Understanding Depression's Course, Prevalence, Causes & Assessment in Development Models, Slides of Abnormal Psychology

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Models of Development and

Mental Health

Object Relations Model: Depression

Depression

• Low Mood Vs Clinical Depression
• Major Depressive Disorder; Manic Depression (primary mood disorders) Vs

depressive symptomatology as secondary feature

• Unipolar (Depression) – Bipolar (Manic Depression)
• Reactive Vs Endogenous
• Co-morbidity: highest rates between Anxiety Disorders and Major Depressive

Disorders; also high rates between Depression and Conduct Disorder,

Oppositional Defiant Disorder, ADHD, Substance Abuse Disorders and Eating

Disorders

Developmental Course

Preschoolers and younger children:

• irritability and somatic complaints rather than dysphoric mood or hopelessness
• less likely to have sleep disturbances, compared with adolescents
• Developmental constraints, such as language, cognition, memory and self-understanding may compromise the accuracy of assessment of MDD in children (Cicchetti & Toth, 1998)
• Assessment tool: Childhood Depression Inventory

Adolescents:

• more likely to report depressed mood, feelings of hopelessness, and low self esteem. The older the individual, the lower self esteem tends to be in clinical samples.

Adults:

• Sleep, eating, mood, activity levels, suicidal ideation and behaviour

• Risk of suicidal behaviour
  • Approx one third of children with MDD and/or dysthymia at risk for a first suicide attempt by age 17 years (Kovacs et al., 1993)
  • 25%-34% of depressed children and adolescents had attempted suicide Ryan et al. (1987); Approx 50% of those who make one suicide attempt make further attempts (Kovacs et al., 1993; Pfeffer et al., 1991)
  • Fatal suicide in young people linked with MDD. Chance of having MDD 27 times higher among those who committed suicide than among case controls (Brent et al., 1993; Shaffer et al., 1996)
• ‘Developmental Costs’ (Kovacs, 1997)
  • during depressive episode children are removed from normal social experiences that serve developmental function of building social-cognitive and interpersonal skills.
  • Attachment may be disrupted. Depressed children show lack of reciprocity (or negative reciprocity) in interpersonal interactions. May elicit negative parental responses and undermine affective bonds.

Assessment Tool

Houghton, S., McConnell, M. O’Flaherty, A. (1998),

The use of the Children’s Depression Inventory in an

Irish context, Irish Journal of Psychology, 19, 2-3,

pp313-331.

Compared Irish sample to norms, differences in age

and gender

Assessment Tool 2

• Houghton, F.Cowley, H., Meehan, F. &

Houghton, S., Kelleher, K. (2006). The short

4-item Center for Epidemiological Studies

Depression Scale for Children (CES-DC) in

Ireland, Irish Journal of Psychology , 27, 3-4,

pp183-

Object Relations Model

• Freud
  • Importance of the unconscious & Defense mechanisms
  • Depression - Object loss:
    • Those with depressive personality can be identified by their object loss &

distinctive object relations (Huprich, 2001)

• Melanie Klein
  • Paranoid-Schizoid phase
  • Depressive phase
  • Defenses of introjection, splitting and projective identification in both

normal and abnormal development

Donald Winnicott

• The facilitating environment

• The transitional object

• Illusions of omnipotence to gradual

disillusionment

Object Relations & Attachment

• Murray, L. (1991). Intersubjectivity, object

relations theory and empirical evidence from

mother-infant interactions, Infant Mental

Health Journal, 12,

• Study of postnatal depression – linking

attachment theory with OR

Effectiveness

• The outcome measures used to determine

treatment effectiveness generally reflect

changes in behaviour or perceived mental

health as opposed to more basic enduring

changes in personality structure. (Peleikis &

Dahl, 2005)

OR & Research

• When is transference work useful in dynamic

psychotherapy? Gabbard, G. (2006). American

Journal of Psychiatry, 163, 10, pp1667-

(commentary on below article)

• Hoglend et al., (2006) Analysis of the patient–

therapist relationship in dynamic psychotherapy: An

experimental study of transference interpretations

(Rct study)

OR & Research

• Cramer, P. (2002). Defense mechanisms

behavior and affect in young adulthood,

Journal of Personality, 70, 1.