Families living with Chronic Mental Illness

1. Depression

2. Introduction
According to the World Health Organization it is estimate that 350 million
people worldwide are living with depression. Of those 350 million people 1
million of them will commit suicide. For every one suicide there are 20 attempts.
Depression is the leading cause of disability worldwide. Depression more
commonly effects women rather than men. Women are most likely to experience
depression after child birth. 2 out of 10 women who give birth will experience
depression. As a result a child may have slowed growth and development
(Depression a Hidden Burden,n.d.). Families struggle when one or more of their
family members suffer from depression. Depression is a treatable condition, but
the majority of people who have depression are not receiving care. In some
countries this number is as high as 1 out of 10 people with depression are not
receiving treatment. Lack of access to mental health care and social stigmas are
often the reasons for people not to seek care (Depression a Hidden Burden,n.d.).
When a family member suffers from depression, they are less likely to complete
the tasks of their role. Putting additional responsibilities on other members of
the family. It is important to recognize the signs of depression and seek help for
this treatable condition.

5. Depression Case Study:
O Mr. and Mrs. Smith have been happily married for 10 years. They have 6-year-
old twin girls, and a four-year-old son. Mr. Smith is the Principal of the local
middle school, and Mrs. Smith has recently started back teaching music lessons
twice a week at the performing arts school in their neighborhood. The whole
family is involved at their church, and regularly visits their parents who live
about an hour away. While Mrs. Smith teaches music lessons, her mother
watches their son.
O Lately, Mrs. Smith has not felt like herself. She thought she just had a case of
the winter blues, but it just hasn’t gone away. She used to love teaching music
lessons, but lately she hasn’t. She even cancelled lessons with her two favorite
students. She has a hard time getting out of bed in the morning, and complains
of generalized aches all over. Her appetite fluctuated on a weekly basis. Mr.
Smith doesn’t know what to do. Nothing he says seems to help her at all. Mrs.
Smith has stopped going to church activities, and even the kids are starting to
notice. They say things like, “why does mommy nap so much,” and “why is
mommy so sad?” Mrs. Smith likes her life. She knows she has a great husband
and a great family, but she just cannot seem to get out of her bad mood.

6. Interventions
O Assess patient’s and significant other’s knowledge about depression and its causes.
Rationale: Depression is a physiologic disorder caused by the interplay of many
factors such as stress, loss, imbalance in brain chemistry, and genetics. Many people
believe that depression is caused by character weakness. This belief contributes to the
stigma experienced by the person suffering with depression and interferes with
seeking treatment.
O Assess individual signs of hopelessness.
Rationale: This helps focus attention on areas of individual need. These signs may
include decreased physical activity, social withdrawal, and comments made by patient
that indicate hopelessness and despair.
O Assess unhealthy behaviors used to cope with feelings.
Rationale: Patient may have tried to overcome feelings of hopelessness with harmful
and ineffective behaviors (e.g., withdrawal, substance abuse, avoidance).
Recognizing these behaviors provides an opportunity for change.
O Conduct a suicide assessment to determine level of suicide risk.
Rationale: High risk will necessitate hospitalization.

7. Interventions
O Inform patient and significant other about the major symptoms of depression.
Rationale: Many people believe depression equates with sadness and fail to recognize
the many other signs and symptoms that make this a holistic disorder. These include
sadness and loss of interest in normal activities, plus at least four of the following:
changes in appetite or weight, sleep, or psychomotor activity; feelings of worthlessness
and guilt; difficulty concentrating or making decisions; recurrent thoughts of death or
suicidal ideation, plans, or attempts. If the depressed individual displays sadness
through irritability, the conclusion that depression is present may be missed, and
consequently, necessary treatment may be delayed or avoided entirely.
O Inform patient and significant other that depression is treatable.
Rationale: Medications are usually indicated for treatment. They do not solve the
stressors or problems that may have precipitated the depression, but they provide the
energy to deal with these issues. Antidepressants or psychotherapy or a combination
of both generally relieves the symptoms of depression in weeks.
O Encourage patient to assume responsibility for own self-care, for example, setting
realistic goals, scheduling activities, and making independent decisions.
Rationale: Helping patient set realistic goals increases feelings of control and provides
satisfaction when goals are achieved, thereby decreasing feelings of hopelessness.

8. Interventions
O Encourage patient to identify and verbalize feelings and perceptions.
Rationale: The process of identifying feelings that underlie and drive behaviors
enables patients to being taking control of their lives.
O Help patient identify areas of life situation that are not within his or her ability to
control. Discuss feelings associated with this lack of control.
Rationale: Patient needs to recognize and resolve feelings associated with inability to
control certain life situations before acceptance can be achieved and hopefulness
becomes possible.
O Teach patient about crisis intervention services such as suicide hotlines and other
resources.
Rationale: It is vital to provide patients with resources for support and safety when
thoughts and feelings about suicide become difficult to manage.
O Administer antidepressant medication or teach importance of taking medication
as prescribed.
Rationale: Suicidal thinking is a symptom of depression that is ameliorated though
appropriate medication.

9. Adaptive Coping
Mechanisms
O “An ongoing process of
adaption, co-creating
ways for the family
members, both
individually and as a
family, to achieve a
sense of well-being”
(Kaakinen et al. 2015
p.251)
Psychotherapy
Self-management
Discuss
Living with illness
Psychopharmacology
Relationships

10. Adaptive Coping Mechanisms
O Psychotherapy – talking with a Psychologist or Psychiatrist in order to learn more about
your condition and your treatment options
O Psychopharmacology – The prescription of certain drugs to treat an individual’s
condition; most common drugs prescribed are selective serotonin reuptake inhibitors
(SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). It is important for a
family to be well educated about these drugs and their potential side effects.
O Self-management which also includes self-efficacy, self-monitoring of illness, and
symptom management.
O Attend all scheduled medical appointments.
O Co-creating a context for living with illness – learning how to develop different ways to
accomplish tasks and meet the needs of the family.
O Discuss the illness – talk openly with the family about the illness.
O Altering relationships – family member may have to get to know each other in different
ways. Some families report that they felt closed to one another when dealing with a
chronic illness.
O Changing roles and tasks – family roles may require adjustment, whether that may be
temporary or permanent.

11. Abusing
Attacking
Criticizing
Rebellion
Dominance
Aggression
Isolation
Private
Activities
Solitary Work
Exaggerated
Independence
Social
Withdrawal
Alcohol
Drugs
Overeating
Masterbation
Self Controlled
Addictive
Self-
Soothing
Maladaptive
Coping
Mechanisms

12.  Many people who suffer from depression withdrawal from
family and friends and feel as if they have no one that will
understand.
 They also feel ashamed and fear rejection for not being able to
cope with situations.
 The more they feel cut off from others the worse the depression
becomes and they tend to sink deeper into self loathing. We
are around individuals who suffer from depression every
single day and don’t even realize it.
 They tend to show two faces to the world. This form of coping
with depression can manifest itself with abusive behavior
towards others, being overly critical, and expressing an overly
dominant personality towards others.

13. Dissociation
Numbness
Fantasy
Denial
Internalizing
Low self-esteem
Overworking
Sleeping
Risk taking
Gambling
Sex
Shopping
People pleasing
Conflict Avoidance
Passive
Submissive
Relies on others
Clinging
Dependent

14. TREATMENTS
O SAD: Light Therapy
O ECT: Electro Convulsive Therapy
O TMS: Transcranial Magnetic Stimulation

15. Q/A
O Do you feel that ECT should be used on a
adolescent younger than 12 years of age?
O What are some positive coping mechanisms
that the Smith family can incorporate into their
lifestyle?
O What should Mr. Smith tell his children about
Mrs. Smith’s depression?

16. References
1. Depression a Hidden Burden. (n.d.). Retrieved April 2, 2015, from
http://www.who.int/mental_health/management/depression/flyer_de
pression_2012.pdf?ua=1
2. Swearingen, P.L. (2012). All-in-One Care Planning Resource (3rd
ed.). (pp. 699-701). St. Louis, MO: Elsevier Mosby Inc.
3. Kaakinen, J., Coehlo, D., Steele, R., Tobacco, A., & Hanson, S.
(2015). Family Health Care Nursing. Philadelphia, PA: F.A. Davis
Company.
4. M. Johnstone. (2012, Oct. 2). I had a Black Dog, His Name Was
Depression. Retrieved from,
<https://www.youtube.com/watch?v=XiCrniLQGYc>