Stakeholder
Our Human Practices sub team values communicating with stakeholders that would help advance our knowledge regarding our research project. As such, we spoke with several professionals who shared with us their expertise and opinions. Our interaction with the stakeholders allowed us to broaden our knowledge and motivated us to further shed light and raise awareness on the very important topic of depression.
Dr. Patten's Interview
Our HP team had the pleasure to interview Dr. Scott B. Patten, who is a clinician investigator psychiatrist working in a local mood disorder clinic. In the 80s, mood disorders were just coming onto the scene, where they used neurobiology and imaging to measure illness. This is what inspired Dr. Patten to further dive into mood disorders as they were coming onto the radar as major health issues. He was interested in factors that affected prognoses such as the numbers in the population, and the interaction between clinical work and neurobiology. Dr. Patten also enjoyed studying real health issues with patients and analyzing those issues in the population.
Our first interview section focused on asking questions about pediatrics, specifically mental health among adolescents and younger individuals.
Mental health in the younger age group cohorts depends on age and the developmental stage as mood disorders emerge unexpectedly or with precursors. Basic syndromes that clinicians look for when diagnosing adolescents are the same; such as depressed mood, change in behaviour, motivation, and declined activity. The symptoms can manifest differently, anxiety or irritability are the first signs which can progress into depression. There are two main approaches to the treatment of MDD (Major Depressive Disorder): pharmacological and psychotherapy. Psychotherapy is recommended as the first line with adolescents, and for adults, it is optional where they can make their own decisions. Before puberty, prevalence is roughly equal in both girls and boys, perhaps even higher in boys. However, after puberty the girl to boy ratio changes to 2:1. This may have to do with hormonal changes, but also biological, psychological and societal differences that contribute. Sex differences do not go away at menopause, but it declines with age. At the age of 80, the rates are higher in men.
As we are the Human Practices sub-team, we were also primarily interested in tackling social concerns such as stigma regarding mental illnesses.
Some mental illnesses are more stigmatized than others, and this is because of the health literacy amongst the population, as many see physical illnesses as actual disorders. One can use attitudinal measures to measure public stigma, health professionals, and self-internalization. This portrays how stigma is enacted and where it is occurring and its effects. Emergency rooms have been a target of stigma within clinical practice. Examples such as the approach to triaging, acute care, and organization are all subject negatively to stigma. The attitudes of health professionals reflect on themselves and can lead to the development of mental illnesses. Furthermore, there is a barrier for professionals from getting the care they need which negatively affects productivity. It also contributes to patient's access to care, if people feel health care settings are not respective then they will be less inclined to seek care.
Stigmatization beliefs revolve around negative attitudes. However, when people are advocating for their illnesses, they are likely to get the care and have more productive relationships with healthcare. Realignment of health care priorities helps put patients in the driver's seat and professionals in a supporting role. There is no longer telling what patients should do, but instead supporting their recovery and helping them make educated decisions for themselves.
We would like to thank Dr. Patten again for this thoughtful and informative meeting. We learned about the different dimensions of stigma, and there has been a general decline in stigma because of more health literacy regarding common disorders. Nevertheless, the severe mental illnesses like BPD (Borderline Personality Disorder) still exist as a current misconception that people are unpredictable and dangerous. In violent crimes, the first thought is whether mental illnesses are involved and can also be used in court as an argument. This informs us that health literacy is an asset as understanding basic facts of illnesses may help one better recognize someone in their personal life and close circle. More interactions with the environment regarding mental illness and awareness can decrease the prevalence of stigmatization. Increasing knowledge of behaviours can help change attitudes.
The above passage used notes taken by Anjana and Mya.
Names: Mya George, Antonette Ong, Anjana Sudharshan, Selina Tang, Aribah Ali, Serena Quine, Joy Heifetz, Anthony Derevyanko
Nicole Costello's Interview
Members of our HP team were able to speak with Nicole Costello, a specialist RN who consults on mental health, addiction, and dementia behaviors in the geriatric population. Based out of the Calgary, Alberta area, our team joined a zoom call with Nicole to discuss the unique mental health presentation of seniors, specifically depression, and to better understand how mental health is considered in one area of healthcare.
In asking about symptoms of depression in seniors, Nicole informed us that behaviors and mannerisms can vary significantly based on how cognitively impaired one is. However, noticed symptoms can include an increased or decreased appetite, feelings of isolation, attention-seeking behaviors (such as seeking reassurance and calling home more often), looking for familiar items, suicidal ideation, and self harming behavior. The way in which older individuals self harm tends to be different from the younger population, they have been seen to bang their head or to pick at their skin or existing lesions. These symptoms can often worsen in times of transition when there is an inherent feeling of loss and fear of changes happening. Another preventative measure to note is the mandatory suicide screening tool that is reassed on an annual basis to ant resident over the age of 65 in Alberta.
Non-therapeutic interventions intended to mitigate the impact of these depressive symptoms focus on trying to limit harm and redirect behavior and focus. Providing valuable social opportunities and keeping people busy is a primary preventative measure, as well as targeting specific habits (such as by covering an area that a resident may be picking at). Nicole also mentioned the unique value in youth and musical interaction with senior residents as they allow them to engage with others and feel included.
One area of concern that was brought up in our line of questioning is the limited mental health training included in health care aid and nursing education, as the approach seems to be that workers are expected to learn through experience and “on the job” unless they pursue more specialized training. HCAs (health care aids) in Alberta receive a 6 month training course that primarily focuses on personal care. There is very little education on health conditions, and especially not information specific to anxiety, depression, or dementia. This is concerning when one considers that HCAs are frontline workers who work with residents directly on a daily basis but lack the resources to do so from an informed perspective. LPNs (licensed practical nurses) have a two year training program that is also very limited in the inclusion of mental health knowledge while RNs (registered nurses) have a 4 month mental health training practicum which varies based on location and does not prioritize interventions or treatments.
Overall, our conversation with Nicole brought up interesting aspects of care and healthcare management specific to the Canadian geriatric population. Nicole emphasized the importance of prioritizing mental health in viewing it as a central part of our health and working to destigmatize it. The topics we discussed had unique applications for our students as a number of people on our team work or volunteer in assisted living facilities or have family members to which this information was relevant. It was particularly interesting to consider the different presentations of depression and how the major transitional time of growing older and requiring more assistance affects the mental health of individuals.
Names: Mya George, Antonette Ong, Anjana Sudharshan, Anthony Derevyanko, Aribah Ali
Dr. Roger McIntyre's Interview
Our Human Practices sub team had the privilege to discuss with Dr. Roger McIntyre regarding depression and other mood disorders, through a phone call interview. Dr. McIntyre is a highly respected professor of Psychiatry and Pharmacology at Toronto University. He is also the head of Mood Disorders Psychopharmacology Unit at University Health Network.
The interview began with Dr. McIntyre sharing with us the prevalence of depression and how mood disorders have become a very common medical condition. A common form of disability that not only affects Canadians but individuals across the world. He explained that despite the available treatments for depression, there are still countless of individuals that do not achieve their long term therapeutic goals. As such, he is very passionate about using his expertise and knowledge to continue to contribute in this area of research.
In light of the recent COVID-19 pandemic, our team was curious about how much it has affected the mood of individuals and how it may have exacerbated symptoms of depression. Dr. McIntyre explained to us that the pandemic indeed increased the number of cases with depression among people, with many factors that come into play. Some contributory factors include:
- Isolation, which led to loneliness
- Economic insecurity such as job loss
- Working from home- promotes isolation as workplace is the only support system for some people
- Shutting down of schools- affects social development
- Partner violence
- Uncertainty about the virus itself
Aside from learning about the impact of the pandemic towards the mental health of individuals, our team was also interested in how the daily lives of individuals with depression are impacted. Dr. McIntyre gave his input and explained that all aspects of their life, including social, personal, family, community involvement, workplace, school, etc… are all impacted when an individual suffers from depression. This is due to the lack of energy, interest and motivation to participate and engage in these activities. They essentially become impaired with depression and it becomes very difficult for them to remain active in their daily life.
However, there are some treatments available that can help aid with the symptoms of depression. For example, Dr. McIntyre touched upon the use of medications. Other treatments also include talk therapy or psychological interventions- cognitive therapy and finally, neurostimulators such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).
Given the nature of our Human Practices sub team, of course we wanted to end the interview by touching upon some issues and concerns regarding misconceptions about depression and mood disorders. Some misconceptions that were discussed include the idea that when an individual has depression, they have some sort of a “character personality flaw”. Some other misconceptions that were touched upon is that one must have a reason to be depressed. For example, their friends or family would ask questions such as, “why are you depressed? You should not be and you have no reason to be”. This further contributes to the cycle of stigma and misconception regarding depression and other mood disorders.
Overall, our discussion with Dr. Roger McIntyre was very educational and we gained valuable knowledge from his expertise. It was an eye opening experience and it has broadened our team’s understanding regarding depression. With the new knowledge that we have acquired, we plan to continue to educate ourselves and the public about depression. As part of the Human Practices sub team, it is our goal to use our platform to help eliminate the still existing misconception regarding depression and continue to raise awareness to the public.
Dr. Mulsant's Interview
Our HP team had the pleasure of speaking to Dr. Benoit Mulsant, regarding the nature of mood disorders and how his work as a psychiatrist had changed his perspective through the years. Dr. Mulsant’s academic journey towards psychiatry began with a somewhat unorthodox interest -- technology. The technological revolution brought on by companies, such as Apple, led Dr. Mulsant to believe that inventions such as the personal computer, would eventually change the world, including the world of medicine. However, noticing how theoretical the field of computer science was during the time, Dr. Mulsant decided to pursue psychiatry, specifically intrigued by the positive changes achieved through therapy and medications
Dr, Mulsant addressed what he saw as one of the crucial issues in the psychiatric care of Canada -- the ratio of psychiatrists to patients being severely outweighed, and thus the overall system not being able to care for all affected persons. Dr. Mulsant discusses that there must then be a change within the system, and this change can be incited through the proper use of technology. Clarifying that singular episodes of depression can be considered normal, and even healthy, he explains that everyone has the capacity to develop depression, regardless of external circumstances. When addressing the impacts of depression, Dr. Mulsant considers general patterns related to age. There is a difference in how depression manifests and impacts the lives of different age groups. In individuals during a midlife range, they may be able to overcome this difficulty due to bodily strength. However, in children, they lose crucial time for socialization and developing other cognitive abilities, and thus earlier intervention is highly recommended. In the elderly, socialization and motivation is crucial and the impacts of isolation are far more damaging. Thus, the time for treatment is short and must be done as soon as possible. As physical and mental health become more dependent of one another, the need for intervention becomes all the more important.
Dr. Mulsant also addressed the importance of social relationships when dealing with depression. Interpersonal psychotherapy, which is popular for cases of mild depression, is designed specifically so people can keep active and stay involved in their community. The effects of isolation and the benefits of social interaction have been witnessed in care homes, where an individual is removed from their typical processes and routines of socialization. In older populations, self harm associated with depression might be more passive, expressed in behaviors of withdrawal in an already isolated environment.
Our team is incredibly grateful for Dr. Mulsant’s time and knowledge regarding psychiatry and mood disorders. His impassioned views regarding how the system of psychiatry can be changed with the progression of technology has been an eye-opener regarding the difficulties we currently face.