Major Depressive Disorder (MDD) PDF

Running head: ESSAY
Case study
Name of the Student
Name of the University
Author Note
WC- 2675

1ESSAY
Introduction- Depression, also referred to as major depressive disorder (MDD) is a
mental disorder that is primarily characterized by low mood, which continues for a minimum of
two weeks across different circumstances. Depression is particularly manifested by loss of
interest and poor self-esteem, in addition to presence of pain, without a definite cause (Gilbert,
2016). It has been identified to be a major contributing factor to worldwide morbidity, and higher
rates of depression are particularly deported from developed countries. According to Klonsky et
al. (2019) suicide refers to the act of inflicting international harm upon oneself, in order to cause
death. The condition has been identified as a direct consequence of different mental disorders
such as, depression, schizophrenia, bipolar disorder, anxiety disorder, personality disorder, or
substance abuse. This assignment will discuss the prevalence of the aforementioned two
conditions in Australia and will also recommend interventions for a client Mary, presented in the
case study.
Answer 1a- It has been estimated that around 45% individuals in Australia are generally
subjected to poor mental health condition during their lifetime (Beyond Blue, 2019). Findings
highlight that not less than 1 million Australian adults, suffer from depression (ABS, 2019). In
the year 2017-18, there were around 4.8 million or one in 5 Australians that accounted for 20.1%
of the population who reported the presence of behavioural or mental conditions. This was a
significant increase from 4.0 million Australians that accounted for 17.5% of the population in
2014-15. This increase was particularly attributed to an augmentation in the number of
individuals who reported feelings of depression. 10.4% or 1 in 10 individuals reported
depression during 2017-18, in comparison to 8.9% during 2014-15 (ABS, 2019). Depression and
anxiety co-occur, with approximately 1.5 million Australian reporting both the conditions.

2ESSAY
In the year 2016 the rate of suicide in Australia was 5.7 deaths for 100,000 individuals,
which was a decrease from 6.6 deaths per 100,000 individuals in the year 2007. Approximately
2,866 persons died from suicide in the nation in the same year. The overall suicide rate in 2016
was around 12.6 per 100,000 individuals, and this was the highest rate that had been observed in
10 years (Lifeline.org.au, 2019). Approximately 3,046 deaths occurred in 2018, thus
demonstrating a rate of 12.2 per 100,000 individuals. In contrast there were 3,128 deaths in the
next year, corresponding to a rate of 12.7 per 100,000 individuals, hence showing an increase in
the number of people (Life in Mind, 2019).
Answer 1b- Evidences indicate that depression is most likely to create an impact on
teenagers. Research evidences put individuals belonging to teenage at the apex of bell curve for
this mental disorder, however individuals present at the end of the curve that is the older adults
and children might also be at a risk of severe depression (Dummett & Williams, 2018).
Depression among teenagers is a serious mental health issue that creates an impact on how they
feel, think, and behave and also result in functional, emotional, and physical problems. Several
issues such as high academic expectations, peer pressure, and changing physiology are the risk
factors that trigger emotional changes, and eventually lead to depression in this high risk group.
However, the comparatively higher risk of teenage girls to suffer from depression can be
attributed to the fact that they manifest low positive thinking, require approval, and also self-
focus on negative conditions (Midgley et al., 2017).
The fact that teenage girls are at an extremely high risk for suffering from depression can
be accredited to negative thinking styles, which encompasses rumination, pubertal changes in the
body, interpersonal stress, and poor self-esteem. Frequent exposure of the teenagers to bullying
or victimization has also been associated to an increased risk of depression, compared to those

3ESSAY
who are not subjected to such behaviour (Hill et al., 2017). Teenagers also demonstrate high
nicotine dependence and substance abuse, which in turn increases the risk of suffering from the
mental health condition.
The rate of suicide is found to be more amongst males, approximately three times higher,
when compared to their female counterparts. While the age specific rate for suicide in males was
roughly 18.7 per 100,000 individuals, thereby accounting for 2,320 deaths due to suicide, the rate
in females was 5.8 per 100,000 individuals, accounting for 726 deaths in 2018 (Life in Mind,
2019). The rate of suicide amongst Aboriginal and Torres Strait Islander individuals is more than
double, when compared to the national rate. 5.2 % Aboriginal and Torres Strait Islander suicide
occurred in 2015, in comparison to 1.8% in their non-indigenous counterparts. The most up to
date Australian Bureau of Statistics (ABS) information on suicide in Australia elucidated that an
average of 100 inhabitants of the indigenous origin put an end to their lives by suicide every year
over the last decade (Department of Health, 2013). The complex factors that increase the risk of
suicide amid the aboriginal and Torres Strait Islanders encompass their ongoing exposure to a
number of psychological stresses and socio-economic disadvantage (Tervonen et al., 2016).
Depression and grief due to stolen generations and premature death of the community
members, friends, and family further trigger their risk of inflicting self-harm, in order to cause
death. Interpersonal conflicts and violence are common in this indigenous community, in
addition to transgenerational trauma, loss and grief, correlated with the ongoing effects of
dislocation from their native land, and forced removal of their children (Dudgeon, Watson &
Holland, 2017). Presence of discrimination and pervasive racism at institutional, individual, and
system levels also result in a loss of sense of meaning and purpose in their life, hence making
them more likely to perform suicide (Cave et al., 2018). Additionally, they do not have access to

4ESSAY
proper healthcare facilities, thus as a consequence suffer from several co-morbidities and have
tremendously compromised emotional and mental health, which in turn increases their risk of
suicide.
Answer 2- Analysis of the case scenario suggests that three factors, which might have
directly contributed to the onset and progression of depression and attempted suicide in Mary are
namely, (i) divorce from husband after 30 years of marriage, (ii) financial difficulties that has
forced her to mortgage on her house, and (iii) family history of suicide. It has often been found
that adjusting to life following a divorce after several years of marriage can take a few weeks or
many years, and during that critical period, either of the partners might be subjected to a myriad
of emotions (Shafer et al., 2017). This in turn increases susceptibility of the partners to particular
conditions such as, depression, post traumatic stress disorder, or other physical conditions. It can
be suggested that separation from her husband acted in the form of a traumatic event, and made it
difficult for the client to adjust to her daily life, hence triggering the onset of low-mood,
miserable feelings, poor concentration, and attempt to take own life (Kiecolt-Glaser, 2017).
Having sufficient amount of money allows a person to provide for the family members,
and effectively plan for future. Financial difficulties impose limitations on choices as in this case
scenario. It also wreaks emotional havoc, on the life of the affected person. It also leads to an
impairment in cognitive functioning and decreases the self-esteem. It has been found by
researchers that thinking about the probability of monetary insecurity acts as a trigger, and
increases emotional suffering and pain among individuals, thereby stimulating the onset and
progression of depressive mood (Gilbert, Spears Brown & Mistry, 2017). Evidences also
highlight the fact that presence of mental health problems reduces self-control and also impacts
the financial judgment of the affected people, in addition to setting-off unsettling emotional

5ESSAY
responses (Kim et al., 2019). Financial stress has been associated to poor physical and mental
health, and ongoing stress about monetary matters has been correlated to mental problems, sleep
difficulties, cardiovascular diseases, migraines and several unhealthy behaviours. This has made
researchers conclude that when they are in debt, poor financial health increases the likelihood of
people to suffer from depression manifold (González & Vives, 2019). The fact that Mary had to
mortgage her own house suggests the presence of monetary problems, which made her more
susceptible to suffer from depression.
A family history of mental disorder, suicide, and substance abuse disorder have been
identified as the most widespread risk factors that increase the risk of suicide among individuals
(Rajalin et al., 2017). Despite that fact that a small proportion of individuals report such family
history, it is essential to be aware of the strong impact that it creates on the emotional wellbeing
of people. Epidemiological studies that have been conducted on community samples or clinical
patients have persistently reported a significantly greater threat for suicidal behaviour, amongst
kin and close acquaintances of suicide victims or those who attempted suicide (Rodante et al.,
2016). Studies conducted among monozygotic twin pairs have also demonstrated a substantially
higher concordance for both attempted and complete suicide, when compared to dizygotic twin
pairs (Wang & Dwivedi, 2017). It has also been found that the risk of suicide is more even after
adjustment for variations in psychiatry history, or individual socioeconomic status, in people
who have a family history of such condition. The researchers also elaborate on the fact that
suicidality and suicidal ideations cluster in different families, and might often be genetically
transmitted. Furthermore, research studies have also elaborated that psychiatric disorders
demonstrate a higher prevalence amongst individuals who have a family history of psychiatric

6ESSAY
illness or suicidal events, thus providing a justification for the mental health concern and suicide
risk that the client was found to be associated with (Ding et al., 2017).
Answer 3- The Mental Health Act 2014 had been formulated with the aim of providing
care, support, treatment, and protection of individuals who suffer from mental illness. The act
emphasizes on providing protection and safety to the rights of individuals, who have been
diagnosed with mental illness, and also highlights the importance of recognising the role of
family members and caregivers, in delivering support and care to such high risk people, suffering
from mental illness (Western Australia, 2018). The major area of risk in the case study is
associated with suicidal ideation in the patient. Hence, according to the Mental Health Act 2014,
the mental health services should be provided to the client in a manner that the treatment and
health assessments are least restrictive, which can be accomplished with voluntary assessment
and the preferred treatment. The act makes it mandatory to deliver those services to patients that
are able to bring out the best therapeutic health outcomes, while promoting their complete
participation in community life and encouraging the recovery from the mental illness (Western
Australia, 2018).
Following the act Mary should be provided the opportunity to remain informed in all
choices and decisions that are made about her health assessment, care plan, and recovery. This
can be accomplished by taking into consideration and respecting her preferences and views.
Additional efforts must also be taken to display respect towards her dignity and rights, while
promoting patient autonomy that would help the client decide about her health, without the
influence of any care providers. An additional objective of this act is that the patients are always
assumed to have the necessary capability and competence to make a particular decision relating
to herself or himself, unless the patient is found to be incapable (Western Australia, 2018).

7ESSAY
Hence, it must be assessed whether Mary has the necessary ability to understand all advice or
information that are being given to her about the care process, comprehend the matters that are
associated in this decision, and understand the implications or the effects of the care plan that is
intended to be initiated.
Moreover, informed consent shall be taken from the client, prior to administering any
form of intervention of therapy. Considering the fact that the act encourages strong
communication between the patient, and their family members and health practitioners, the
daughters of the client will also be informed about her current emotional health status and they
will be asked to provide their opinion and perceptions during shared decision making, which in
turn would prove effective in enhancing the mental health outcomes (Western Australia, 2018).
Moreover, any communication with Mary under this act must be done in a manner and language
that she is likely to comprehend, and that is practicable. In addition, all possible efforts must be
taken by the mental health service in order to show compliance to the Charter of Mental Health
Care Principles, while delivering care, treatment, and support to the patient (Western Australia,
2018).
Answer 4- The signs and symptoms demonstrated by the client that helped in the
diagnosis of major depressive disorder (MDD) are given below:
 Incapability to experience pleasure or enjoyments in activities that was previously
enjoyed
 Feelings and thoughts of worthlessness and hopelessness
 Lack of concentration at work and apprehension of losing the job
 Sleeping difficulties

8ESSAY
 Constant fatigue
 Struggle in getting out of bed and reaching work
 Unexplained loss of body weight
 Loss of appetite
 Suicidal ideations
 Lethargy and slow movement
Administration of Selective Serotonin Reuptake Inhibitors (SSRI) such as, paroxetine and
escitalopram would be the first intervention. This class of drugs is generally used in the form of
antidepressants and it functions by augmenting the extracellular level of serotonin, the
neurotransmitter, by imposing restriction on its reuptake or reabsorption into presynaptic cell,
thereby drastically increasing the amount of serotonin that is available in the synaptic cleft, in
order to bind to postsynaptic receptor (Pawluski et al., 2019).
The second intervention would focus on cognitive behavioural therapy (CBT), a
psychotherapy that teaches patients to acquire a set of behavioural and cognitive skills that can
be employed on their own. The psychosocial intervention has been found to enhance mental
health by altering and challenging cognitive distortions, like attitudes, believes and thoughts that
are unhelpful, thereby improving emotional regulation (Watkins, 2018). It helps in the
development of coping strategies that resolve existing problems, and is based on the combination
of cognitive psychology and behavioural psychology. CBT has been found effective in
depression, since it is an action oriented and problem focused type of psychotherapy, suggesting
that it treats particular problems that are associated to the diagnosed mental illness. It provides
assistance to the client to explore and practice effective methods that help in addressing the
identified objectives, thereby reducing the symptoms (Hawley et al., 2017). This in turn can be

9ESSAY
accredited to the fact that CBT is based on the premise that maladaptive behaviour and distortion
of thoughts play an important influence on the maintenance and development of psychological
disorders, and that all signs and symptoms of distress can be decreased by teaching coping
mechanisms and information processing skills.
Expressive psychotherapy would be another intervention that particularly puts into use
artistic expressions, while treating clients suffering from mental disorders. Music therapy is an
important aspect of expressive psychotherapy that will prove helpful in addressing the depressive
signs by using different facets of music like mental emotional, physical, aesthetics, spiritual, and
social that will enhance the motor, cognitive, communicative, sensory, and social domains of the
client, utilising receptive and active music experiences (Aalbers et al., 2017). Music therapy has
often been associated with stress relief and enhances the mood of clients suffering from
depression, through emotional expression, thereby improving functioning such as, activities,
involvement in jobs, and relationships (Cohen & Maxwell, 2020).
Conclusion- To conclude, Mary has been suffering from depression, which has been
triggered following her divorce. Depression and suicide are extremely prevalent in Australia.
Poor monetary condition, distance from her daughter, lack of concentration at work, worries
about occupation, and family history of suicide has further aggravated her health condition.
Considering the purpose and rules set out in the Mental Health Act 2014, care will be delivered
in a manner that does not violate her rights, autonomy and dignity. The three interventions that
will be implemented are namely, antidepressant administration, cognitive behavioural therapy,
and music therapy.

10ESSAY
References
Aalbers, S., Fusar‐Poli, L., Freeman, R. E., Spreen, M., Ket, J. C., Vink, A. C., ... & Gold, C.
(2017). Music therapy for depression. Cochrane Database of Systematic Reviews, (11).
Australian Bureau of Statistics. (2019). 4364.0.55.001 - National Health Survey: First Results,
2017-18.
https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4364.0.55.001Main+Features702
017-18
Beyond Blue. (2019). The facts. https://www.beyondblue.org.au/the-facts
Cave, L., Shepherd, C., Cooper, M., & Zubrick, S. (2018). Prevalence of racial discrimination in
a cohort of Aboriginal and Torres Strait Islander children.
https://www.lifecoursecentre.org.au/wp-content/uploads/2018/10/2018-19-LCC-
Working-Paper-Cave-et-al.-1.pdf
Cohen, D., & Maxwell, E. (2020). Music Therapy for Depression. American Family
Physician, 101(5), 273-274.
Department of Health. (2013). Aboriginal and Torres Strait Islander suicide: origins, trends and
incidence. https://www1.health.gov.au/internet/publications/publishing.nsf/Content/
mental-natsisps-strat-toc~mental-natsisps-strat-1~mental-natsisps-strat-1-ab
Ding, Y., Pereira, F., Hoehne, A., Beaulieu, M. M., Lepage, M., Turecki, G., & Jollant, F.
(2017). Altered brain processing of decision-making in healthy first-degree biological
relatives of suicide completers. Molecular psychiatry, 22(8), 1149-1154.
https://doi.org/10.1038/mp.2016.221

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Dudgeon, P., Watson, M., & Holland, C. (2017). Trauma in the Aboriginal and Torres Strait
Islander Population. Australian Clinical Psychologist, 3(1), 1741.
https://www.lifecoursecentre.org.au/wp-content/uploads/2018/10/2018-19-LCC-
Working-Paper-Cave-et-al.-1.pdf
Dummett, N., & Williams, C. (2018). Overcoming Teenage Low Mood and Depression: A Five
Areas Approach. CRC Press.
Gilbert, L. R., Spears Brown, C., & Mistry, R. S. (2017). Latino immigrant parents’ financial
stress, depression, and academic involvement predicting child academic
success. Psychology in the Schools, 54(9), 1202-1215. https://doi.org/10.1002/pits.22067
Gilbert, P. (2016). Depression: The evolution of powerlessness. Routledge.
https://books.google.co.in/books?
hl=en&lr=&id=WNHLDAAAQBAJ&oi=fnd&pg=PP1&dq=depression&ots=ZAACNW
QT0C&sig=FlGc5kFRhgyFrK6DqiagZpoqyOA&redir_esc=y#v=onepage&q=depression
&f=false
González, G., & Vives, A. (2019). Work status, financial stress, family problems, and gender
differences in the prevalence of depression in Chile. Annals of work exposures and
health, 63(3), 359-370. https://doi.org/10.1093/annweh/wxy107
Hawley, L. L., Padesky, C. A., Hollon, S. D., Mancuso, E., Laposa, J. M., Brozina, K., & Segal,
Z. V. (2017). Cognitive-behavioral therapy for depression using mind over mood: CBT
skill use and differential symptom alleviation. Behavior therapy, 48(1), 29-44.

12ESSAY
Hill, R. M., Mellick, W., Temple, J. R., & Sharp, C. (2017). The role of bullying in depressive
symptoms from adolescence to emerging adulthood: A growth mixture model. Journal of
affective disorders, 207, 1-8. https://doi.org/10.1016/j.jad.2016.09.007
Kiecolt-Glaser, J. K. (2018). Marriage, divorce, and the immune system. American
Psychologist, 73(9), 1098. https://psycnet.apa.org/doi/10.1037/amp0000388
Kim, Y. K., Lim, Y., Maleku, A., Kagotho, N., & Yang, M. (2019). Financial Stress and
Depression Among African Refugees in the Southern United States: A Serial Multiple
Mediation Analysis of Financial Self-Efficacy and Financial Anxiety. Journal of
Immigrant & Refugee Studies, 1-21. https://doi.org/10.1080/15562948.2019.1593571
Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal
ideation. Annual review of clinical psychology, 12, 307-330.
https://doi.org/10.1146/annurev-clinpsy-021815-093204
Life in Mind. (2019). Suicide facts and stats. https://www.lifeinmindaustralia.com.au/about-
suicide/suicide-data/suicide-facts-and-stats
Lifeline.org.au. (2019). Statistics on Suicide in Australia. https://www.lifeline.org.au/about-
lifeline/lifeline-information/statistics-on-suicide-in-australia
Midgley, N., Parkinson, S., Holmes, J., Stapley, E., Eatough, V., & Target, M. (2017). “Did I
bring it on myself?” An exploratory study of the beliefs that adolescents referred to
mental health services have about the causes of their depression. European child &
adolescent psychiatry, 26(1), 25-34. https://doi.org/10.1007/s00787-016-0868-8

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Pawluski, J. L., Brain, U., Hammond, G. L., & Oberlander, T. F. (2019). Selective serotonin
reuptake inhibitor effects on neural biomarkers of perinatal depression. Archives of
women's mental health, 22(3), 431-435.
Rajalin, M., Hirvikoski, T., Renberg, E. S., Åsberg, M., & Jokinen, J. (2017). Family history of
suicide and interpersonal functioning in suicide attempters. Psychiatry research, 247,
310-314. https://doi.org/10.1016/j.psychres.2016.11.029
Rodante, D., Rojas, S. M., Feldner, M. T., Dutton, C., Rebok, F., Teti, G. L., ... & Daray, F. M.
(2016). Differences between female suicidal patients with family history of suicide
attempt and family history of completed suicide. Comprehensive psychiatry, 70, 25-31.
https://doi.org/10.1016/j.comppsych.2016.06.006
Shafer, K., Jensen, T. M., & Holmes, E. K. (2017). Divorce stress, stepfamily stress, and
depression among emerging adult stepchildren. Journal of child and family studies, 26(3),
851-862. https://doi.org/10.1007/s10826-016-0617-0
Tervonen, H. E., Aranda, S., Roder, D., Walton, R., Baker, D., You, H., & Currow, D. (2016).
Differences in impact of Aboriginal and Torres Strait Islander status on cancer stage and
survival by level of socio-economic disadvantage and remoteness of residence—A
population-based cohort study in Australia. Cancer epidemiology, 41, 132-138.
https://doi.org/10.1016/j.canep.2016.02.006
Wang, Q., & Dwivedi, Y. (2017). Genetics of Suicidal Behaviour. In Handbook of Suicidal
Behaviour (pp. 73-90). Springer, Singapore. https://doi.org/10.1007/978-981-10-4816-
6_4

14ESSAY
Watkins, E. R. (2018). Rumination-focused cognitive-behavioral therapy for depression.
Guilford Publications.
Western Australia. (2018). Mental Health Act 2014.
https://www.legislation.wa.gov.au/legislation/prod/filestore.nsf/FileURL/
mrdoc_40843.pdf/$FILE/Mental%20Health%20Act%202014%20-%20%5B01-f0-
03%5D.pdf?OpenElement