Reflections on Reflections on DepressionDepression

Hilary BradleyHilary BradleyCheryl WoolleyCheryl Woolley

Dave ClarkeDave Clarke

Presentation OutlinePresentation Outline

This Study

Method and Analytical ApproachAnalytical Approach

Results

LimitationsLimitations

Conclusions

This StudyThis Study Much is known about the prevalence of

depression, but little about the qualitative experiences of people who have experienced depression.

This study explores the experiences of previously clinically depressed adults in New Zealand.

It is unique in that this group of people were able to reflect on what depression meant to them – causes, coping strategies etc. - from their current non-depressed outlook.

MethodMethodParticipants 13 volunteers – 5 women, 8 men All had DSM-IV diagnosis of unipolar depression at the beginning of

a Dietary Intervention Study (DIS) Present research utilised interview data collected one year after

completion of that study

Data Collection Semi-structured in-depth interviews by independent interviewer Explored perceptions of causes of depression, attachment, earliest

recollections, trauma, school life, changes since original study, aspects of original study that were helpful

Analytical ApproachAnalytical Approach

Thematic Analysis

Flexible

Inductive latent analysis

Six phases of thematic analysis (Braun & Clarke, 2006)

Predominant Predominant ThemeTheme

Stress and AnxietyStress and Anxiety

QuoteQuote

““I just put it down to being so stressed out, not I just put it down to being so stressed out, not coping. Yeah. It’s many factors but putting coping. Yeah. It’s many factors but putting your finger on it, I don’t know”your finger on it, I don’t know”

““If I’ve got assignments due or lots of stuff If I’ve got assignments due or lots of stuff happening that I can’t control then I’ve noticed happening that I can’t control then I’ve noticed that like, at Teachers College when I was that like, at Teachers College when I was actually there full time, it triggered it again and actually there full time, it triggered it again and I just couldn’t cope and I had to get sleeping I just couldn’t cope and I had to get sleeping pills and things so I could sleep...”pills and things so I could sleep...”

Common Sub ThemesCommon Sub Themes

Early TraumaEarly Trauma

BulliedBullied

AttachmentAttachment

AvoidanceAvoidance

Early TraumaEarly Trauma

11/13 perceived to have experienced 11/13 perceived to have experienced childhood traumachildhood trauma

Earliest memoriesEarliest memories

Childhood illnessChildhood illness

Multiple traumas including loss and Multiple traumas including loss and adjustmentadjustment

Loss of SupportLoss of Support

““...I have come to the conclusion that I was ...I have come to the conclusion that I was suffering from a degree of depression at suffering from a degree of depression at that period I left home and got to that period I left home and got to Auckland. I had no social network up there Auckland. I had no social network up there at the time. I was boarding rather than at the time. I was boarding rather than flatting. I was an 18 year old, flatting. I was an 18 year old, fundamentally lonely I suppose for those fundamentally lonely I suppose for those first few months...”first few months...”

BereavementBereavement

INT: INT: “You had a couple of fairly major traumas “You had a couple of fairly major traumas happen when you were younger. You had a happen when you were younger. You had a friend who was killed. How did that affect friend who was killed. How did that affect you?”you?”

““Um, quite bad. I can still remember just about Um, quite bad. I can still remember just about everything that happened that afternoon. It everything that happened that afternoon. It would have been 10 years ago last would have been 10 years ago last week...Pretty messed up...I didn’t sleep for week...Pretty messed up...I didn’t sleep for God knows how many days, let alone eat.”God knows how many days, let alone eat.”

BulliedBullied

9/13 bullied at school9/13 bullied at school

Attribute to cause of depressionAttribute to cause of depression

““That’s a good question. Probably fairly young. That’s a good question. Probably fairly young. Probably just before or just after I started Probably just before or just after I started primary school maybe. Just when the bullying primary school maybe. Just when the bullying started.”started.”

Bullied Cont.Bullied Cont.

Bullied as source of angerBullied as source of anger Not changed over last generation – needs Not changed over last generation – needs

to be addressedto be addressed “…“…because when you’re bullied you do get because when you’re bullied you do get

a lot of anger and I have kids in my class a lot of anger and I have kids in my class who are bullied at school and they have so who are bullied at school and they have so much anger and it reminds me so much of much anger and it reminds me so much of me.”me.”

Linked to suicidality?Linked to suicidality?

Negative Attachment Negative Attachment StylesStyles

Overprotected – dependencyOverprotected – dependency ““Because when you are in formative years doing those Because when you are in formative years doing those

things are part of growing up and you’re forming your things are part of growing up and you’re forming your own personality but if they are suppressed, physical or own personality but if they are suppressed, physical or mentally, then you don’t develop them and so therefore I mentally, then you don’t develop them and so therefore I believe it has an effect on my total overall depression.”believe it has an effect on my total overall depression.”

““Oh because I was a soft touch. Because I was Oh because I was a soft touch. Because I was mollycoddled at home...It was certainly a desire on the mollycoddled at home...It was certainly a desire on the part of the bullies to dominate and I was a subject that part of the bullies to dominate and I was a subject that wasn’t too difficult to dominate at the time I think.”wasn’t too difficult to dominate at the time I think.”

Attachment Cont.Attachment Cont.

Poor communication/conflictPoor communication/conflict

Father’s expected therefore acceptedFather’s expected therefore accepted ““No. I never really talked to him”; “He was so busy No. I never really talked to him”; “He was so busy

making ends meet”; “working such long hours at making ends meet”; “working such long hours at work...he was just too tired to be dealing with us...”work...he was just too tired to be dealing with us...”

Abuse, mostly parental, mostly emotionalAbuse, mostly parental, mostly emotional

Problematic sibling relationshipsProblematic sibling relationships

AvoidanceAvoidance Avoiding situations that cause distress – Avoiding situations that cause distress –

ignoring stress increased its intensityignoring stress increased its intensity

Dependence on significant othersDependence on significant others

Hiding and escapingHiding and escaping

Avoid confrontationAvoid confrontation

Often starting at school or beforeOften starting at school or before

QuoteQuote

““I, um, would hide pretty much. Try to I, um, would hide pretty much. Try to escape things. I am not one for escape things. I am not one for confrontation. I don’t like it so yeah, my confrontation. I don’t like it so yeah, my friend and I, at school, we would just try to friend and I, at school, we would just try to stay away from the other girl who was stay away from the other girl who was bullying me because it was just easier and bullying me because it was just easier and even now I think I still try to avoid things if even now I think I still try to avoid things if I’m not comfortable with it, try to stay away I’m not comfortable with it, try to stay away from it.”from it.”

DiscussionDiscussion Perceived stress and factors associated with it Perceived stress and factors associated with it

strongly correlated to clinical depressionstrongly correlated to clinical depression GP’s prescribing anti-depressants without GP’s prescribing anti-depressants without

addressing causesaddressing causes Stress can be successfully addressed at school Stress can be successfully addressed at school

levellevel Bullying needs to be addressed in schoolsBullying needs to be addressed in schools Social components including context rather than Social components including context rather than

biological or medical modelbiological or medical model

ContextContext

““I think being able to talk about it. You know, the idea, I think being able to talk about it. You know, the idea, because I don’t you see, I keep it to myself and I have because I don’t you see, I keep it to myself and I have also tried talking it over with my doctor and also a doctor also tried talking it over with my doctor and also a doctor I have got here and it’s clear cut they’ve got no bloody I have got here and it’s clear cut they’ve got no bloody idea of what I’m talking about, you know because, you idea of what I’m talking about, you know because, you know, the first time I tried to talk about that problem, I know, the first time I tried to talk about that problem, I mean, the psychologist gave me a book to read and that mean, the psychologist gave me a book to read and that was just, I mean you had to be frigging stupid to come was just, I mean you had to be frigging stupid to come up with that as a possible solution to someone who’s up with that as a possible solution to someone who’s saying “I don’t study”. That book caused me heaps of saying “I don’t study”. That book caused me heaps of problems!”problems!”

LimitationsLimitations

Small sample sizeSmall sample size

Emotional content difficult to ascertainEmotional content difficult to ascertain The presence of the interviewer may have The presence of the interviewer may have

influenced their responses.influenced their responses. Participants had regular contact with Participants had regular contact with

previous researchers which might previous researchers which might influence how they currently perceive their influence how they currently perceive their depression.depression.

ConclusionsConclusions Perceived stress, anxiety, trauma, avoidance, Perceived stress, anxiety, trauma, avoidance,

loss and bullying strongly correlate to clinical loss and bullying strongly correlate to clinical depressiondepression

Social components including contextSocial components including context Bullying needs to be addressedBullying needs to be addressed Relapse likely if social issues are not addressedRelapse likely if social issues are not addressed Research the role of avoidance with regard to Research the role of avoidance with regard to

depressiondepression Anxiety or depression?Anxiety or depression?

ReferencesReferences

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, Qualitative Research in Psychology, 3, 77-101.77-101.

Fight Crime: Invest in Kids. (2003). Bullying prevention is crime prevention. Retrieved May 15, 2008, from http://www.fightcrime.org/reports/BullyingReport.pdf.

Goldstein, B., & Roselli, F. (2003). Etiological paradigms of depression: The relationship between perceived causes, Goldstein, B., & Roselli, F. (2003). Etiological paradigms of depression: The relationship between perceived causes, empowerment, treatment preferences, and stigma. empowerment, treatment preferences, and stigma. Journal of Mental Health, 12Journal of Mental Health, 12(6), 551-563. (6), 551-563.

Granek, L. (2006). What’s love got to do with it? The relational nature of depressive experiences. Granek, L. (2006). What’s love got to do with it? The relational nature of depressive experiences. Journal of Journal of Humanistic Psychology, 46Humanistic Psychology, 46(2), 191-208. (2), 191-208.

Katz, D. (2007). The right Rx for sadness. U.S. News & World Report, 143(4), 58-61.

Moffitt, T.E., Caspi, A., Taylor, A., Kokaua, J., Milne, B.J., Polanczyk, G. & Poulton, R. (2009). How common are Moffitt, T.E., Caspi, A., Taylor, A., Kokaua, J., Milne, B.J., Polanczyk, G. & Poulton, R. (2009). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. retrospective ascertainment. Psychological Medicine 1Psychological Medicine 1, 1-11., 1-11.

Oakley-Brown, M.A., Wells, E., Scott, K.M., & McGee, M.A. (2006). Lifetime prevalence and projected lifetime risk of DSM-IV disorders in Te Tau Hinengaro: The New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry, 40, 865-874.

Hilary.Bradley@bopdhb.govt.nz