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