Depression: A Training for Community Health Workers in Iowa - - PowerPoint PPT Presentation

Depression: A Training for Community Health Workers in Iowa

December 11, 2017 Presented by Iowa Chronic Care Consortium and Molly Lee, DVM, MPH

Learning Objectives

• 1. Explain what depression is (and what it is

not), including its symptoms, causes, and common co-morbidities, and how it is diagnosed and by whom.

• 2. Describe the impact of depression and the

importance of understanding depression, and be able to apply this to your community and patients or clients.

• 3. Identify barriers to treatment of depression

and tools to overcome these barriers.

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What is Depression?

 Common  Serious  Illness  Feel, think, act  Sadness  Loss of interest  Emotional  Physical  Interferes with daily life

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Forms of Depression

 Many types, with different

 Symptoms  Severity  Duration

 CHWs can help with describing, logging symptoms  Knowing the specific diagnosis helps with treatment  Most common types

 Major Depression  Persistent Depressive Disorder

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What Depression is NOT

 Simple  Situational depression

 Grief

 Other disorders  Overlap

 Triggers  Coexisting conditions  Misdiagnosis

Manic Depression Dysthymia Bipolar Disorder SAD Schizophrenia Psychosis Alcoholism Situational Depression

Postpartum depression

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Symptoms of Depression

 Feeling sad, empty, hopeless  Decreased interest in activities  Weight changes  Changes in sleep  Restlessness and agitation  Tiredness  Worthlessness, guilt, low self-esteem  Indecisiveness, difficulty concentrating  Thoughts of death or suicide

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Symptoms of Depression (cont’d)

In children  Performing poorly in school  Frequent nightmares  Frequent disobediences, aggression or temper tantrums In teens  Tardiness, absence, poor performance in school and extracurricular activities  Neglected appearances  Self-harm  Withdrawl from friends, family

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What Causes Depression?

 Biological

 Genetics/family history  Gender  Race  Age  Brain changes  Other medical conditions

Image: Mayo Foundation

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What Causes Depression?

 Environmental/Social

 Violence  Abuse  Neglect  Poverty  Stress  Lack of social support  Loneliness  Substance abuse, smoking  Cultural views, stigma

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What Causes Depression?

 Psychological

 Behavioral Shutdown

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Common Co-morbidities

 Chronic health conditions

 Hormone disorders  Heart disease  Chronic pain  Stroke  COPD

 Drug or alcohol abuse  Note difficulties with treatment adherence

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The Healthcare Team

 Primary Care Provider

 Physicians, Nurse Practitioners, Physician’s Assistant  May refer to psychiatrist

 Clinical Psychologists, Social Workers

 Behavioral interventions

 Counselor/Therapist  ER Physician  Community Health Worker

Primary Care Provider Counselor/ Therapist Psychiatrist Clinical Psychologist

Community Health Worker

Image: M. Lee

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Diagnosing Depression

 Screening tests

 Beck Depression Inventory (BDI)  Hamilton Rating Scale for Depression (HAM-D or HRSD)  Inventory of Depressive Symptomatology (IDS or QIDS)  Patient Health Questionnaire (PHQ-9)

 Pre-screening tests

 PHQ-2  Screening, Brief Intervention and Referral to Treatment (SBIRT) for substance abuse

 DSM-5

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Treating Depression

 Medication

 Antidepressants  Anti-anxiety meds  Mood stabilizers  Antipsychotic meds  Co-occurring condition treatment

 Psychotherapy (“talk therapy”)

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Treating Depression

 Environmental Supports

 Self-care  Social support  Alternative care

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Impacts of Depression

 Reduced life span  Lost productivity/work days  Increased risk of suicide

Image: Mental Health America

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Impacts of Depression (Cont’d)

 Family system

Image: World Health Organization

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Barriers to Overcoming Depression

 Medication

 Compliance, side effects

 Access to care

 Transportation  Finances  Environment

 Stigma  Discomfort from healthcare team  Depression  Relapses

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CHWs- Follow up and Monitoring Response to Treatment

 Combination of supportive treatments  Identifying and

• vercoming obstacles

 ID when additional care is needed  Motivation and support

Image: World Health Organization

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CHWs- Finding Resources to Assist in Recovery

 Providers  Insurance  Transportation  Self-care tools  Other tools

 Peer-to-peer support programs  Organizations  Online resources  Helplines

Image: World Health Organization

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Stories of Depression

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Stories of Depression

www.friendshipbenchzimbabwe.org

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Review

 Depression is  Depression is not  Symptoms  Causes  Common co-morbidities  Diagnosis  Providers  Impacts  Importance of understanding  Barriers  Tools to overcome

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Review- Role of the CHW

 Describing symptoms  Keeping appointments

 Providers  Community support, self-care activities

 Non-judgmental listening  Involvement with family systems

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Thank You! Questions? For more information, contact us at the Iowa Chronic Care Consortium Deb Kazmerzak: 515.554.3788

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