PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

MR.PHILIP JOHN

FIRST YEAR M.Sc NURSING,

PSYCHIATRIC NURSING,

YEAR 2009-2011.

PADMASHREE COLLEGE OF NURSING

GURUKRUPA LAYOUT, NAGARBHAVI

BANGALORE-560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / Mr. PHILIP JOHN
IYEAR M.SC( NURSING)
PADMASHREE COLLEGE OF NURSING,
GURUKRUPA LAYOUT,
NAGARBHAVI,
BANGALORE-560072.
2. / NAME OF THE INSTITUTION / Padmashree College of Nursing,
Bangalore-560072.
3. / COURSE OF THE STUDY AND
SUBJECT / I Year M. Sc Nursing,
Psychiatric Nursing.
4. / DATE OF ADMISSION TO THE COURSE / 10th June 2009
5. / TITLE OF THE STUDY / Assessment OfThe Knowledge and Attitude of Teachers Regarding the Prevention of Depression in College Students in Selected PU Colleges, Bangalore.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

World health organization (WHO) has defined health as “physical, mental, and social well being”. The mental health of individual plays a significant role in the wellbeing of a person. There is a saying “A healthy mind has a healthy body”

Adolescence is a time of transition – an age when the person is not yet an adult but is no longer a child. The issues raised during adolescence are to personal development. Adolescence is a unique stage of development that occurs between ages 11 and 20 years, when a shift in growth and learning occurs. The developmental tasks that emerge during adolescence threaten the person’s defenses. They can either stimulate new adaptive ways of coping or lead to regression and maladaptive coping responses. 1

Depressive disease universal and has been prevalent in the society since time immemorial. Its clinical features were described in ancient Indian literature. The term depression is so commonly used in every day parlance that it fails to convince the people around that ‘depression could be a disease in itself. The adolescents are more irritable, have less depressive moods, instead of weight loss; there is a failure to weight gain. The adolescents have more physical symptoms like unexplained head ache, pain in abdomen, generalized body aches, fatigue and tiredness. The incidence of depressive disease in adolescents is increasing over the years. Twenty years back, we hardly used to see such cases in adolescents.

The incidence of depressive disease is around 2.5 percent in adolescents. It means there are about 30 crore adolescents around the world, who will develop diagnosable and treatable depressive disease. This depressive disease is the cause of 20% of the suicide in the country, and the cause of third of the alcoholic taking to drink.

During the past two decades, interest and research in the field of mental health and mental disorder have grown rapidly. A recent study conducted by WHO has predicted that in terms of burden, by the year 2020(that is in the next 20 year), depressive disease will become the number 2 disease in the world overriding diabetes, cancer, arthritis etc. 2

In addition to learning to recognize the symptoms and signs of depression in adolescents, the school counselor can initiate school-based prevention programs. Preventive activities may address topics such as drug and alcohol use, physical and social development, and peer relationships

There is no single cause for depressive disease. In fact depressive disorder is a result of combination of genetic, biochemical, psychological, and social factors. Hence, the depressive disease is a bio-psycho-social disease and not just psychological as is wrongly believed.

The academic performance is affected early in the depressive diseases. There is difficulty in concentration, poor memory, lack of interest and motivation and slowed thinking. All these will lead to poor academic performance. Majority of the patients have sleepiness rather than sleeplessness. There are difficulties in psychosocial functions. They avoid friends. Some have suicidal ideation and recurrent thoughts of death.

School counselors/ teachers can also provide follow-up and ongoing monitoring for students who have received inpatient treatment for depression to prevent a reoccurrence. This could involve short individual sessions to help the student reintegrate into the school setting and cope with day-to-day problems. The recovering student could also participate in small group counseling with at-risk students as deemed appropriate by the school counselor in collaboration with the mental health care provider.

6.2 NEED FOR THE STUDY

According to the epidemiological studies, 15% to 20% of the children and adolescents experience at least one depressive episode before adult hood. The consequence of early development of depressive disorder may persist for one year after adolescents. Depressive symptoms at a young age also increase the probability of major depression, and other psychopathologies later in life.3

Major depression in adolescents is a common recurrent and impairing condition that predicts future suicide attempt, academic failure; inter personal problems, unemployment, substance abuse and delinquency, because less than one third of depressed youth receive treatment. It is crucial to develop preventive programmes of this pernicious condition.

Depression may be one of the most overlooked and under-treated psychological disorders of adolescence. It is a syndrome disorder that is more than just feeling sad, blue, or down in the dumps. This disorder affects multiple areas of personal functioning, including the behavioural, emotional, somatic, and cognitive domains. It involves changes not only in mood, but also in almost every other area of the adolescent's life such as sleep, appetite, energy, and general health. It interferes with the ability to concentrate and think quickly, causing school performance to decline.

Depression is the fourth most important disease in the estimation of the burden of disease Murray 2006 and is a common problem with prevalence rates estimated to be as high as 12% in young people. Depression in young people is associated with poor academic performance, social dysfunction, substance abuse, suicide attempts, and completed suicide. This has precipitated the development of programmes aimed at preventing the onset of depression. This review evaluates evidence for the effectiveness of these prevention programmes’.

The symptoms of depression in adolescence are somewhat different than those seen in adults. Adolescents have difficulty describing their emotional or mood states. Girls have been found to worry more than boys, feeling they have less control over their environment and what is happening in their actions and activities 2

For both groups, however, symptoms of depression in adolescence strongly predict an episode of major depression in adulthood.4

Depression causes stress in family relationships precipitated by the adolescent's moodiness and emotional outbursts. It affects friendships as the depressed adolescent becomes more withdrawn and isolated and more aggressive and argumentative. During adolescence, complications of depression such as antisocial behavior may emerge, and depressed youngsters are likely to have increasing difficulty in school, possibly dropping out altogether. Many depressed teenagers also abuse drugs and alcohol. Finally, depression increases the risk of suicide, a leading cause of death among older adolescents. Depression in adolescents is more than just teenagers with "growing pains" or in a moody stage.

Clinical as well as epidemiological investigations have shown that 40% to 70% of adolescents with depression have co morbid disorders, and at least 20% to 50% have two or more co morbid diagnoses. This suggests that co morbidity may be the rule rather than the exception. A study of depressed adolescents in a large, community sample showed girls more likely to have co-existing eating disorders and boys more likely to have disruptive behavioural problems. Although the most frequent of the co morbid diagnoses are anxiety and substance abuse, conduct problems may develop as a complication of the depressive disorder and persist after remission.

Depression has been shown to be significantly related to suicidal behaviour, as have diagnoses of conduct disorder, bipolar disorder, and substance abuse.5

Suicide is the fourth leading cause of death among children age 10 to 14 years and the third leading cause of death among youth age 15 to 24 years. The suicide rate for people age 15 to 24 years has more than tripled in the past 30 yrs.6

Until the 1960s, there was considerable debate on whether or not depression even existed before adulthood. However, in World today, depression and depressive disorders are seen as a pervasive problem with adolescents as well as adults, the overall prevalence of depressive symptoms increases appreciably for both sexes at some point in early-to-middle adolescence, with girls manifesting significantly higher rates of symptoms. The lifetime prevalence rate of Major Depression in adolescents has been estimated to range from 15% to 20%, which is comparable to the adult lifetime rate.7

Teachers are the prominent group, who can identify the symptoms of depression in the students. Some students may exhibit depressive symptoms, however, not be referred or diagnosed. After screening, the school counsellor/ teacher may decide that a student's behaviours warrant ongoing monitoring but no referral for evaluation. In this case, the counsellor may want to include the student in secondary prevention activities. Conversely, based on an assessment, the school counsellor/ teacher may decide that further evaluation is necessary.

School counsellors/teacher may be asked to provide important information to the community mental health professional to which a referral is made regarding the adolescent's school behaviour. School counsellors may even be asked to serve as part of a multidimensional treatment team to support the student receiving outpatient services for depression. In collaboration with the treatment team, the school counsellor can serve as a resource person to aid the adolescent in coping with everyday issues arising in the school environment.8

The researcher felt that, since increase in prevalence rate of depression in adolescence is more and teachers are the right persons in preventing depression by early identification and prevention because they spent maximum time in school with children. All these instances prompted the researcher to conduct the study on teacher’s knowledge and attitude, regarding the prevention of depression in college students in selected PU colleges Bangalore.

6.3 STATEMENT OF THE PROBLEM

A Study To Assess The Knowledge And Attitude Of Teachers Regarding The Prevention Of Depression In College Students In Selected PU Colleges, Bangalore.

6.4 OBJECTIVES

  1. To assess the level of knowledge of teachers regarding factors contributing, clinical manifestations and preventive measures of depression among PU

college students.

  1. To assess the attitude of teachers regarding preventive measures of depression among PU college students.
  2. To correlate between knowledge and attitude of teachers regarding preventionof depression among PU college students.
  3. To associate the knowledge and attitude of teachers regarding the preventionof depression among PU college students with their selected demographic variables.

6.5 OPERATIONAL DEFNITIONS

  1. Knowledge:

Knowledge refers to awareness and understanding of teachers regarding the factors contributing, identification of signs and symptoms, and preventive measures of depressionamong PU College students

  1. Attitude:

Attitude refers to opinion and way of thinking of teacher in identifying and action to be taken in prevention of depression among PU college students.

  1. Prevention of Depression:

It refers to measures taken to reduce the burden, avoid sense of inadequacy or feeling of sadness during their study period, through adequate guidance and counseling.

  1. College students:

Refers to both male and female students, who are studying in 1st and 2nd Pre University colleges,Bangalore.

  1. Teachers:

Refers to both male and female faculty, teaching PU students with qualification of M.Sc, B.Ed/ M.Ed.

6.6. ASSUMPTIONS

  1. The teachers may have inadequate knowledge regarding factors contributing, signs and symptoms, identification and preventive measures of depression among PU college students
  2. The teacher’s lack of knowledge and unfavorable attitudewill lead to complications such as suicidal tendency, poor performance, depression etc. among PU college students.

6.7. HYPOTHESIS

H1-There is a significant correlation between knowledge and attitude of teachers regarding prevention of depression in PU college students.

H2-There is a significant association between knowledge and attitude of teachers regarding prevention of depression in PU college students with their selected demographic variables.

6.8 REVIEW OF LITERATURE

It has been found that females often score higher on depression measures than males. However, this gender difference has not been thoroughly studied across ethnicities. This study examined gender differences in depression between African-Americans and Whites. The Center for Epidemiological Studies-Depression scale (CES-D) was administered to 143 (74 males, 69 females) undergraduate students enrolled in introductory psychology classes (39% African-American and 61% White). The results indicate that White males scored significantly lower on depression than African-American males and females of both ethnic groups. Directions for future research are offered.9

A study conducted to develop a multi-dimensional model that might explain suicide ideation among college students. Face-to-face interviews were conducted with 1,249 first-year college students. Depressive symptoms, low social support, affective dysregulation, and father-child conflict were each independently associated with suicide ideation. In the group who reported low levels of depressive symptoms, low social support and affective dysregulation were important predictors of suicide ideation. Alcohol use disorder was also independently associated with suicide ideation, while parental conflict was not. Results highlight potential targets for early intervention among college students.

A study conducted to evaluate the effectiveness of a schools-based psycho educational intervention designed to help teachers recognize the symptoms of clinical depression in their adolescent pupils. Around 151 teachers in eight high schools in Scotland, UK were randomly assigned to experimental and control groups and all received training on depression. The teachers were reporting on 2262 pupils who had been independently screened for clinical depression. Systematic evaluation showed that training teachers with this package did not improve their ability to recognize their depressed pupils. Recognizing depressive illness in adolescence is one of the main public health challenges for adolescent mental health services and this study adds to the growing literature on the difficulties in achieving this.10

Depressive disorders are common in adolescent general practice attenders. In this study, adolescent attenders were screened/interviewed for depressive disorders; general practitioners (GPs) completed a checklist indicating recognition of psychopathology prior to and following GP training in the identification/management of adolescent depression.Results: One hundred and thirty consecutive adolescent attenders were screened before and 184 after training. Ten GPs completed the training. Psychiatric interviews with 38 adolescents with high depressive scores prior to and 44 following training identified 10 (26%) and 21 (48%), respectively, as clinically depressed..Conclusions: Training GPs is feasible and may improve recognition of adolescent depression.11

An article on the recent Treatment for Adolescents With Depression Study (TADS) that found that cognitive behavior therapy (CBT) was less efficacious than fluoxetine alone and no more efficacious than pill placebo in the treatment of depression in adolescents.To explore these issues, we recommend that (a) the results be broken down by therapist and site, and (b) the CBT as implemented in TADS be compared to that provided in other studies that have found greater change in adolescent depression. Finally, we also question whether it was premature to move to large multisite effectiveness trials before establishing the relative efficacy of the respective interventions.12

Major Depressive Disorders affect between 2% and 5% of adolescents at any one point in time. Depression in adolescence is associated with serious psychosocial deficits and has negative effects on functioning during young adulthood. Many psychosocial interventions have been developed and studied, with generally positive results. It seems reasonable to conclude that CBT has been demonstrated to be an effective treatment for depressed adolescents.. They concluded by suggesting future directions and several additional areas of application for adolescent depression treatments13.

A study to assess the Factors related to correspondence between teacher ratings of elementary student depression and student self-ratings. Fourth through 6th graders (n = 418) completed the Children's Depression Inventory (CDI; M. Kovacs, 1980). Each teacher (n = 31) rated 6 students with high, low, or medium CDI scores (n = 181) using the CDI items (teacher-CDI) and a single global rating. Remaining students received the global rating only. 16 teachers were randomly assigned to receive instruction on childhood depression. Instruction improved knowledge, but not correspondence. School-related behaviors yielded the highest correspondence. The teacher-CDI displayed high test–retest reliability.14

Research on depressive phenomena during adolescence has focused on 3 separate constructs: depressed mood, depressive syndromes, and depressive disorders. The constructs share a common set of symptoms reflecting negative affectivity but differ in their inclusion of symptoms of anxiety, somatic problems, and disrupted concentration and in the duration and severity of the symptoms they include. Depressed mood, syndromes, and disorders are integrated as 3 levels of depressive phenomena in a hierarchical and sequential model, and moderating factors are hypothesized to account for the relationships among the 3 levels. The need for a stronger developmental focus to understand depressive phenomena during adolescence is emphasized.15

A study on Depression and Anxiety in Children and Adolescents with Learning Disabilities, Conduct Disorders, And No Disabilities describes, Depression and anxiety levels in three groups of children andadolescents, those with learning disabilities (LD), with conductdisorders (CD), and with no disabilities (ND), were measuredwith the student self-report scale and teacher rating scaleof the Depression and Anxiety in Youth Scale. Results revealedhighest self-ratings and teacher ratings in both depressionand anxiety for the group with CD. Self-rating did not reveal, as teachers' ratings did, a progressiveincrease in anxiety and depression with age. Females self-ratedhigher than males in depression and anxiety; however, teachersrated males as more depressed and anxious than females. Specialeducation teachers of students with CD and those with LD weremore accurate than general educators in identifying studentswho self-rated as significantly depressed and/or anxious. 16