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Depression and the social stigma amongst Asians

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By: Aliena Mahmood

Psychology student Aliena Mahmood talks about the “hush…hush” approach in Asian families when it comes to mental health issues

Recently my attention was drawn to how we deal with depression. Being British Pakistani myself, I have grown up to understand both cultures, Western and Eastern, and the distinct differences between them.

Experts say symptoms of depression can be characterised by feeling down, loss of interest in activities, significant change in sleeping and/or eating patterns, increased agitation, and fatigue, feeling sad or hollow and in some cases, suicidal thoughts.

Depression is a predominant mental health worldwide issue, but does the South Asian community really understand depression?

Depression has been looked down upon in our community. It’s not truly understood of how significant the impact can be on someone’s life, particularly people from an older generation, who see mental health as irrelevant perhaps, or a common response being “it’s all in your head”.

It is important not to diagnose yourself or even someone else, but it is crucial that we are aware of the symptoms so that we can recognise the signs.

Often among Asians, if we hear of someone with depression, their family is scrutinised or said to be far from their religion. There are even instances where due to one person’s mental health, a marriage within that family would be “shameful”. This noxious outlook must be eradicated.

By speaking to other students, I have recognised that many do not speak or confide in their families. They are therefore suffering alone, the stigma which would be inflicted on them is enough to not speak out.

I recently witnessed the impact of this stigma when a friend of mine experienced the over-bearing harshness of her family as she expressed her views on her mental health and how she may be suffering from depression. Fingers pointed to her not praying enough or over-over-thinking things in her own head.

But as a 17-year-old student, with the pressures of education, parents marital issues, financial worries and the constant feeling of “hopelessness”, her problem was bigger than a simple “misunderstanding”.
She told me how she had no one to turn to in her family. She did however often confide in me, telling me “I feel alone, and sometimes I don’t want to feel at all”.

As her friend, this impacted me heavily and I felt I had to step in and urge her to speak to a school counsellor or her doctor.

Soon after being diagnosed with depression, she was given the correct guidance that she so desperately needed. Her quality of life eventually improved.

It angered me that as adolescents we cannot speak to our own families about our concerns, social desirabilities, peer-pressures and above all how we appear in the eyes of others from the same ethnic background as ourselves.

Our culture is brutal towards those with poor mental health, due to this societal construct many individuals do not reach out for help.

Almost 90 per cent of all individuals who have had mental health problems report they have suffered stigma and discrimination.

There is no single cause of depression, and no single cure. It is vital that we become more open minded. Adolescents are heavily affected due to the immense work load and social standards they feel they must meet i.e. the influence of social media and body image.

We look down upon the idea of therapists and it is often considered a taboo to consult one.

Around 75% of young people with a mental health problem are not receiving treatment; it is not something that will go away overnight, but there are solutions, talk therapies such as cognitive behavioural therapy, mindfulness and interpersonal therapy are all recommended by the National Institute of Health and Care Excellence.

As a Psychology student, I have become progressively interested to understand how the human mind functions, and how our behaviour can impact people around us.

By changing our views on mental illnesses such as depression, we can destroy toxic societal attitude towards it, and begin to help those who suffer from the constant over shadowing they feel they cannot get rid of.

If you have any concern about someone’s mental health urge them to seek advice from their GP.

Is your 14-year-old daughter battling depression?

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University academics reveal that one in four young teenage are suffering

More than 230,000 youngsters under the age of 14 are battling depression, with more than two-thirds of sufferers believed to be girls according to researchers. It’s estimated that around 166,000 girls and 67,000 boys of that age across the UK are depressed.

It comes following a recent study by academics at University College London and the University of Liverpool.

Worryingly, they concluded that one in four girls have depression by the time they hit 14.

This has been put down to body image, bullying and social media – each of which can have a huge impact on young people’s mental health.

It is estimated that 24 percent of 14-year-old girls and nine percent of boys the same age have depression.

The study suggests that parents underestimate the signs of depression among teenage girls, although overestimate how common the condition is among boys that age too.

Counselling Directory member and psychotherapist Christine Fortune has revealed that significant changes in behaviour can be a cause for concern.

Teenagers will rely on parents, teachers or other adults around them to notice their suffering and help them find the support they are seeking. But that isn’t always easy. However, if you think your child is depressed, there are ways you can support them.

Don’t forget to be aware of the effect on your own feelings as an adult, if you feel you need it, seek support for yourself.

Adolescence is a time when your child is trying to become independent of you and as part of this separation process, she may say hurtful and painful things and her growing independence can lead to a sense of loss.

If your daughter is depressed you may feel that you are not doing enough, that it is your fault or that you need to do something to make her feel better. Always remember you will be doing enough by being there for her and letting her know she is loved.

If you are struggling with your child being depressed or you’re seeking support for your child, consider speaking to a professional. You can find a registered psychotherapist or counsellor in your local area by using Counselling Directory, or through your doctor.

 

 


 

How to support your daughter with depression

  • Be available to listen and encourage her to talk, especially about how she feels and her concerns. Avoid giving advice, telling her not to worry or making judgements – acknowledge how she feels, give her the space to express it and to offload.
  • If she is reluctant to talk to you, continue to make yourself available, give her time, be around enough for her to be able to talk to you if she needs to. It may be that she needs to talk to someone she is not so close to and may benefit from speaking to a counsellor or teacher.
  • You may feel anxious if you think your daughter is depressed, but try not to let this show. Some girls are reluctant to tell their parents how bad they are feeling if they feel it will distress them.
  • Encourage her to be social, to sit with you in the evenings and to see friends and family members, even if only for short periods.
  • Make sure she has a good balance between school work and relaxation, and that she has time for herself, particularly in the evenings and weekends.
  • Reassure her if she has strong feelings and mood swings. Young people can become fearful of being bipolar or of “going mad” and can be frightened by the strength of what they feel. Because she feels really low now does not mean she always will – strong, negative feelings will pass.
  • Encourage her to exercise as much as possible.
  • Encourage her to eat well, to have breakfast and to avoid junk food.
  • Do not expect her to “snap out of it”. Depression has its own time frame but it invariably does pass.

 


 

Five signs your daughter may be depressed

1. Changes in sleep patterns

Most teenagers show changes in their sleep patterns and often sleep for long periods but if your daughter is sleeping excessively, or is showing unusual sleep patterns or finding it very difficult to sleep, this may indicate depression.

2. Lack of motivation, loss of interest

Depression can manifest itself in a general apathy and lack of interest, possible reluctance to take part in activities the teenager previously enjoyed and which they could realistically be expected to still take pleasure in. Working obsessively, losing interest in school work, poor concentration and memory are also possible indicators of depression. Schools are judged by academic results and can put tremendous pressure on students to excel, often at the expense of a reasonable work-life balance. It is also easy for parents to become caught up in this. Students, however, need to achieve “good enough” results that will enable them to achieve their career goals. This can be a factor leading to depression.

3. Social Isolation

Today’s young people rely a great deal on social media as a means to communicate with their peers so may spend long periods physically alone in their rooms but in contact with their friends via their mobiles or tablets. However, if they hide away and avoid social contact for long periods this may indicate depression.

4. Lack of personal care or obsessive concerns about appearance

There is tremendous pressure on young people to look and behave in certain ways. If this becomes too obsessive or if your daughter shows no interest in personal hygiene and self-care this may be an indication of depression.

5. Changes in eating habits

For some, depression can lead to loss of appetite and interest in food, for others it can lead to comfort eating.

6. Mood Changes

For some adolescents, depression is manifested through low mood and a sense of sadness but anger can also be a symptom of depression.

 


 

Article courtesy of Counselling Directory

 

£9.2 billion spent on mental health but over half patients relapse

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DEPRESSION: Over half the patients in the study suffered a relapse event, with up to 79 per cent of events occurring within the first six months after treatment

DEPRESSION: Over half the patients in the study suffered a relapse event, with up to 79 per cent of events occurring within the first six months after treatment

 

  • 53 per cent of NHS patients treated for depression and anxiety relapsed within a year of treatment
  • 79 per cent of relapses occurred within six months of treatment
  • Mental health costs the NHS £9.2 billion every year

“Incomplete or insufficient treatment also costs the NHS, as patients who relapse often need further care or support.”

Over half of NHS patients experience relapse of depression and anxiety problems after discharge from mental health care.

A new study reveals approximately 53 per cent of NHS patients had a clinically significant deterioration of depression and anxiety symptoms within a year after completing brief psychological treatments.

A total of 439 patients, who were considered to have recovered from their symptoms after the most widely available therapy on the NHS, took part in the study. Over half of these were found to have suffered a relapse event, with up to 79 per cent of events occurring within the first six months after treatment.

The study, published by leading scientific journal Behaviour Research and Therapy, was conducted by a team of NHS clinicians and scientists from the Universities of Sheffield, York, Huddersfield and Trier.

According to a report in February 2016 from the independent Mental Health Taskforce to the NHS, poor mental health carries an economic and social cost of £105 billion a year in England. In total, £9.2 billion is spent every year by the NHS on mental health support and services.

Dr Shehzad Ali, from the University of York, says: “Our study highlights that, under the current system, some patients are being discharged too soon. As a result, patients who have low levels of depression at the time of discharge are more likely to relapse within a few months.”

Depression and anxiety are highly common and often disabling mental health problems, experienced by one in six adults in the United Kingdom.

STUDY: Dr Shehzad Ali from the University of York says patient-relapse may be due to being discharged too soon

STUDY: Dr Shehzad Ali from the University of York says patient-relapse may be due to being discharged too soon

 

Available treatments in the NHS include medication and psychological therapy. The most widely available form of psychological care for these conditions is known as Low intensity Cognitive Behavioural Therapy (LiCBT), which is a brief and simplified adaptation of a treatment called Cognitive Behavioural Therapy (CBT).

LiCBT involves weekly contact with a mental health professional who guides patients on how to look after their mental health and typically lasts under two months. LiCBT has been found to lead to short-term improvement of depression and anxiety in previous studies, although there is as still limited evidence about its long-term effectiveness after treatment.

Participants in the study were in contact with researchers on a monthly basis for 12 months after treatment to monitor their wellbeing and to quantify the percentage of cases that relapsed. Patients with residual depression symptoms at the end of treatment were twice as likely to relapse.

Dr Jaime Delgadillo, from the University of Sheffield, said: “These findings underline the importance of monitoring patients’ wellbeing for at least six months after treatment and offering adequate support to ensure they stay well. We argue that relapse prevention is a crucial but often neglected aspect of psychological care in the NHS.

“Incomplete or insufficient treatment also costs the NHS, as patients who relapse often need further care or support.”

Controversial contraceptives

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COMBINATION OF FACTORS: Dr Ali Kubba believes depression is a complex illness that is caused by a mixture of life events, cultural and social reasons

COMBINATION OF FACTORS: Dr Ali Kubba believes depression is a complex illness that is caused by a mixture of life events, cultural and social reasons

The pill may be linked to depression in women

A recent study, published in the Journal of the American Medical Association Psychiatry, has revealed that women who take the contraceptive pill are more likely to be treated for depression.

In Denmark, a research project has also examined the scale of the problem, involving the medical records of more than a million women and teenage girls.

Those on the combined pill were 23 per cent more likely to be prescribed an antidepressant by their doctor, most commonly in the first six months after starting on the pill.

Women on the progestin-only pills, a synthetic form of the hormone progesterone, were 34 per cent more likely to take antidepressants or get a first diagnosis of depression than those not on hormonal contraception.

Dr Ali Kubba, a fellow of the Faculty of Sexual and Reproductive Healthcare at the Royal College of Obstetricians and Gynaecologists in London told the Asian Express: “Depression is twice as common in women as in men.

“The causation is a combination of life event, cultural and social reasons including relationship problems, family stresses, economic and gender dynamics.”

He continued: “Women, especially young women, may be distressed by body image with such treatable or preventable conditions such as acne and obesity.”

He went on to say that sexual difficulties tend to have a ‘two-way relationship’ with physical and social factors.

“South East Asian women in the UK have similar or lower rates of depression than the general female population.

“This difference is explained by some experts as due to Asian women expressing depression or anxiety in a physical way such as experiencing headache or weakness.

“The scientific term for these phenomena is somatisation. Hormonal fluctuations in a woman's menstrual cycle may increase the severity of mood changes, something that women notice in the week or so before their periods.”

When told about the Danish research, Dr Kubba said there was ‘no evidence’ however, that the pill actually causes depression.

He said: “Indeed, other large older studies do not show a link.  Could this be a situation arising from the pressures in modern societies? Possibly.”

Dr Kubba said that women use the pill for therapeutic reasons such as reducing heavy periods or period pains, which itself could impact on the mental state of a woman.

“Facial acne, so common in young women in Asia responds well to the pill,” he added.

“We know that women suffering from acne have an altered body image, suffer depression and six per cent have suicidal thoughts.

“Of all regions of the world, Asia has the lowest use of the pill with only 10 per cent of contraceptive use being hormonal versus 35 per cent in Europe.”

Dr Kubba said that women taking the pill anywhere in the world make the choice to suit their life style and health needs.

“This recent study on depression and the pill should be considered against the many benefits of the pill to the individual woman.”

Depression top cause of illness in teens

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Depression is the top global cause of illness and disability for adolescents, with suicide the third-biggest cause of death, the World Health Organisation said this week.

The finding is in a new report by the UN agency, which has pulled together a wealth of published evidence with direct consultations with 10 to 19-year-olds around the world to assess the health issues that affect them.
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"The world has not paid enough attention to the health of adolescents," says Flavia Bustreo, head of the WHO's family, women and children's health division.

Some studies show that half of all people who develop mental disorders have their first symptoms by the age of 14, said the report.

"If adolescents with mental health problems get the care they need, this can prevent deaths and avoid suffering throughout life," it said.

The study looked at a broad range of issues, including tobacco, alcohol and drug use, HIV, injuries, mental health, nutrition, sexual and reproductive health, and violence.

Traffic injuries were the number two cause of illness and disability, behind depression, with boys three times more likely to die than girls.

WHO said it was crucial for countries to reduce the risk by increasing access to reliable and safe public transport, improve road safety regulations such as alcohol and speed limits, establish safe pedestrian areas around schools and graduated licensing schemes where drivers' privileges are phased in over time.

Worldwide, an estimated 1.3 million adolescents died in 2012, it said. The top three causes of death globally were road traffic injuries, HIV/AIDS, and suicide.

HIV was the second cause of deaths in adolescents globally, WHO said, with estimates suggesting the number of HIV-related deaths among adolescents was rising.

This was predominantly in Africa, at a time when HIV-related deaths were decreasing in all other population groups.

"We must not let up on efforts to promote and safeguard the sexual and reproductive health of adolescents, including HIV," said WHO scientist Jane Ferguson, lead author of the report.

For adolescent girls alone, the second-biggest killer after suicide was complications during childbirth.

That was despite major progress on that front, WHO said, with death-rates plummeting since 2000 -- by 57 percent in Asia, 50 percent in the Middle East and 37 percent in Africa.

Other infectious disease also remained major killers, despite marked successes such as a 90-percent decline in death and disability from measles in Africa over the past decade, thanks to childhood vaccination.

Common infectious diseases that have been a focus for action in young children were among the hardest-hitting.

For example, diarrhoea and lower respiratory tract infections ranked second and fourth among causes of death in 10 to 14-year-olds.

Combined with meningitis, these conditions accounted for 18 percent of all deaths in this age group, little changed from 2000, WHO said.