Microsoft PowerPoint - 36161 [Compatibility Mode]Mental Health
Stress Mental Health Stress Mental Health Stress Mental Health
Stress -- DepressionDepressionpp
::
Assistant Professor Assistant Professor L Li dL Li dLoma Linda Loma
Linda
University School of University School of P bli H l hP bli H l
hPublic HealthPublic Health
Depression StatisticsDepression StatisticsDepression
StatisticsDepression Statistics
•• 12 4 million women12 4 million women 200200•• 12.4 million
women12.4 million women ,200,200
•• 6.4 million men6.4 million men 640640
•• Leading cause of disabilityLeading cause of disability
•• 340 million world340 million world--widewide 3.43.4
DEPRESSIONDEPRESSION -- Hong KongHong Kong DEPRESSIONDEPRESSION --
Hong KongHong Kong
19981998 •• 7% of people over 70 7% of people over 70 -- 26,000
26,000
70707%7%--26,00026,000,, •• 5% of them (1,300) under treatment 5%
of them (1,300) under treatment
5%(1 300)5%(1 300)5%(1,300)5%(1,300)
•• Every day Every day -- 3 people commit suicide3 people commit
suicide •• 50% of them 50% of them -- depressivedepressive •
50%-50%
Data from 1998 government health reportsData from 1998 government
health reportsData from 1998 government health reportsData from
1998 government health reports
19981998
Symptoms of DepressionSymptoms of Depressiony p py p p
•• 11. . Deep Deep sadnesssadness or emptinessor emptiness
•• 2. 2. ApathyApathy
•• 4. 4. SleepSleep disturbances disturbances
•• 5. 5. WeightWeight/appetite disturbances /appetite
disturbances
•• 6. Lack of 6. Lack of concentrationconcentration
•• 7. Feelings of excessive guilt or 7. Feelings of excessive guilt
or worthlessnessworthlessness
•• 8. 8. Morbid thoughtsMorbid thoughts (())
•• 9. 9. FatigueFatigue
Depression increases risk of…Depression increases risk of…
•• Deaths from Deaths from cancercancer (HK #1)(HK #1)
•• Death in Death in heart attackheart attack survivors by 2.5
timessurvivors by 2.5 times (HK #2)(HK #2)( )( )
•• ,,2.52.5
•• FatalFatal strokesstrokes by 50%by 50% (HK #3)(HK #3)Fatal Fatal
strokesstrokes by 50% by 50% (HK #3)(HK #3) 50%50%
•• Deaths fromDeaths from pneumoniapneumonia (HK #4)(HK #4)Deaths
from Deaths from pneumonia pneumonia (HK #4)(HK #4)
•• SuicideSuicide 50 50 -- 80% 80% (HK#7)(HK#7)%% ( )( ) 50 50 --
80% 80%
:
•• Unemployed Unemployed
•• Housewives Housewives
•• School dropoutsSchool dropouts•• School dropouts School dropouts
•• 25% in debt 25% in debt 25%25%
–– gambling gambling
–– credit cardcredit card
Source: South China Morning Post 25 July, 2003Source: South China
Morning Post 25 July, 2003
credit card credit card
g y,g y,
•• 2 Apathy2 Apathy ISOLATIONISOLATION •• 2. Apathy 2. Apathy
ISOLATION ISOLATION
•• 3. Agitation or restlessness 3. Agitation or restlessness
//
4 Sl di t b4 Sl di t b •• 4. Sleep disturbances 4. Sleep
disturbances
•• 5. Weight/appetite disturbances 5. Weight/appetite
disturbances
6 L k f t ti6 L k f t ti •• 6. Lack of concentration 6. Lack of
concentration
•• 7. Feelings of excessive guilt or worthlessness 7. Feelings of
excessive guilt or worthlessness
NO PLEASURENO PLEASURE NO PLEASURE NO PLEASURE
•• 8. 8. MORBID THOUGHTS MORBID THOUGHTS (())
•• 9. Fatigue 9. Fatigue
Bridge Watchman
• He stopped 42 people of committing suicide g jumping off the
bridge since lastbridge since last year (2004). • (2004) 42 .
Quiz TimeQuiz Time
•• 1 Mention 2 diseases related to1 Mention 2 diseases related to1.
Mention 2 diseases related to 1. Mention 2 diseases related to
depression?depression?
•• 2. Mention 2 symptoms of 2. Mention 2 symptoms of
depression?depression?pp
•• 3. Why do people commit 3. Why do people commit
suicide?suicide?suicide?suicide?
Depression and ExerciseDepression and Exercise
•• Physical exercise in Physical exercise in bright lightbright
light had a positive had a positive effect on mood and healtheffect
on mood and health--related quality of life related quality of life
in a sample of healthy, workingin a sample of healthy, working--age
people.age people.
•• ,, ..
Exercise and Mental HealthExercise and Mental Health
• Depression
• Anxiety
• Eating disorders
• Stress (reduces tension and anger) ()()
• Chronic fatigue
• 1900 participants 1900• 1900 participants 1900
• Women who don’t exercise have 2 x risk of major depression
,
• Farmer et all, 1988 • Exercise increase serotonin and• Exercise
increase serotonin and
norepinephrine
(fluorine-18-labeled deoxyglucose positrondeoxyglucose positron
emission tomography) in cognitive behaviorcognitive behavior
therapy (CBT) responders (top) and p ( p) paroxetine responders
(bottom) following treatment. --
Goldapple et al 2004
• Overgeneralization • Overgeneralization
A bit l i • Arbitrary conclusions
• Basic principle: change our current wayp p g y to interpret
things and events in life
DEPRESSION, EXERCISE, and , , TREATMENT
65 5 68.870
more more depressiondepression
50
Exercise
•• 11 -- Combined Ex+MedCombined Ex+Med 40
1 1 Combined Ex+Med Combined Ex+Med + +
22 O l E iO l E i Different Different
•• 2 2 -- Only Exercise Only Exercise
•• 3 3 -- Only Medication Only Medication
Treatment Treatment GroupsGroups
•• 16 weeks 1616 weeks 16
Quiz TimeQuiz Time •• 4. Why exercise is good for mental health, 4.
Why exercise is good for mental health,
specially depression?specially depression? •• 5 Give one example of
distorted or5 Give one example of distorted or5. Give one example
of distorted or 5. Give one example of distorted or
wrongful thinking?wrongful thinking?
Sleep and Mental HealthSleep and Mental HealthSleep and Mental
HealthSleep and Mental Health
77--8 hours/night8 hours/night 7788
Sleep and the mindSleep and the mindpp
•• 40%40% of those with insomnia will have a of those with insomnia
will have a mental problemmental problem in the futurein the
futuremental problemmental problem in the future in the future
,,40%40%
•• Risk of major depression is Risk of major depression is 40
times40 times higher among insomniacshigher among insomniacshigher
among insomniacshigher among insomniacs
•• 4040
How to improve your sleep How to improve your sleep ??
•• Light dinner Light dinner
•• Avoid caffeine alcohol andAvoid caffeine alcohol and•• Avoid
caffeine, alcohol and Avoid caffeine, alcohol and nicotine nicotine
,,
•• Exercise in day lightExercise in day light•• Exercise in day
lightExercise in day light
•• Quiet, silent room Quiet, silent room
•• Calming activities Calming activities (reading, music,
meditation (reading, music, meditation and prayer and prayer
,,,,))
•• Herbals + Hydrotherapy Herbals + Hydrotherapy y pyy py +
Di t d th Mi dDi t d th Mi dDiet and the MindDiet and the Mind
????
Is there any connection?Is there any connection?Is there any
connection?Is there any connection? ??
Michael SpurlokMichael SpurlokMichael SpurlokMichael Spurlok One
month onOne month onOne month on One month on
McDonald’s food:McDonald’s food:
Gained 12 kgGained 12 kgGained 12 kgGained 12 kg 1212
Depression, irritation, Depression, irritation, mood swingsmood
swingsgg
,,,,
Undersize Undersize Undersize Undersize my brain!my brain!
Sugar Sugar ?? Coffee ?? Coffee ????Sugar Sugar ?? Coffee ?? Coffee
???? •• Sugar and caffeine give you a Sugar and caffeine give you a
quick liftquick lift ---- but can but can
leave you leave you feeling downfeeling down when their effects
wear when their effects wear off. off.
•• ,,,,
•• Feelings of depression often improve when theirFeelings of
depression often improve when theirFeelings of depression often
improve when their Feelings of depression often improve when their
consumption is minimised. consumption is minimised.
•• •• ,,..
AlcoholAlcoholAlcoholAlcohol
•• Fetal Alcohol SyndromeFetal Alcohol Syndrome
•• First Gateway DrugFirst Gateway Drug
Alcohol is associated with Alcohol is associated with
AlcoholAlcohol
•• Alcohol in the USAlcohol in the US
cancers of the mouth, cancers of the mouth, tongue, throat,
esophagus, tongue, throat, esophagus, stomach liver andstomach
liver and
•• Why?Why? ??
stomach, liver, and stomach, liver, and pancreas. pancreas. •• Why?
Why? ??
Car accidents Car accidents –– 50%50% 50%50%
50%50% •• Suicide Suicide –– 35%35% 35%35%
•• Homicide Homicide –– 3030--4040%% Child abuse, rape, Child
abuse, rape, violence,violence, assaults etcassaults etc
3030--40%40% •• Spouse abuse 30%Spouse abuse 30%
assaults, etc. assaults, etc. ,,,,,, pp
-- 30%30%
Alcohol Alcohol
•• Alcohol for instance is oftentimes used as anAlcohol for
instance is oftentimes used as an
Alcohol Alcohol
•• Alcohol, for instance, is oftentimes used as an Alcohol, for
instance, is oftentimes used as an escape from depression, but in
actuality, escape from depression, but in actuality,
l h l l d tl h l l d t it i d fi i i (Bit i d fi i i (B))alcohol
can lead to alcohol can lead to vitamin deficiencies (Bvitamin
deficiencies (B)) which can contribute to depression.which can
contribute to depression.
•• ,, BB,,BB,,
Alcohol Encourages Criminal Behavior
Percent of Adults Under the Influence When Percent of Adults Under
the Influence When C i i A C iC i i A C i
CRIME PERCENT Murder 49
68Manslaughter 68 Rape 52 Robbery 48Robbery 48 Assault 62 Burglary
, 44 Auto Theft 51 Fraud 22
7th SRUSC 1990, pp. 171-175
T t h
•• Mood lowering Mood lowering
•• Memory impairment Memory impairment
•• Increased aggressionIncreased aggression //•• Increased
aggression Increased aggression //
•• Depression relapseDepression relapse in women taking in women
taking antianti--depression depression medication(serotonergic
drugs)medication(serotonergic drugs)medication(serotonergic
drugs)medication(serotonergic drugs)
•• (())
Foods rich in TryptophanFoods rich in Tryptophan
Whole milkWhole milk
TofuTofu TofuTofu
B Vitamins > TryptophanB Vitamins > Tryptophanyp pyp p B
>B >
Whole wheat bread and productsWhole wheat bread and products Wanna
take a
Brown Rice Brown Rice pill?
?
Fruits Fruits
Other vegetablesOther vegetables
Beans Beans
The case of omega 3 The case of omega 3 33The case of omega 3 The
case of omega 3 33
1/3 f f tt id i th b i1/3 f f tt id i th b i•• 1/3 of fatty acids
in the brain are 1/3 of fatty acids in the brain are omega 3 type
omega 3 type 33
•• Prevention of stress depression andPrevention of stress
depression and•• Prevention of stress, depression and Prevention of
stress, depression and dementia dementia ,,
•• Medicine Sciences (Paris) Feb, 2005Medicine Sciences (Paris)
Feb, 2005
The case of omega 3 The case of omega 3 33 •• Ohara, K Ohara, K --
japanese researcher said japanese researcher said
gg jj
that patients with major depression that patients with major
depression have have lower levels of omega 3lower levels of omega 3
fatty acids fatty acids gg yy 3333
•• Omega 3 has been used with success Omega 3 has been used with
success toto treat depressive patientstreat depressive patientsto
to treat depressive patients treat depressive patients 33
•• Ohara, K (2005)Ohara, K (2005)
The case of omega 3 The case of omega 3 The case of omega 3 The
case of omega 3 33
•• Dalian Medical University Dalian Medical University -- China
China yy
•• 200 participants study 200200 participants study 200200
participants study 200200 participants study 200
•• Low level of omega 3 in suicidal participants Low level of omega
3 in suicidal participants compared to controlcompared to
controlcompared to control compared to control
•• Suicidal patients Suicidal patients -- EPA levels in RBC =
.74EPA levels in RBC = .74 •• Control group Control group -- EPA
levels in RBC = 1.06EPA levels in RBC = 1.06 •• Huan M, et all,
2004 (Biological Psychiatry)Huan M, et all, 2004 (Biological
Psychiatry)( g y y)( g y y)
HERBALSHERBALSHERBALSHERBALS
•• Saint John’s Wort Saint John’s Wort -- (500(500--1000 1000 mg mg
-- dayday) ) minor depressionminor depression minor depression
minor depression
•• Kava Kava -- (100 (100 mg/day)mg/day) ith an iet componentith an
iet componentwith anxiety componentwith anxiety component
•• Gingko Biloba Gingko Biloba -- (80 (80 mg mg -- 3 x day) 3 x
day) for people over 50for people over 50
•• GinsengGinseng (200(200 mg/day)mg/day)Ginseng Ginseng (200 (200
mg/day) mg/day) StressStress
Quiz TimeQuiz Time •• 6. Mention 2 things to improve sleep?6.
Mention 2 things to improve sleep? •• 7. Mention 2 foods reach in
Tryptophan?7. Mention 2 foods reach in Tryptophan? •• 8 Mention 2
foods rich in Omega 3?8 Mention 2 foods rich in Omega 3?•• 8.
Mention 2 foods rich in Omega 3?8. Mention 2 foods rich in Omega
3?
Lifestyle Lifestyle -- What is it?What is it? --??
Mary was a nurse that everybody Mary was a nurse that everybody y y
yy y y likedliked
Doctors, colleagues and mostly the patients.Doctors, colleagues and
mostly the patients. ,,
Her friends started noticing she was Her friends started noticing
she was depressed and stopped eatingdepressed and stopped
eatingdepressed and stopped eatingdepressed and stopped
eating
,,..
She was diagnosed with major depression and anorexiaShe was
diagnosed with major depression and anorexiaShe was diagnosed with
major depression and anorexia She was diagnosed with major
depression and anorexia nervosa nervosa -- a very lethal
combinationa very lethal combination --
And he had to hospitalise her for a And he had to hospitalise her
for a few days and give her antifew days and give her anti--
depressant medicationdepressant medicationpp
Then Dr. Brown send her to another doctor Then Dr. Brown send her
to another doctor who was specialised in lifestylewho was
specialised in lifestyle
,,,,
Mary started following a Mary started following a i il t h t ii il
t h t iprogram similar to what is program similar to what is
taught in this seminartaught in this seminar ,,
..
For one month, she improved a lot,For one month, she improved a
lot,For one month, she improved a lot, For one month, she improved
a lot, but…but…
,,,,......
...she gave up on the diet, exercise and the whole...she gave up on
the diet, exercise and the whole...she gave up on the diet,
exercise and the whole ...she gave up on the diet, exercise and the
whole lifestyle, then she got depressed again.lifestyle, then she
got depressed again.
--,,,,
B h d id dB h d id dBut she decided to come But she decided to come
back to the new life.back to the new life.back to the new life.back
to the new life.
..
Now, after six months, her life is changed, sheNow, after six
months, her life is changed, sheNow, after six months, her life is
changed, she Now, after six months, her life is changed, she went
back to work and again she is the same went back to work and again
she is the same wonderful and excellent nurse she used to
bewonderful and excellent nurse she used to bewonderful and
excellent nurse she used to be.wonderful and excellent nurse she
used to be.
,, ,,..
Mental Health LifestyleMental Health LifestyleMental Health
LifestyleMental Health Lifestyle --
•• Physical exercise outdoor Physical exercise outdoor
•• Diet rich in fruits, vegetables, whole Diet rich in fruits,
vegetables, whole grains and beansgrains and beansgrains and beans
grains and beans ,,
A id j k f dA id j k f d •• Avoid junk food Avoid junk food
•• Regular sleepRegular sleep Regular sleep Regular sleep
•• Avoid negative thinking Avoid negative thinking
Mental Health • Prevention:
– Lifestyle
• Treatment: – Medical
2. Spiritual leader, community leader, role model, older person
Medical
– Counselling
3. Professional counsellor - Social worker, h ll– Lifestyle youth
counsellor, etc
-,
5. Psychiatrist
Deep Breath Exercises
Dr. Harold KoenigDr. Harold KoenigDr. Harold KoenigDr. Harold
Koenig Journal of the American Medical Association, 2000Journal of
the American Medical Association, 2000
20002000 20002000
850 studies of mental health have found850 studies of mental health
have found850 studies of mental health have found 850 studies of
mental health have found that that religious involvementreligious
involvement and and spiritualityspirituality
are associated withare associated with better healtbetter
healthhare associated with are associated with better healtbetter
health h 850850,,
..
WhyWhy ??Why Why ?? Spiritual practices such as meditation, p p ,
prayer and worship engender positive emotions such as hope
loveemotions such as hope, love, contentment, and forgiveness, and
limit negative emotions such as hate angernegative emotions such as
hate, anger and hostility. /
Positive emotions will producePositive emotions will producepp
::
•• Less stress Less stress
•• Less anxiety Less anxiety
•• Less depression Less depression
L bl dL bl d •• Lower blood pressure Lower blood pressure
•• Lower heart rateLower heart rate Lower heart rateLower heart
rate
•• Better immune functionBetter immune function
Are you depressed?Are you depressed?
A goo of the
1 I f l d h t d d bl
d part tim
1 I feel downhearted and blue.
1 2 3 4
2 Morning is when I feel the best2 Morning is when I feel the
best
4 3 2 1
3 I have crying spells or feel like it.
1 2 3 4 1 2 3 4
4 I have trouble sleeping at night.
1 2 3 4 1 2 3 4
5 I eat as much as I used to.
4 3 2 1 4 3 2 1
6 I still enjoy sex. 4 3 2 1
Are you depressed? 7 I notice that I am losing weight.
1 2 3 4
y p
8 I have trouble with constipation. 1 2 3 4
9 My heart beats faster than usual. 1 2 3 4
10 I get tired for no reason 1 2 3 4
11 My mind is as clear as it used to be. 4 3 2 1
12 I find it easy to do the things I used to. 4 3 2 1
13 I am restless and can’t keep still. 1 2 3 4
Are you depressed? 14 I feel hopeful about the future.
4 3 2 1
y p
15 I am more irritable than usual. 1 2 3 4
16 I find it easy to make decisions. 4 3 2 1
17 I feel that I am useful and needed. 4 3 2 1
18 My life is pretty full. 4 3 2 1
19 I still enjoy the things I used to. 4 3 2 1
20 I feel that others would be better off if I were dead. 1 2 3
4
Are you depressed?
Are you depressed?
Most people with depression score 50 to 69Most people with
depression score 50 to 69. 5069