RISK FACTORS FOR MDD AND BIPOLAR I

 

 

RISK FACTOR                   MDD                                               BIPOLAR I  

 

Sex                                       Women > Men                               No difference

Race                                     Cauc. > Afro Amer                        No difference

Age                                      Young > Old                                  Young > Old

SES                                      Lower > Higher                             Higher > Older

Marital Status                     Separate/Divorced Higher            Separate/Divorced Higher

Family Hx                           + Fam Hx. Higher                          + Fam Hx. Higher

Childhood exper.                Early parent death, disrupt.           Low perceived prestige

                                                childhood environ.                        w/in community

Life stressors                     Negative Stressor – Higher          No known difference

Absence of confidant         Absence in ♀ Increased Risk        No known difference

Residence                           Urban > Rural                                Suburbs > Inner city

DIFFERENTIATING BIPOLAR AND UNIPOLAR DEPRESSION

 

                                                                    Bipolar                                Unipolar

 

Hx of mania or hypomania                       Yes                                       No

Temperament – personality                     Extroverted                         Introverted

Sex Ration                                                 Equal                                    Women > Men

Age of Onset                                             Teens, 20s, 30s                   30s, 40s, 50s

Postpartum episodes                                More common                    Less common

Onset of episode                                       Often Abrupt            More insidious

Number episodes                                      Numerous                Fewer

Duration of episode                                  3-6 months              3-12 months

Psychomotor activity                               Retardation > Agitation     Agitation > Retardation

Sleep                                                          Disrupted                            Disrupted

Family Hx                                                  Yes                                       Yes

Response to Medication

           Antidepressants                             Induce mania/hypoman      Usually effective

           Lithium                                           Usually Effective               Ineffective

SUICIDE IN MAJOR DEPRESSION

 

 

v    Approximately 15% suicide rate in depressive disorders

 

v    Suicide attempt rate more difficult to determine (often not reported)

 

v    Depression is more common in women, however, suicide rate is higher among men

 

v    Young and elderly males at higher risk for suicide

 

v    Statements about suicidal intent are not “attention-seeking” behaviors

 

v    Best predictors of suicide:

·        Previous suicide attempt

·        Mental health - particularly mood disorders such as depression

·        Combined mental health and substance abuse issues

·        Family history of suicide

·        Hopelessness/Helplessness

·        Impulsive and/or aggressive tendencies

·        Barriers to accessing mental health services

·        Loss (relationships, health, identity status)

·        Stressful Life event

·        Accessibility to lethal methods, especially guns

·        Unwillingness to seek help because of stigma attached to mental health issues and suicidal thoughts

·        Exposure to suicide (family, peers, significant others)

·        Physical, emotional and sexual abuse

·        Legal issues/arrests/incarceration

·        Sexual identity conflict