Bio-Psychological Factors Contributing to Depression: Nursing Interventions and Ethical Implications

This essay discusses the bio-psychological factors contributing to depression, nursing interventions, and ethical implications. The patient in the case study is suffering from severe depression, and the essay provides insights into the various factors that contribute to the mood disorder. The nursing interventions that can be applied to help the patient recover fast are also discussed. Additionally, the essay highlights the ethical implications that may arise while providing treatment to the patient.

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Mental health Nursing
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Depression
Depression is the common and major mood disorder which causes serious health
problems that may affect the brain’s normal process of thinking, feeling and doing daily life
activities like eating, sleeping and working. It affected more than 300 million people
worldwide and nearly 800000 people commit suicide every year (World Health Organisation,
2018). Particularly in America depression affects around 15 percent to 19 % people ages
more than 65 (Lippincott Nursing Center, 2018). Depression is also associated with other
psychological disorders such as stress and anxiety. There are various types of depressions
such as persistent depressive disorder, postpartum depression, psychotic depression,
psychotic depression, bipolar, and seasonal affective disorder (National Institute of Mental
Health, 2018). The symptoms associated with depression include feeling sad, loss of interest,
change in appetite, loss of energy, feeling worthless, difficulty in breathing, thoughts of
suicide (CAMH, 2018). Depression is affecting one adult among 15 young people in a year.
And one in 6 people experience this disorder once in their life and can affect anyone any time
(American Psychiatric Association, 2018). In the given case scenario the patient is suffering
from a severe and long-term depression which affecting the eating and sleeping habits of the
diseased person. In this essay, the bio-psychological factors that contribute to developing
mood disorder will be discussed. The appropriate nursing interventions beneficial in this case
and the ethical implications related to this case study will be mentioned in this essay.
The bio-psychosocial factor associated with depression includes biological,
psychological and social factors. The biological factors that may contribute to developing
depression may be genetic, biochemical, physical. Various studies have been conducted on
the genetic factors that may take part in developing depression. The predisposition to cause
depression can be inherited and it is likely to be an effect of many genes rather than one gene
(Jeon, Amidfar & Yong, 2017). It has been studied that the risk of developing depression is

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nearly 40 percent if a single parent is affected with this disorder, and the remaining 60 % is
due to the individuals own environment (Legg, 2016). The patient in the given case study has
a family history of depression which may be the factor in developing depression in Amy, as
she also has the same symptoms as her mother. The person with this disorder may also have
an imbalanced activity of neurotransmitters which are the chemical that used by brain cells to
communicate with each other. The imbalance occurs in these neurotransmitters prevents the
normal functioning of the brain and develop symptoms like sleeplessness, low thinking
ability and loss of appetite (Dobson, & Dozois, 2011). Gender and age are also the risk
factors of this mood disorder. Although depression may develop at any age, the elderly
people are more likely to be depressed. Women’s experience this disease more than males;
this may be due to the hormonal factors during pregnancy, pre-menopause, and menopause
(Albert, 2015). According to a study conducted by Sowoslo and Orth (2013), depression and
low self-esteem are strongly related, they further stated that decreased self-esteem contributes
to depression and can be a predictor of the mood disorders such anxiety and stress.
The psychological factors may contribute in Amy's case are low self-esteem,
pessimist behavior, sensitivity to rejection or loss and overwhelmed with stress. She was
admitted to four different hospitals for the same health issues and not treated well. Because of
this, the patient felt worthlessness, hopelessness, and helplessness. After she diagnosed with
diabetes and hypertension, she started to feel depressed and suffers for ten years with this
psychological disorder. A study conducted on forty hypertensive patients by Rubio-Guerra,
Rodriguez, Vargas-Ayala, Huerta-Ramirez, Serna, and Lozano-Nuevo (2013) revealed that
the depression is the common feature in diseased people experiencing uncontrolled
hypertension. Various studies show the effects of social factors in developing the mood
disorder. According to Legg (2016), prolonged social isolation is the common source of
depression, feeling of loneliness and the feeling of exclusion may be contributing to the

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stressful events. Major life events considered social factors for depression are losing a job
and loved ones (Taylor, 2014), getting divorced, retiring and moving to a new city or country.
In the given case study the patient was living alone in a retirement village after the death of
her husband and had no one to talk as she mentioned. This might be contributed to her health
problem. She has also stated that her two daughters come to visit her every month but she
feels like she is just a burden for them. The patient expressed her suicidal thoughts as she said
that thing might be easier for her daughter if she dies, this shows that the person is suffering
from extreme depression.
The patient is under severe depression and nursing intervention can play an important
role in to help the patient to recover fast. Depression is the condition in which the patients are
themselves not able to recognize. The mood disorder is not a new concept for the peoples; it
has been affecting people for many years. The nurses are well trained to provide care for the
people with depression. As the symptoms of this disorder indicated that the patient might feel
alone and removed from their loved ones, they need to be deal politely. The first thing a nurse
needs to do is assessing the patient for symptoms and their behavior. In the next step, nursing
interventions can be applied according to the identified symptoms. The patient with this
mood disorder can be provided with psychosocial interventions such as socialization and
physical activities. Various studies have been revealed that conducting the physical and social
activities may lead to the decreasing the severity of the disease, improves the quality of life
and mental health. According to Strohle (2009) association of physical activities helps to
stimulate the cascade of events which results in the higher resilience the stress associated
with mental disorder.
Another intervention is beneficial in such cases is touch therapy. In some patient,
depression might be caused due to the lack of socialization and loneliness. In this case,
touching the patient might be a good intervention a nurse can provide. The diseased person

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feels more comfortable and light by applying this method. As mentioned in Amy’s case she
has been living alone for three years and had no one to talk to, these nursing interventions
may help to make her social and happy. The suicidal thoughts may be prevented by helping
the patient feel that her life is worth living. It is much important to make the person realize
that someone really cares for her and she is not a burden for anyone. Trust is another factor
that needs to be developed in the patient for the nurses so that she can express her thoughts to
the caring person. Involving the patient’s family member in the treatment might be beneficial
in this case. Helping the patient to take psychiatric medicines is the important nursing
function. The patients need to be guided about the antidepressant medicines and its effects.
Sometimes the several dosages of psychiatric medication prescribed to the patient before a
more effective treatment are found that fit for the person. This may be frustrating and
confusing for patients and some of them may give up before completing the treatment. By
reminding them that the physician has many treatment options for the person, and there is no
single right medication that is effective for everyone (Lippincott Nursing Center, 2018). The
older patients should be assessed for any adverse effects associated with the given
medication. People with low self-esteem should be dealt with the slow pace and low firm
tone.
A nurse should assess the patient for how she views herself and how she deals with
the problems she faced during depressive events. The patients should be encouraged to care
about self and eating and sleeping properly. Music therapy, pleasant activities, and relaxation
therapies can be implemented to achieve the health goals already set for the patient.
Emotional support such as supportive listening, hope instillation encourages the expression of
thoughts and feelings are favorable in the case scenario of Amy. Educating the patient about
the importance of adherence to prescribed medication and treatment is helpful to prevent
recurrence. Providing the information about the depression and it is common, curable is the

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nursing intervention should be included in the treatment of older people with depression
(Harvarth, T. A., & Mckezie, G. L. (2012). As the patient is also diagnosed with diabetes and
hypertension, regular sugar check-ups are important. Diet less with sugar content should be
maintained for the patient. Other therapies can be implemented to treat the depressive patients
are psychosocial therapy and interpersonal therapy.
There are various different ethical implications can be raised in the case of Amy such
as actual conflict of interest, a potential conflict of interest, confidentiality, decision making
and resistance to treatment (Lavrestsky, 2015). Conflicts may be arising when both family
members and professional caregivers provide care for the patient about the correct treatment
for the patient. Depression is the disorder for which various types of treatments have been
tried to find the effective one. This may be irritating and frustrating for the patient and their
family and this may create conflicts. The patient reported that she is not eating properly and if
a nurse or other health provider tries to feed him/her forcefully, this might create another
ethical issue. The confidentiality is the major ethical challenge in this case. The patient feels
that she is just a burden for their daughter but never wanted to disclose this to them. But not
discussing the full health-related information with the family is also unethical. Sometimes the
physicians consider the depression as normal and prescribe antidepressants; this might be
problematic for the treatment of the patient.
The old age people may or may not have the capacity to participate in the decision-
making process for their treatment. Such decisions are likely to have lasting effects on the
future care of the patient. So the elder care providers are responsible to focus on diseased
person's needs and her interest must be highly considered (Kane, Ouslander, Abrass, &
Resnick, 2013). As the patient discussed that she also have sleeping problems, for that health
care providers can provide sleeping pills. The patient can be restrained chemically because of
excessive use of these medicines and other treatments for diabetes. To provide the emotional

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support for the depressed person nurses uses touch method but some people are not really like
to be touched by another person without their permission. Nurses are only allowed the
movement of the person chair or to their sleeping place. Trying is also problematic, and it
might create conflicts with the professional ethics. As discussed in the case study the patient
is a caring person and likes to keep things to herself, this may also create a challenge for the
nurses when they try to help the patient with daily life activities. The patient has also lost his
interest in her activities so involving her forcefully in physical activities may also cause
ethical issues.
Depression is a mood disorder that causes serious effects on the normal process of the
brain, the ability of a person doing normal daily tasks, and eating and sleeping habits. The
symptoms of depression include loss of interest in activities, sad feelings, breathing
difficulties, suicidal thoughts, sleeplessness, and change of appetite. In the given scenario the
patient is suffering from the depression which is which became severe after the death of her
husband. She is an independent woman living alone in a retirement village. Her daughter
comes to visits her once a month. The patient has developed suicidal thoughts because she
thinks that she is a burden for her daughters. She has been admitted to four different hospitals
previously for depression. There are various biological factors that contribute to the mood
disorder are family history, imbalanced neurotransmitters, female gender, age. Psychological
factors include low self-esteem, pessimist behavior, and feeling rejected or lost. Another
factor that associated with depression, in this case, is a lack of socialization. Providing
nursing care such as dealing politely, socialization activities with the patient, encouraging
them to do physical tasks, touching a patient while talking whenever necessary, and helping
the patient feel life is worth living. there are various ethical issues can be raised while
providing treatment to the person like potential conflict interest, confidentiality related and
the involvement of the patient in decision making for the treatment options.

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References
Albert, P. R. (2015). Why is depression more prevalent in women?. Journal of psychiatry &
neuroscience: JPN, 40(4), 219.
American Psychiatric Association (2018). What is depression?. Retrieved from:
https://www.psychiatry.org/patients-families/depression/what-is-depression
CAMH (2018). Depression. Retrieved from: https://www.camh.ca/en/health-info/mental-
illness-and-addiction-index/depression
Dobson, K. S., & Dozois, D. J. A (2011). Risk factors for depression. Amsterdam,
Netherland: Elsevier.
Harvarth, T. A., & Mckenzie, G. L. (2012). The nursing standard of practice Protocol;
depression in older adults. Retrieved from:
https://consultgeri.org/geriatric-topics/depression
Jeon, S. W., Amidfar, M., Yong, Y. (2017). Bio-Psychosocial risk factor of depression.
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file:///C:/Users/System04088/Downloads/Chapter5NOVAbiopsychosocialriskfactorsf
ordepression.pdf
Kane, R. L., Ouslander, J. G., Abrass, I. B., & Resnick, B. (2013). Essentials of clinical
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https://www.healthline.com/health/depression/risk-factors#1

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