Depression And The Social Environment: Research And Intervention With Neglected Populations
Editors: Philippe CappeUez; Robert J. Flyrm McGill
Queen’s University Press, 3430 McTavish St, Montreal, QCH3A 1X9, 1993, 428 ppl
The title of this book clearly expresses the concepts within. It is well written and includes fairly complete literature reviews, along with some of the authors’ personal work on research related to depression in specific populations. Most of the populations studied are often neglected by health planners and service providers.
This book is valuable for all mental health professionals in general psychiatric practices and for family physicians who subspecialize. It is, however, highly academic and slow to read. Although it promises to be practical, it is not necessarily so in all chapters. Chapter 3 on adolescent depression and chapter 6 on depression among patients attending a general practice are exceptions. These chapters are extremely good and are valuable reading for family physicians. In fact, both chapters should be mandatory reading for family practice residents.
Chapter 1 is an introduction to the text. It explains that the information in the book is psychosocially based and will be the foundation for policy recommendations and individual practical interventions. The book largely ignores biological considerations, a fact that reduces its relevance for the average family physician.
Chapters 2, 3, and 4, respectively, are related to childhood depression, adolescent depression, and suicide in young adults. For childhood depression, comprehensive assessment and treatment planning is stressed. The authors suggest that there is a “lack of evidence for efficacy of any specific treatment,” and therefore “sound clinical judgement” is required. They suggest that increased training of professionals, along with increased resources for treatment and further research, are required to make advances in this field.
In the chapter on adolescent depression, the phenomenology of depression in adolescents is compared with that in adults. However, hypersomnia; negative thoughts; irritability; and increased anxiety, especially in younger teens, are seen perhaps more often. The course of depression is also slighdy different. Depressed moods appear to last between 20 and 40 days in younger adolescents and increase in length in those who are older. The authors stress that rating scales should not be used to make a diagnosis but rather to follow patients once a clinical assessment is completed.
The chapter on suicide reviews the increase in suicide attempts in Canada during recent years. The difficulties of preventing suicide among young adults is discussed and strategies to make teens “more active and engage… in projects with other people” are suggested.
It is also suggested that the period of crisis immediately after a suicide attempt is crucial for restoring self-confidence, and therefore emergency services should be available and trained to assist at that time.
Other chapters address sex issues, the effects of unemployment, depression among Canadian Natives, depression among immigrants and refugees, depression among people with physical disabilities, depression among caregivers of impaired elderly family members, depression among elderly persons themselves, and mediators of depression in community-based seniors. Themes common to all the chapters emphasize the difficulty of separating depressive symptoms from syndromes and the importance of recognizing this as a problem to be researched itself. It would appear that the more specialized the population the bigger problem this distinction becomes. All of the chapters emphasize the need for further general study of these populations.
Chapter 14 is really the conclusion. In it the editors summarize and integrate material from all the other chapters and come to conclusions and recommendations. Reading the last chapter first puts the whole book into perspective. The editors suggest improving the training of professionals in both diagnosis and treatment of depressive illness. In particular, the focus should be on a comprehensive multidisciplinary approach. I believe this book is a helpful tool for working toward those goals.