Common Mental Disorders Depression - New Zealand Doctor

The ‘hopelessness theory’ 94 concentrates on hopelessness as the core characteristic
of depression, the presence of which signifies the need for further exploration of
depressive symptoms. Stresses and vulnerabilities combine to exacerbate hopelessness,
especially when the person attributes stress to global and stable causes (eg, ‘It’s always
like that’ or ‘You can’t do anything about it’), or catastrophises thoughts, or views her
or himself as deficient or incapable. 95
These two theories and others coalesce under the umbrella of ‘developmental
psychopathology’, which takes into account vulnerabilities, contexts and timing.
In this theory, mental health is conceptualised as a consequence of intra-individual
and extra-individual circumstances, which fits in with the stress-vulnerability model. 96
Obvious signs of stress in children are associated with later mental health problems. 97
Some personality types are particularly vulnerable to depressive tendencies. Depressive
symptoms in 18-year-old boys are often associated with a pattern from early childhood
of antisocial, aggressive and outwardly-directed behaviour. 98 Girls are more likely to
have a history of overly-compliant, self-blaming and inwardly-directed behaviour. 98
Anxiety is a risk factor for developing substance dependence (1.3 – 3.9 times more
likely) among young people in New Zealand. The association appears to be largely
non-causal, reflecting adverse factors that increase individual susceptibility to both
anxiety disorders and substance use, such as family adversity, parental psychopathology,
child abuse, personality factors and behavioural adjustment in childhood. 99
1.5 Special issues
Depression in the antenatal and postnatal period
Depression in the antenatal and postnatal period is common, although estimates
of prevalence vary. 100 A systematic review of prevalence and incidence suggests
that about 13% of women have an episode of major or minor depression during
pregnancy, of which up to 6% meet the diagnostic criteria for major depression. 100
Similarly, up to 19% of women have an episode of major or minor depression within
3 months of childbirth, of which approximately 7% are major depression. 100
The etiology of mental disorders in the antenatal and postnatal period is complex and
reflects the profound social, psychological and biological changes occurring in this
period. Genetic, biochemical, endocrine, and social factors may all play a part. 101
Although the course and prognosis of depression in the antenatal and postnatal
period is similar in many respects to depressive disorders experienced at other times,
there may be distinct causative factors for postnatal depression occurring in women
with no history of a mood disorder (ie, de novo), possibly associated with postnatal
neuroendocrine changes. 102,103 Women with de novo postnatal depression appear
to recover more quickly than those with a history of a mood disorder. 102 It has also
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Identification of Common Mental Disorders and Management of Depression in Primary Care