Anxiety, Depression, & Stress

The mind & Body connection

AgendaCurrent State of Mental HealthGeneral Characteristics of Anxiety & DepressionDepressionAnxietySelf-Harm & SuicideAddictionMental Health Treatment/Intervention

Community Mental Health Crisis47% of people killed by police, north of NYC, over a 5 year period suffered from a mental illness or were emotionally disturbed

About 17% of U.S. prison population have mental illness; 3x the rate of the general public

8,000 inmates are cared for by NYS Office of Mental Health

56% of NYS prison population have a mental health problem including substance abuse; 5x the rate of general public

Law enforcement have become primary providers to those with serious mental illness

Cuts, consolidations, and closings in mental health continue

In 1955 the U.S. had 558,000 beds for mentally ill; today we have about 40,000

Mentally ill are more likely to be victims of crime, than criminals, and they are more likely to be harmed by police, than harm policePoverty & Mental HealthThe number of poor in the entire Buffalo Niagara metropolitan area grew from 120,861 in 1970 to 162,917 in 2011

52 percent of this areas poor reside in the suburbs

Mobile Safety-Net Team (John R. Oishei Foundation): Ken-Ton School District is the largest human service of 38 agenciesFree/reduced lunch (#1): 27% in March of 2001 compared to 41% in March of 2013Youth & Mental HealthQuestion #4CDC (2012): About 20% of American youth (aged 3 17) suffer from a mental health disorder (ADHD, anxiety, depression, and conduct problems)

ADHD= 6.8%Conduct Problems= 3.5%Anxiety= 3%Depression= 2.1%Autism Spectrum Disorder= 1.1%

ADHD diagnosis has jumped 53% in past decade

Chronic health problems (i.e. asthma & diabetes) are associated with mental illness in adulthood

Question #3$247 Billion is spent per year for mental health services from medical bills, special education, and juvenile justice

Question #2Suicide has become the 2nd leading cause of death among youth (aged 12-17) behind accidents

Emotion & MoodEveryone experiences varying emotion and mood, including symptoms of anxiety and depression

Mood: sustained emotional state which impacts how we respond on a regular basis; becomes more of an internal state, independent of external circumstances

Emotion: short-term and more influenced by external factors

Emotion is the weather, mood is the climate. (C. Smith)

Mood exists across species; the more developed the species the more intensely mood exists independent of external events

Some manage the interaction of mood, personality, and stress well; for others it becomes damaging

Anxiety & DepressionAnxiety & Depression often co-exist and influence each

Share a single set of genes, which are also involved in alcoholism

Depression: a response to loss; Anxiety: a response to future loss

Depression with high anxiety increases risk of suicide & complicates recovery Intervention needed when anxiety and/or depression interferes with a life function (i.e. work, school, family relationships/functioning.).

7Both can be healthy.Biochemistry- some individuals have increased levels of biochemicals associated with stress/anxietyCertain events (death in the family) can trigger problematic anxiety in those that have a particular genetic make up or personality

Biopsychosocial ModelThe BrainBrain Plasticity

Between approximately 10 to 18 months of age is a critical period of plasticity and shaping of the brain (right frontal lobe) for attachments & emotional regulation

Neglect/trauma during this time can shape wiring for attachments & emotional regulation which can continue into adulthood

Limbic System (hypothalamus, hippocampus, & thalamus) is involved in emotional regulation

Dopamine (pleasure neurotransmitter) likes novelty & enhances brain circuitry

DepressionAbout 19 million Americans suffer chronic depression (over 2 million are children)

About 15% will commit suicide

2.3 million suffer from Bipolar Disorder

Could be leading cause of death when considering its influence on suicide, substance abuse, heart disease, and other health issues

Anger & violence may be symptoms of depression, particularly in males (destructive, but short-term remedy)

Question #5Leading cause of disability in U.S. for those over the age of 5 and leading cause worldwide (WHO); costs tens of billions yearly in lost productivity

11DepressionFemales are 2x more likely to suffer depression, a ratio consistent throughout Western societies

Males synthesize serotonin 50% more rapidly than females

Rate of depression is about the same among working and non-working married females

Males are more likely to have ADHD, autism, and alcoholism

Closeted people and single people have a higher rate of depression

Question #6Women who are pregnant or have just given birth are more likely than anyone else to suffer depression, but least likely to commit suicide

Question #7Poverty & parent depression are highest predictors of child depression

Question #8GLBT are at increased risk for depression and anxiety problems. Suicide is the number 1 cause of death for this group

12Characteristics of DepressionFewer social skills and close relationshipsFewer social interactionsLimited interest in activitiesLimited motivation and academic achievementIrritabilityLimited energyLimited affectWorsened with the presence of learning weaknessesMost challenging during adolescence13The Brain & DepressionThere are particular genes which predispose depression, but whether one suffers depression is dependent on life events/experiences

These genes are involved in serotonin regulation in the brain

There are three possible gene combinations, one from each parent: short/short, short/long, and long/long

A short/short combination with multiple uncontrollable bad life events makes it about twice as likely to suffer from depression than long/long combination

Significant episodes of depression alter brain chemistry and structure

Decrease in serotonin receptors and rise in cortisol (stress hormone) are known to occur with depression

With each episode of depression there is an increased 10% risk depression will become chronic and inescapable

Depression & PovertyMany studies show that socioeconomic status is the number one predictor of depression

Question #9Those in poverty represent the highest rate of depression compared to any other class in U.S.

Depression is so common in poor communities awareness that an internal problem exists is lacking; perceived the problems are only due to uncontrollable external factors

Poverty is highly associated with a learned helplessness & passivity

Rate among welfare recipients is about 3x higher

Question #1085 95% of those with serious mental illness are unemployed

Low income families: untreated depression because of poor awareness and lack of access to healthcareExperiencing more parents out of work on disability- some known to be depressed, others not. Treatment with painkillers.

15Depression & PovertyQuality mental health care is lacking most among the poor

Investment in addressing mental health needs may be worthwhile, financially and socially

The cost of not treating mental illness, may far outweigh the cost of adequately treating it

Mothers with DepressionDepressed mothers greatly influence the likelihood that a child will suffer depression or other emotional / behavioral issues

Having a depressed mother is often more detrimental than a schizophrenic mother

With a depressed mother, signs of depression can be seen in infants, as early as 3 months

Children are often weepy, angry, & aggressive

If mothers depression is treated early, children show improvement, reversal becomes more challenging with ageMothers with DepressionFive potential impacts on childs emotional / behavioral development (Sameroff, A.):

GeneticsEmpathetic mirroring: repeating back what they experienceLearned helplessness: giving up on connecting due to lack of parent approval for emotional outreachRole-playing: taking on the illness role to avoid unpleasant things as observed by parentWithdrawal: consequence of seeing no pleasure/meaning in communication with unhappy parent

Children with DepressionAnaclitic depression: occurs in second half of the childs first year when separated from too much from their mother

May develop in failure to thrive starting at age four or five; limited affect & dont bond

At age five to six show extreme crankiness, irritability, poor sleeping, and poor eating

Low self-esteem, high anxiety, and bed-wetting become common problems

The Course of DepressionDepressed children usually go on to be depressed adults

The earlier the onset the more resistance to treatment

Occurs in many before puberty, but peaks in adolescence

Early/preventative intervention is critical

Why So Much Depression?Four possible theories of evolution:

Served an important purpose in pre-human times

The stresses of modern life are incompatible with the brains we have evolved.

It serves a useful function.

It is a secondary result of other characteristics.

1. Hibernation2. Our brains evolved much slower than our rapid lifestyle and society. A consequence then might be us doing what we are not evolved or biologically able to do. 3. Mild depression elicits intense self-reflection which guides one to make