• Mental Health  o “State the successful performance of mental function, resulting in productive  activities, fulfilling relationships with other people, and the ability to adapt to  change and to cope with adversity”  USHDDS, 1994, page 4  

 

  • Mental Illness  o Refers collectively to all diagnosable mental disorders  

 

  • Mental Disorder  o “Health conditions that are characterized by altering thinking, mood, or  behaviour… associated with distress and-or impaired functioning”  USHDDS,

1994, page 4   o Ex: Anxiety, depression

 

Mental Health Problem

  •    Signs and symptoms of insufficient intensity or duration to meet criteria for  mental disorders
  •    Symptoms are sufficient enough to potentially warrant active efforts in health  promotion, prevention, and treatment

 

Continuum of Mental Illness, Mental Health Problems, and Mental Health

Mental Illness —– Mental Health Problems ———————————– Mental Health !

 

Depression Defined

 

  •    Mood disturbances: Influences mood regulation beyond the usual variations
  •     Persistent low mood and inability to find enjoyment in activities
  •     Lack of motivation to begin or continue activities
  •    Feelings of worthlessness

 

 

 

Major Depressive Disorders 

 

  •    Depressive disorder  unipolar major depression
  •        Bipolar disorder  –   Dysthymia
  •    Cyclothymia

 

Major Depressive Disorder

  • Depressed mood, loss of interest or pleasure are primary symptoms  o Not driven by physiological causes  Ex: Drugs  or medical condition  Ex:  Hypothyroidism
  •    Other symptoms can vary widely
  • Episodes last approximately nine months if untreated  o 80-90  remit within two years of first episode
  • 50 will recur
  •    Symptoms cause significant impairment in social, work, or other important areas

 

Bipolar Disorder

  •    One or more episodes of mania or mixed episodes of mania and depression
  • Mania can range from pure euphoria-elation to irritability o Thoughts are grandiose or delusional  o Decreased need for sleep  o Easily distracted, with racing thoughts
  • Excessive involvement in pleasurable activities that are likely to have painful consequences  Ex: Unrestrained shopping spree, sexual indiscretions   – Higher familial prevalence  e. Stronger genetic component

 

Dysthymia

  •    Chronic form of depression
  •     Fewer than five persistent symptoms
  •    Duration of approximately two years for adults, approximately one year for children  –   Increased susceptibility to major depression
  •    Seldom remits spontaneously
  •     Women are twice as likely be diagnosed as men

 

Cyclothymia

  •    Marked by manic and depressive states, but of insufficient intensity-duration to  diagnose as bipolar or major depressive
  •     Increased risk of developing bipolar disorder

 

Depression Generally Characterized by the Following

  •     Feelings of sadness-elation
  •     Feelings of guilt-worthlessness
  •     xisturbances of appetite
  •    xisturbances in sleep patterns
  •    Lack of energy
  •     xifficulty concentrating
  •     Loss of interest in all-most activities
  •     Problems with memory
  •    Thoughts of suicide
  •    Hallucinations

 

Prevalence

  •     xisability Adjusted Life Years  xALYs
  • Estimate of the years of healthy life lost to premature death and years lived with a severe disability  e., disease and disability burden
  • Of the mental illnesses, major depression was 2nd only to cardiovascular problems and ranked ahead of alcohol use and traffic accidents in disease and  disability burden
  •  Mood disorders  e.g., major depression, bipolar disease  are in the top 10 list of  disabilities worldwide
  •  In a given year, 21  of the U.S. adult population will have a diagnosable mental  disorder, which includes a 7.1  one-year prevalence rate for any mood disorder

 

Costs

  • Overall costs of depression: $83 billion per year in 2000
  • Breakdown of costs:  o 31  on direct treatment and rehabilitation, 7  on mortality, and 62  for  absenteeism and reduced work productivity
  • Other costs:  o Increased risk for other diseases

o xecreased quality of life for the individual and families

 

 

Causes

  •    Not well understood
  •    Physiological and psychosocial factors interact in response to some stressful events
  •    Some research has focused on biological factors  e.g., neurotransmitter deficiencies   but this is an insufficient explanation
  •    Individual variation in manifestation

o Heredity, coping skills, experience, gender, environment, and social support

 

Treatment

  •     Depression is often untreated – due to stigma of mental illness
  •    When depression is treated:
  • Pharmacotherapy and psychotherapy o Noncompliance is frequent
  • Can be expensive and have unwanted side-effects
  •    Physical activity could help both prevent and treat depression

 

Measurement

  • Standard Classification Criteria  o Diagnostic#and#Statistical#Manual#of#Mental#Disorders  4th edition, revised,

DSM-IV-TR

  • Other classification criteria included:
    • Research Diagnostic Criteria RDC
    • International Classification of Diseases ICD-10
  •    SelfCReport Measures
  • Questionnaires

 

 

Self-Report Measures

  • The two most common and well-validated questionnaires are:
  • Beck Depression Inventory o Zung Self-Rating Depression Scale
  • Center for Epidemiological Studies – Depression Scale CES-D

 

Research on Preventive Effects of Exercise

  •    Research shows a connection between prevalence of decreased physical activity  and increased mental health problems
  •    Least active individuals have the greatest incidence of mental health problems,  including symptoms of depression
  •    Regular physical activity can help prevent mental health disorders or reduce their  risk of occurrence

  

Research on Treatment of Nonclinical Depression

  •     Various meta-analyses have shown:
  1. Exercise resulted in decreased depression
  2. Some factors moderated exercise treatments effects while others did not
  3. Exercise was as effective as, and sometimes more effective than, traditional therapies

 

Exercise Variables as Moderating Factors

  •     Mode of exercise 
  • No difference for different types of exercise
  •    Length of exercise program
  • Length of exercise program is not as important as “just doing it”
  •    Exercise intensity
  • More research needed
  •    Duration or frequency
  • More research needed
  •    Acute vs. chronic
  • Both single bouts and long-term exercise reduced depression
  •    Age
  • Exercise decreased depression for all ages
  •    Gender
  • Exercise decreased depression for both genders
  • Initial level  o Regardless of initial depression level, all participants showed decreases in  depression

 

Effectiveness of Exercise vs. Traditional Treatments

  •    Exercise is better than no treatment
  •        Exercise – traditional treatments  i.e., relaxation, psychotherapy, some medication  –   Exercise + psychotherapy is best
  •    Exercise is cost effective
  •    Exercise also increases physical health, as an added benefit

 

Research on Treatment of Clinical Depression

  •    Hospitalized psychiatric patients rated exercise as the most important part of  comprehensive treatment plan
  •    Both aerobic and nonaerobic exercise result in significant psychological  improvements
  •    Interventions should last at least 10 weeks
  •    Patients should exercise 3-5 times per week
  •    For patients engaging in aerobic exercise, exercise intensity should be 50 to 85  of  maximal heart rate
  •     For patients doing resistance training, intensity should be 80  of 1-RM
  •    Exercise sessions should be 45-60 minutes in duration
  • Exercise treatment – pharmacotherapy  drug  treatment; also – combination  drug-exercise treatment  o Follow-up study at 6 months, exercise group was more likely to be fully or  partially recovered
  •    Exercise might reduce the level of medication needed, length of time it is needed,  and perhaps even the need for medication at all

 

Consensus Statements about Exercise and Depression

  •     Exercise can be effective as a treatment for mild to moderate depression
  •     Exercise may be an effective component in the treatment of severe depression

 

Mechanisms of Change

  •    Anthropological Hypothesis
  •    Endorphin Hypothesis
  •    Monoamine and Neurogenisis Hypothesis
  •    Mastery Hypothesis
  •     Affect Regulation Hypothesis  you feel better when you exercise
  •    Social Interaction Hypothesis

 

 

Anthropological Hypothesis

  •    Evolutionary perspective
  •     We are genetically predisposed to be physically active
  •    Technology has progressed so that we no longer have to engage in vigorous activity  for our survival
  •     Incidences of depression have increased dramatically
  •    By violating our genetic predisposition by being sedentary, we risk having health  problems

 

 

Endorphin Hypothesis

  •    During stress  e.g., exercise , the body produced endorphins – natural painkillers
  •    Increase in endorphins may reduce depression
  •    More research is needed before firm conclusions can be reached

 

 

Monoamine and Neurogenesis Hypothesis

  •     Effects of exercise on depression are due to altered brain neurotransmitters
  • Serotonin o Norepinephrine   o Epinephrine
  • Dopamine
  •     Neurotransmitters involved in the regulation of emotion
  •     Exercise increases the rate of neurotransmitter production

 

  • Neurogensis:  o The synthesis of new neurons in the brain, particularly in brain areas shown  to be affected by depression
  • Exercise promotes neurogenesis by increasing levels of brain-derived neurotrophic factor  BDNF

 

 

Mastery Hypothesis

  •    Psychological effects of exercise are derived from accomplishment or mastery felt  upon completion of a task
  •    Individual has a sense of greater self-worth and personal control over the  environment

 

 

Social Interaction Hypothesis

  •    Exercise provides an individual an opportunity to interact with others
  •    They hypothesis may account for part of depression reduction, but it cannot be the  sole explanation

 

Practical Recommendations

  •    Regular exercise can be useful in treating depression as well as in protecting  against depression
  •        Monitor the exercise dosage and modify as the individual’s level of fitness changes  –   Type of exercise doesn’t seem to matter; just make it enjoyable