated that up to 28% of Hispanics suffered complicated forms of depression. The study by Robison et al. (2002) emphasizes that up to 50% of Puerto Ricans reported depression. 34% of them suffered the DSM-IV level of major depression. Dunlop et al. (2003) reported that 7.3 percent of Hispanic immigrants, 6.8 percent of African Americans, as well as 5.2 percent of White, suffered from all levels of major depression. Summary sentence?
Local Problem
Depression is a significant problem worldwide in terms of prevalence. The World Health Organization (2007; 2003) predicts that by the early 2020s depression will be second only to ischemic heart disease and will become a global burden of disease.. Lifetime prevalence levels from community-based surveys range from approximately 5 to 17% (Pignone, et al., 2002).
Any cause of depression is explained by some external event that stimulates depression development. As a rule, chronic illness is closely linked with problems about other people, financial problems, disease, etc. Sometimes, genetic inheritance and external factors act together. Stress factors act selectively, as some people are more subjected to the negative influence of one group of factors, while the others require stimulants of other nature. (Simon, 2004)
Another factor of depression aggravation and development is associated with the socioeconomic status of a person. , Lorant and Deliege (2009) emphasize that low socio-economic status causes poor resistance to psychological risk factors, consequently, this status is often regarded as immunity against depression and psychological problems. However, a comparison of two different groups of patients revealed that the difference between patients of lowest and highest socioeconomic statuses is not essential (1.24 and 1.81 of odds ratios correspondingly).
Intended Improvement
The purpose of this project is to implement a brief 2-item questionnaire for depression screening in a primary care practice. A secondary aim is to evaluate the acceptability and effectiveness of the screening tool in a culturally and ethnically diverse patient population. The second objective of this research study is to examine whether race/ethnicity impacts self-reported depressive symptoms in the primary care population. Participants will be recruited from Eglinton Medical, Crystal Ray primary, and Physical therapy offices. The identification of the problem and its scope may be effective for early identification and management of depression with people. This may not only decrease the substantial morbidity associated with the current episode but may also decrease the likelihood that the illness will become chronic.
Study Questions
This research is aimed at considering the problem of depression and the incidence in primary care practice. It is important to realize that early identification of the depression symptoms helps to avoid problems and complications in the future. The main problems which are going to be considered in the study are as follows. The study is designed to:
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Describe the incidence of depression in an ethnically diverse primary care practice;
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To evaluate the acceptability of depression screening among an ethnically diverse patient population in the New York metropolitan area.
Ethical Issues
Procedure
Participants for the study will be recruited from Eglinton Medical and Crystal Rays primary physical therapy offices. Initially, informed written consent will be obtained from all willing participants. After obtaining socio-demographic and clinical data, a self-administered PHQ-2 will be completed. It will take 1 min to complete a 2-item questionnaire. For those individuals who answer yes to at least one of the questions, the Beck Depression Inventory will be administered. This involves test questions worked out by Beck which are aimed at studying the depression depth. Medical records of those who meet the diagnostic criteria for depression will be reviewed for previously diagnosed depressive disorders, and patients will be referred to a psychiatrist for evaluation and treatment.
Setting
Eglinton Medical and Crystal Ray Medical are private clinics that are aimed at providing primary medical care services which include: internal medicine, physical therapy, occupational therapy, herbal medicine, massage therapy, occupational therapy, pain management.
Planning the Intervention
Convenience sampling will be used to enroll 100 adults, who visit Englinton Medical P.C and Crystal Ray medical P.C for their routine care. This study aims to find the relationship (non-directional) between two sets of questionnaires, with a predetermined effect size of r =.30 (medium), a significant alpha =.05, and a statistical power of.80, the desired sample size to test these relationships as indicated in Table 3.4.1 is 85 (Cohen,1992). This means that 85 respondents are sufficient to perform this statistical analysis. A total of 100 participants will be recruited in this research study, to provide a more effective sample. Participants will be recruited from Eglinton Medical P.C and Crystal Ray medical P.C offices, where patients receive physical therapy as a result of MVC. An inclusion criterion includes the following: cognitively intact, speaks and understands English, hearing intact.
The PHQ-2 screen will be scored by summing the affirmative responses, with scores ranging from 0-6. On the Beck Depression Inventory, participants will be scored positive for symptoms when the sum of the intensity and frequency will measure 15 or greater.
Spearman rank correlation will be calculated to assess test-retest reliability for an ordinal scale, while kappa coefficients will be used to determine agreement for individual items.
Planning the Study of the Intervention
A quantitative research design will be used for this study. The study will consist of three steps, the first being a short set of questionnaires on socio-demographic and clinical data, the second 2 item Patient Health Questionnaire. Those who will answer yes to at least one of the questions in the 2-item Patient Health Questionnaire will proceed to step three, where they will answer 21 questions form Beck Depression Inventory.
100 adults are interviewed by in 2-item Patient Health Questionnaire. Those who answer affirmatively on at least one question are going to be asked to answer 21 questions from Beck Depression Inventory. The information is going to be analyzed through the reference to people who are most affected by stress and depression based on their ethnic origin.
Being aware of the patients socio-demographic and clinical data and their current attitude to stressful and depressive situations, it is possible to consider the changes which may be applied to make the expected changes. All the possible symptoms as well as the intensity of the depression level tend to decrease if the patients social environment provides the necessary support based on empathy (Bruce, et al. 2004). The mechanism (Beck Depression Inventory) implemented by Aaron T. Beck is going to be the main mechanism for measuring depression.
Applying this mechanism on experiment subjects, we are going to check the level of depression of people and to understand where the line when these people are not affected by stress. This mechanism may help prevent people from stress and make the rehabilitation process easier. Hence, as Keen (2002, p. 451) stated:
Feeling sad is a normal part of life, especially following an event like the loss of a loved one or a job. It is a normal reaction to experiences that are stressful or upsetting. Feeling sad is a part of a healthy adjustment to a loss or disappointment, and a part of the healing process, but depression can be harmful.
The study design is observational research that predicts the questionnaire of the patients in two city clinics. This research is going to affect the primary outcomes which should be the basis for another research focused on the specific measures taken for treating people subjected to depression. It should be stated one more time that medical records will be reviewed for previously diagnosed depressive disorders to those who will meet the diagnostic criteria for depression, and patients will be referred to a psychiatrist for evaluation and treatment.
Reference List
Andrews, G. (2001). Should depression be managed as a chronic disease? BMJ, 322 (7283), 419421.
Bruce, M. et al. (2004). A randomized trial to reduce suicidal ideation and depressive symptoms in older primary care patients: The prospect study. Journal of the American Medical Association, 291, 1081-1091.
Cooper, R. et al. (2002). Economic and demographic trends signal an impending physician shortage. Health Affairs, 21 (2), 140-154.
Dunlop, D. D., Song, J., Lyons, J. S., Manheim, L. M., & Chang, R. W. (2003). Racial/ retirement adults: Ethnic differences in rates of depression among pre- retirement adults. Public Health, 93, 1945-1952.
Ellison, J. M. & Verma, S. (Eds.). (2003). Depression in Later Life: A Multidisciplinary Psychiatric Approach. New York: Marcel Dekker. Did you use a specific chapter? Your literature should be primary research sources.
Englinton Medical PC. (2010). HealthGrades. Web.
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Hurt, N. E. (2007). Disciplining through Depression: An Analysis of Contemporary Discourse on Women and Depression. Womens Studies in Communication, 30(3), 284.
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Keen, E. (2002). Depression: Self-Consciousness, Pretending, and Guilt. Westport, CT: Praeger.
Lorant, V., Deliège, D., (2009) Socioeconomic Inequalities in Depression: A Meta-Analysis American Journal of Epidemiology, Vol 157, Issue 2, Pp. 98-112.
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Pignone, M. et al. (2002). Systematic Evidence Review. North Carolina: Research Triangle Park.
Robison, J., Gruman, C., Gaztambide, S., & Blank, K. (2002). Screening for depression in middle-aged and older Puerto Rican primary care patients. The Journal of Gerontology.
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Romando, J. (2005). The perceived effects of social alienation on black college students enrolled at a Caucasian southern university. College Student Journal, 52, 238-269.
Rosenberg, E. (2002). The Tyranny of Diagnosis: Specific Entities and Individual Experience. Milbank Quarterly, 80, 237-60.
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Schnittker J. (2005) When mental health becomes health: Age and the shifting meaning of self-evaluations of general health. The Milbank Quarterly, 83 (3), 397-423.
Simon, G. et al. (2004). Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial. Journal of the American Medical Association, 292, 935-42.
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