Parental Depression Affects 15 Million Kids

Repost from WebMD. For entire article go here

Report: More Than 7 Million U.S. Parents Are Depressed; Family Focus Needed for Treatment

By Miranda Hitti
WebMD Health News

Reviewed by Louise Chang, MD

June 10, 2009 — Parental depression can take a serious toll on children, and the whole family should be involved in depression care, according to a new report.

That report, issued today by the National Research Council and the Institute of Medicine, estimates that in any given year, 7.5 million U.S. parents are depressed and at least 15 million U.S. children live with a parent who has major or severe depression.

Those are conservative estimates, notes Mary Jane England, MD, who chaired the committee that wrote the report. England is president of Regis College in Weston, Mass., and a past president of the American Psychiatric Association.

Depression is a “major problem that affects a significant number of people” but is “very treatable,” England tells WebMD.

The new report is about how parental depression affects children — and what to do about it.

Parental Depression Affects Kids

The new report traces the impact that parental depression may have on children — starting even before birth.

Here are some of the findings cited in the report:

• Depressed pregnant women may be less likely to get prenatal care.
• Depressed moms may be less attentive or less able to respond in a healthy way to their babies’ needs.
• Parental depression has been linked to children’s early signs of, or vulnerability to, having a more “difficult” temperament, including more negativity, less happiness, poorer social skills, more vulnerability to depression, more self blame, less self-worth, and a less effective response system to stress.
• Older children and teens may experience stress from a depressed parent.

The risks to children differ depending on the child’s age, notes committee member William Beardslee, MD, of the psychiatry department at Children’s Hospital in Boston.

“Early in life, we worry most that somehow the fundamental bond between the mother and father and the infant may be weakened because of depression,” Beardslee says.

“A little later on, when children are older, parents are vitally important in providing structure, order, encouragement, support, helping with school, helping with friendships, and those processes tend to be disrupted when a parent is depressed,” Beardslee says.

Most of the research done on parental depression has focused on mothers, especially during pregnancy or when their babies are very young. But parents can become depressed at any age, and depression in dads is also important.

“Fathers are a really critical part of families, and depression in fathers also has an impact on their children,” committee member Mareasa Isaacs, PhD, executive director of the nonprofit National Alliance of Multi-Ethnic Behavioral Health Associations, tells WebMD. “In some households the depression of the father is a direct response to the mother’s illness. He in turn pulls away from the family–directly impacting the child or children. It is not uncommon, from the father’s withdrawl, for the children, themselves to become withdrawn and unable to connect in future positive relationships.”

Depression saps energy, which can make it harder for patients to seek help.

But “parents care most about their kids and they want to do the right things for their children, so that’s a major motivating factor,” Isaacs says.

Big Picture Approach

The new report calls for a family focus in treating parental depression that includes parenting skills and attention to children’s well-being.

Tiffany Field, PhD, a pediatrics professor at the University of Miami Miller School of Medicine, agrees with that approach, though she wasn’t on the IOM committee.

“It’s critical to look at the whole family,” says Field, who studies parental depression. She notes that when a parent is depressed, the children will often become depressed, and then the parent gets even more depressed. “It’s like a vicious loop,” Field says.

The committee members want parental depression care to be available in several different settings — not just at mental health clinics or in specialists’ offices.

“There are childcare settings, school-based settings … other community settings where parents may feel more comfortable getting services,” Isaacs says. “We feel very strongly that we want to mainstream depression treatment,” England says.

The new report also recommends making policy changes and prioritizing research on parental depression. 

“We have a major systems problem,” England says. “The system is truly broken, in the sense that we do not focus on families. We focus only on the individual, and if you happen to walk in the right door, then you will get care, but only as an individual.”

She and her colleagues recommend that state task forces be formed to make it easier to find parental depression resources. That way, England says, families dealing with depression won’t have to spend their scarce energy looking for help.

Read more about parental depression on WebMD’s news blog.

Understanding When A Patient Refuses Treatment

From: Fordham Urban Law Journal

Article Excerpt:
INTRODUCTION

The role of psychology and related mental health disciplines in the informed consent process has gradually evolved from an essentially non-existent role into a central and important one. The importance of informed consent as a mechanism for protecting patient autonomy cannot be overstated. Both the ethical principals of psychologists as well as countless legal decisions have emphasized the importance of patient autonomy. (1) Rooted in the constitutional right to privacy, the importance of autonomy as a guiding principal in medical decision making (as in other forms of decision making) has been well established and is essentially unchallenged. (2)

I. INFORMED CONSENT

As is perhaps common knowledge for many clinicians and legal scholars, the doctrine of informed consent requires three elements to be present in order to validate medical treatment decisions. (3) The decision must be knowledgeable (i.e., the treatment provider must have disclosed relevant information to the prospective patient), voluntary (i.e., a decision made of the patient’s own free will), and competent (i.e., by an individual with an adequate level of decision making ability). Although psychologists have been involved in providing research and clinical expertise to virtually all aspects of the informed consent process, psychology’s role is most important in determining whether the patient is competent to make a treatment decision. (4)

The burden of the first element of informed consent, the “knowledge” element, rests with the treating clinicians. Specifically, the doctor must provide a reasonable amount of information regarding the known risks and benefits of a recommended treatment, as well as the risks and benefits of treatment alternatives. Not surprisingly, the volume of information necessary to make an informed decision varies depending on the nature and complexity of the decision at hand. Furthermore, different patients will certainly differ in the amount of information they desire. In general, however, a standard has emerged that is consistent with numerous other areas of the law: the “reasonable person” standard, or that amount of information that the typical person would find adequate and/or necessary to make such a decision. (5) Although psychologists have begun to use research tools to clarify the boundaries of the reasonable person standard, literature has not yet focused squarely on informed consent. (6) Instead, most mental health research has addressed the impact of disclosed information on treatment decisions or methods to improve comprehension and retention of disclosed information. (7)

Voluntariness, the second element of informed consent, pertains to the patient’s decision making process. Individuals must be free to make their own decisions without undue coercion from others. Although studies of the patient’s perceptions of coercion and the factors that influence this perception have begun to emerge in the psychology literature, this issue remains largely outside the domain of psychology. (8) Instead, defining the contours of voluntariness occurs primarily in the courts. Even so, no clear definitions or standards have been forthcoming. (9)

Competence, the final aspect of informed consent, is arguably the most important element of consent. Although only recently identified as a topic worthy of scientific scrutiny, the competence question has increasingly attracted the attention of the psychological sciences. (10) While the burden of competence falls primarily upon the decision maker, the clinician or researcher is responsible for ensuring that this requirement has been satisfied. (11) Importantly, the law presumes that every adult is competent to make decisions for themselves unless proven otherwise; for many individuals the burden of demonstrating competence may shift as a practical matter, if not a legal one. Mentally ill, mentally retarded, severely medically ill, and even healthy elderly adults share this burden, in that many individuals perceive their competence to be questionable. (12) This discussion focuses on three scenarios in which questions of competence, and the role of the mental health professional, play a central role.

II. LEGAL STANDARDS, CLINICAL ASSESSMENTS

Separating legal theory and clinical decision-making is necessary to any discussion of legal and ethical principals guiding real-world situations. Among the many crucial distinctions, few are as important as the distinction between law and clinical practice. (13) Although the decision-making capacity is clinical, determinations of competence are legal conclusions that are based only partially on clinical input. (14) Until a judge has declared an individual incompetent, the law’s presumption of competence remains. (15) Moreover, when determinations of incompetence are rendered, they are typically situation-specific, pertaining to only a single issue or decision (although some individuals might be declared incompetent for a broad range of purposes). (16) Third, although the responsibility for determining whether an individual is competent or incompetent rests with a judge, formal proceedings to determine competence are relatively rare.

Frequently these decisions arise during end-stage life conditions, however, in the field we do come across the ocassional patient who has given up due to life-stress and life-strain conditions. It is due to this that guidance from a mental health professional is warranted to clearly determine: is the patient’s quality of life diminishing (via biological illness) or is the patient merely giving up on life?

The DNR order is not a rite for individual suicide. If the patient’s condition can be treated with marginally invasive means, but the patient refuses to access the treatment (medication, dialysis, etc.) that could not only save their life but improve the biological quality of life, the primary doctor, clinic, hospital should seek consult from a mental health professional to institute a discussion on whether the patient is mentally competent to make medical decisions.

(Note: Refusing dialysis or medication which will in turn prevent further medical issues such as stroke seems to indicate a state of depression. You need to engage your supports now. You need to recognize that there are people who would like to help you through these difficult times.)

The Psychology of Selfishness

Values without a valuer

 

(Repost by Ifat Glassman) 

 

 

What is “important” in life? A commonly accepted answer is: Getting your name down in history books, bringing progress to humanity, helping people, changing things on a major scale. 

 

Then, there is a sub-version of what is “important”: the idea of what is “successful”. “Successful” means being famous, having a triple degree in something, rich, popular, having people who love you, being good looking.

 
Even though this concept of “important” refers to an individual, and what an individual should do – What it fails to consider is the actual individual. It prescribes what is “important” to an individual while making irrelevant the actual opinion of an individual person. 

 

Ethics taken as duty are experienced as an end in themselves: A person is honest for the sake of being good, she does well in school for the sake of being good, she is a good partner or spouse for the sake of being loyal, she goes on a diet for the sake of being “successful” etc’.

Philosophically she views morality as duty: as a set of rights and wrongs dictated to her from something outside herself (like society or God). 

Psychologically this view of morality puts a wedge between her self esteem and desires; because she needs to choose if she wants to be good and obedient, or pursue her own desires and goals–thus giving up being good (which means to give up self-esteem).  

 

 

 

 

 

Philosophically, a proper moral code depends on a human’s choice to live and achieve her needs. It’s opposite, a moral code prescribed as duty, makes personal goals and thinking irrelevant, and is therefore improper as a guide to life (which is what ethics in essence IS).

Psychologically, the distinction between morality from choice or from duty is not between following good morality or bad morality – rather the method by which a person accepts her moral code and why she accepts it.

 

Does she choose her moral code to better her life, or does she accept it unquestionably, as something above herself, for the better good of other as something expected to live up to?

 
If an individual sees morality as “the good” (i.e. “this is what I should do to be good!”) and not as “the good for me” (“I should do X if I want good things for myself”) then she accepts morality as a matter of duty, regardless of how good the moral code is philosophically. 

 

The person with the first approach (“be good!”) has no explanation of why these things are important. It seems to her like there is no explanation – those things simply ARE important, even though she never reached this conclusion herself nor recalls ever choosing those things. Her concept of “important” is divorced from her desires and ideas. She, in her duty to be morally good is living for others with little regard to herself–goes through life denying her own needs for the good of others. She sees life and relationships with others as desired, but holds herself responsibilities. The goal of “doing good” becomes evasive, the chasm between personal value and the lofty unreachable mark of fulfillment of duty falls further and further from her grasp.

 

For many it can be difficult to grasp that a proper moral code actually depends on their choice; Many of us are educated to accept what is “good” or “bad” as irrelevant to our choice and beyond our reasoning. Kids are taught what is “important”, such as; it is important to get good grades, important to keep a safe, traditional path vs. pursuing a “hopeless” dream, important to have friends, not to upset anyone, to “get along”. It is important to do “great things”, to have money, important to share, important to be modest, nice, etc’. All this is demanded from a child as measurement of how good she is, without providing an explanation what makes these things good for the child. Without giving her incentive or reason to choose this course of behavior herself. [Additional note at the end regarding this point]

This sort of “education” sets the psychological state of mind for having values without a valuer. To pursue “important” things that one does not enjoy and that are not part of individual self-fulfillment, rather they stand above one’s self, as a test of her worth.  

 

What kind of psychology leads an individual in one direction or the other? I find that the answer lies in the trait of selfishness. 

 

A selfish person is primarily motivated to achieve her own enjoyment. And unless some enjoyment logically follows in exchange for the effort of acting – she does not move an inch. When there is something she values – she does not give it up.

 
A non-selfish person gives up her pleasure and her values easily if she is taught that the good is to do so.  She does not act to achieve pleasure – rather she acts in a “moral” way for the sake of not disappointing others – for the fear of being bad or the attempt to be good, without any further purpose – without attempting to gain something of personal importance to her, something she enjoys. 

 
For example: Suppose someone enjoys romantic relationships. And some day she learns that according to an accepted ethical principle, this kind of behavior is bad. If she is selfish she will say: “To hell with this principle, it’s taking away my enjoyment. Unless I understand in what way this principle is good for my life, I say to hell with it”. 
The person who sees morality as duty, however, will think: “Well, to be good I must give up my pleasure from having this relationship. Being good and all the “others” in the world are more important than my pleasure”. 

In what way, then, can morality be selfishly chosen? 

As we grow up we learn that a certain course of action is required to achieve the things we aim at getting. We look for some guidance for the kind of person we want to be in order to deal with the difficulties in our lives and enjoy it, we look for some ideal or role model for guidance of the kind of person we want to be. Most people do not realize that this is their first step to choose a moral code – and not what they were taught to believe is “the good”.

 

The correct method to choose a moral code is highly personal: It is acting as the kind of person you are inspired to be, for the sake of achieving things you enjoy. And the process of integrating a chosen moral code to one’s life goes through one’s ability to understand it.

 

Most of us get educated with one bad idea or another. It is therefore important to make sure what we consider as important actually serves our enjoyment and well being. 

 

If there is one advice I could offer someone who wants to get rid of morality from duty it would be – focus on your pleasure, use the fullest capacity of your reasoning mind to maximize your enjoyment through the whole of your life. Learn to notice what you enjoy and what you drag yourself through in order to be “good”. 

One cannot chose a career or personality that are good for him and yet make him self-alienated and bored.

  

Often, an individual who lives life through duty to others and morality only reaches a state of hopelessness–journeying through life with no sense of personal achievement or value to themselves or others–which leaves them to question why they are at all (ex: the character George Bailey in “It’s a Wonderful Life,” who spent his entire life delaying his pleasure for the good of others until he wanted to kill himself).

 

Likewise a truly selfish person who acts only for the pleasure of herself through achieving instant gratification and material possessions may also reach that same state of failure–though frequently delayed to a time when she become old or ill (ex: The character Kane in the film “Citizen Kane” who came to realize that he had a great many things but no real value to anyone).

 

The purpose of morality compatible with human life is to provide us the principles to guide our lives: to teach us the kind of person we need to be in order to enjoy and sustain our lives.

 

Don’t give up any portion of your life for any purpose less than that. 

 

*Note to MJ: the truly selfish path is giving up on life altogether. You do matter to so many though you may not hear their voices anymore.