NR 503 Week 6 Chronic Health Paper

Chronic conditions are the leading causes of premature deaths, disability-adjusted life years (DALYs), and increased care costs. Raghupathi & Raghupathi (2018) define a chronic condition as “a physical or mental health condition that lasts more than one year and causes functional restrictions or requires ongoing monitoring and treatment” (p. 1). The World Health Organization [WHO] (2022) categorizes these conditions as noncommunicable diseases (NCDs).

Depression is among the most common and burdensome chronic conditions, considering its prevalence and adverse effects, such as premature deaths associated with suicide, functional impairments, disability, and the high cost of preventive and management care. Mayo Clinic (2022) presents depression as a multifactorial condition whose clinical manifestation includes anxiety, feeling of helplessness, reduced appetite, irritability, frustration, and sleep disturbances.

These symptoms exacerbate adverse complications, including suicidal thoughts, self-harm, alcoholism, family conflicts, and premature deaths. The purpose of this paper is to comprehensively discuss the epidemiology of depression, including the background and significance of the disease, surveillance and reporting, epidemiological analysis, screening and guidelines, and an evidence-based plan for preventing depression.

Background and Significance of Depression

Definition

Depression lacks one standard definition due to the presence of various clinical manifestations and risk factors. However, Chand & Arif (2022) define it as “a mood disorder that causes a persistent feeling of sadness and loss of interest.”

Additionally, Chand & Arif (2022) contend that the fifth edition of the American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders (DSM-5) categorizes depressive disorders into various classifications, including persistent depressive disorder (dysthymia), a depressive disorder associated with medical conditions, disruptive mood dysregulation disorder, and premenstrual dysphoric disorder.

Although these categories of depressive disorders signify different causal factions and risks, they share similar signs and symptoms, including somatic and cognitive changes, as well as mood alterations (Chand & Arif, 2022). The presence of similar signs and symptoms across the five classes of depressive disorders enables healthcare professionals to adopt comprehensive screening tools and develop informed care plans for people with depression.

Description

The etiology of depression entails the interplay between genetic and environmental factors, rendering it a multifactorial condition. Although the exact causes of depression are subjects of scientific scrutiny, there are clear associations between major depressive disorders and multiple genetic and environmental risk factors.

According to Mayo Clinic (2022), aspects that increase the individual propensity to depression are traumatic or stressful events, a family history of depression, bipolar disorder, alcoholism, and the effects of some medications, such as sleeping pills and hypertension medications.

Equally, depression can emanate from multiple social issues. Mayo Clinic (2022) identifies personality traits like low self-esteem, abuse of recreational drugs, and social stigmatization due to individual sexual orientation and other variations as significant causes of depression. Finally, people with underlying medical conditions like chronic diseases are likely to suffer from depression due to overdependence on medications, health deterioration, disease-induced disability, pain, and suffering.

Besides these environmental and genetic risk factors, age and gender are equally essential when determining individual susceptibility to depression. In this sense, women and adults are more susceptible to major depressive disorders than children and men. The disproportionate effects and prevalence of depression rely massively upon the individual propensity to social, genetic, and environmental risk factors. For example, women are more likely to encounter depression emanating from domestic violence than men.

Signs and Symptoms

Although the DSM-5 classifies major depressive disorders into five categories, they share similar clinical manifestations, signs, and symptoms. According to the World Health Organization [WHO] (2021), people with depression experience mood alterations that manifest as a feeling of helplessness, irritability, loss of pleasure or interest in activities, and the perception of worthlessness. Besides these symptoms, depression manifests through various bodily signs, including fatigue, pain, and weakness.

Equally, major depressive disorders result in functional declines, relational issues like difficulties establishing a personal, family, and social relationships, and a decline in occupational and educational performance (World Health Organization, 2021). Other common symptoms of depression are insomnia, changes in weight and appetite, and suicidal thoughts that emerge as the primary cause of premature mortalities for people with depression.

People with depression demonstrate different patterns of mood disorders despite exhibiting common signs and symptoms. According to the World Health Organization (2021), it is possible to categorize depressive episodes as mild, moderate, and severe consistent with the number and severity of the reported symptoms. Equally, the symptoms’ impacts on the individual’s functioning can determine the level of depressive episodes.

In the context of defining the patterns of mood disorders in people with depression, single episodes, recurrent depressive disorder, and bipolar disorder emerge as three primary themes for categorizing depressive episodes. In this sense, bipolar disorder remains the most adverse pattern of major depressive disorder characterized by periods of manic symptoms, including increased activity, increased talkativeness, racing thoughts, impulsive behaviors, insomnia, and distractibility (World Health Organization, 2021). These symptoms prompt healthcare professionals to implement strategies for improving patient outcomes and averting depression-related complications.

Incidence and Prevalence Statistics

Major depressive disorders remain a significant public health concern in the United States and California. According to the National Institute of Mental Health [NIMH] (2022), about 21 million adults in the United States had at least one major depressive episode in 2020, representing approximately 8.4% of all US adults.

In the same vein, the prevalence rate of major depressive episodes was highest among adults aged 18-25 years (17.0%). Adult females (10.5%) were more susceptible to depression than males (6.2%) (National Institute of Mental Health, 2022). Further, 2020 statistics revealed the disproportionate prevalence of depression based on ethnicity and race. In this sense, adults of two or more races were the most vulnerable group (29.9%), followed by White (18.7%) and Hispanic (15.7%).

The COVID-19 pandemic exacerbated the major depressive episodes in California and the United States. According to KFF (2021), about 31.6% of adults in the United States reported various symptoms of anxiety and depressive disorder, including insomnia and mood alterations, representing a prevalence rate of more than three in ten adults. Compared to the United States, about 32% of adults in California reported different episodes of depression, such as anxiety.

Further, in the state, 6.7% of adults (aged 18 years and over) reported alcohol use disorder in the past year (2018-2019) compared to 5.7% in the United States (KFF, 2021). Between 2018 and 2019, about 4.5% of adults in California grappled with suicidal thoughts, a rate which was similar in the United States (4.6%). Based on such statistics, it is valid to argue that California bears a massive burden of depression and its predictors, like the proliferation of suicidal thoughts.

Despite the availability of statistics regarding the prevalence of depression in California and the United States, there are unaddressed information gaps that require statistical input. For instance, identifying a comprehensive dataset for depression prevalence and incidences in the state is a daunting process. Therefore, these information gaps can jeopardize an analysis of the state’s performance consistent with national performance benchmarks and metrics.

Social Determinants of Health

Social determinants are circumstances in the environment where people live and work that shape their health and wellness. According to Alegria et al. (2019), these social determinants of health cause underlying health inequalities and exacerbate adverse ramifications, including lower life expectancy, the massive economic burden of diseases, and increased mortality rates.

In the context of major depressive disorders in California and the United States, core determinants of individual propensity to the disease include employment status, poverty, infrastructural deficiencies, sociocultural contexts like discrimination, and the level of educational attainment. These aspects determine the individual level of exposure to causal factors for depression and the capacity to implement self-management interventions for preventing and managing major depressive disorders.

In California, various factors increase people’s susceptibility to stress and depression. For instance, about 10% of adults are tobacco users, while 26% of adults grapple with adult obesity. In the same vein, excessive drinking affects approximately 19% of adults in California state (County Health Rankings & Roadmaps, 2022).

Equally, socioeconomic factors can determine people’s vulnerability to major depressive episodes. For example, the rate of unemployment in the state is about 10.1% compared to the national rate of 8.1%. Equally, about 15% of children live in poverty, while income inequality affects approximately 5.1%. 57% of African Americans in California face residential segregation. The interplay between economic and social factors results in increased rates of major depressive disorders in California and the United States.

Surveillance and Reporting

Although depression poses a significant health concern to Americans, about 60% of people with symptoms of depression do not understand the thresholds for quality care or seek medical interventions. The underlying disparities in care accessibility and poor health literacy are among the factors that lead to fewer people seeking professional interventions for treating and managing depression. As a result, the US government supports widespread surveillance and reporting measures.

According to the Centers for Disease Control and Prevention [CDC] (2022), the most profound surveillance and reporting systems for depression and other mental disorders include Behavioral Risk Factor Surveillance System (BRFSS), Household Pulse Survey, National Health and Nutrition Examination Survey (NHANES), and National Health Interview Survey (NHIS). These surveillance systems monitor depressive symptoms, mental illness and stigma, trends in mental health, challenges in accessing psychiatric care, health insurance coverage, mental health service use, and people’s nutritional status.

Epidemiological Analysis

Major depressive disorders result in multiple negative effects, including a massive economic burden on healthcare systems, premature deaths, disability-adjusted life years (DALYs), and altered educational and occupational functioning. According to Greenberg et al. (2021), the economic burden associated with depression has significantly upsurged from $236 billion in 2010 to $326 billion in 2018.

The costs of depression cover various aspects, including direct costs of care delivery, suicide-related burden, and work absenteeism. The prevalence, effects, and incidences of major depressive disorders are relatively disproportionate to people with specific modifiable and non-modifiable factors. For example, individuals aged 18-25 years are most susceptible to depression (17%).

Adult females are more vulnerable to depression than males (10.5% and 6.2%, respectively) (National Institute of Mental Health, 2022). Equally, ethnicity is a non-modifiable factor for depression, where people of two or more races are the most vulnerable population in the United States (29.9%), followed by White (18.7%) and Hispanic (15.7%).

Individual propensity to depression is consistent with the prevailing social determinants of health (SDOH) that contribute to preventable disparities and health gaps. According to Prencipe et al. (2021), multivariate social, cultural, environmental, and economic issues that increase depression prevalence include poverty, education level, employment status, self-esteem and locus of control issues (LOC), exposure to violence, stigma, poor neighborhood, and access to drugs.

Equally, the prevailing cultural beliefs that anchor masculinity and discrimination can contribute to depression. Further, social issues, such as failed marriages, disrupted schooling, adolescent pregnancy, and relationship difficulties, are significant causal factors for major depressive disorders. As a result, preventive and management actions should focus on addressing modifiable factors and poor social determinants of health.

Screening and Guidelines

The international screening guidelines for major depressive disorders rely massively upon self-reported symptoms. Maurer et al. (2018) discuss different screening and diagnostic scales for major depressive disorders. These screening instruments include the Patient Health Questionnaire (PHQ), the Five-Item Geriatric Depression Scale, the 15-item Geriatric Depression Scale, and the DSM-5 Diagnostic Criteria for Major Depressive Disorders.

Other assessment instruments include Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D), Social Problem-Solving Inventory, Children’s Depression Inventory (CDI), and Reminiscence Functions Scale (RFS).

Psychiatrists should use screening instruments that are accurate and specific to the symptoms of major depressive disorders to improve depression diagnostics. The Patient Health Questionnaire (PHQ-9) is a reliable scale for screening depression by scoring 9 items in the DSM-5 criteria.

These items are little interest or pleasure in doing things, feeling down or depressed, insomnia, feeling tired, loss of appetite, self-blame, alterations in movement and speech, and suicidal thoughts. Patients can score a maximum of three points in each item, enabling healthcare professionals to categorize depressive episodes based on a 27-score scale.

The scale is relatively cost-effective because it entails self-administered questionnaires and simple items that guarantee tentative and reliable results regarding the severity of depression. Negeri et al. (2021) conducted a systematic review and data meta-analysis to establish the sensitivity and specificity of the PHQ-9 scale. The study revealed that this scale had a sensitivity of 85% and specificity of 85%, depending on the sample size and the cut-off value.

On the other hand, Levis et al. (2021) argue that the PHQ-9 screening instrument has a positive predictive value of 52%. Although different studies record differing findings of the PHQ-9 test’s sensitivity, specificity, and positive predictive value, it is valid to argue that this scale is reliable and relatively accurate in determining the severity of depressive symptoms.

A Plan for Addressing Depression

Healthcare professionals play a significant role in preventing, treating, and preventing major depressive disorders. Their roles and responsibilities in reducing the prevalence of reported depressive episodes fall under three levels of prevention; primary, secondary, and tertiary. According to Singh et al. (2022), primary prevention for depression entails early interventions such as health promotion and educating people about risk factors and preventive approaches for depression.

On the other hand, secondary prevention focuses on intercepting the disease’s progression by conducting early diagnosis and treatment, rehabilitation, and disability limitation. Finally, tertiary prevention aims at alleviating further complications, preventing disability, and reducing mortality associated with major depressive disorders (Singh et al., 2022).

At this point, healthcare professionals can implement pharmacological and non-pharmacologic approaches and develop follow-up plans to ensure adherence to treatment options. When engaging in primary, secondary, and tertiary prevention for depression, it is essential to involve at-risk people and patients in collaborative care plans for addressing social determinants of health, reducing symptoms of major depressive episodes, and preventing adverse complications associated with depression.

Summary/Conclusion

Depression is a burdensome chronic condition that manifests through alterations in moods and functions. Major depressive disorders are among the leading causes of premature deaths associated with suicide, disability, functional declines, and increased care costs. The disproportionate nature of depression prevalence, incidences, and effects prompts measures for identifying and addressing poor social determinants of health and risk factors that contribute to people’s propensity to this condition.

Healthcare professionals ensure primary, secondary, and tertiary prevention of major depressive disorders. They implement early screening, community health promotion programs, rehabilitative therapies, and phonologic interventions for improving depressive symptoms.