Public Health Foundation for Health Promotion

BIOLOGICAL AND PHYSIOLOGICAL INTERVENTIONS

These involves the use anti depressants medications and the use of light therapy, electro convulsive therapy, diet and also exercise in promoting positive health promotion.

In relation to the depression interventions explained above I related all my interventions which are the social interventions, psychological interventions, biological and physiological inteventions to the TANNAHILL MODEL OF HEALTH PROMOTION which is classified into health education, health Prevention and health protection,

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In health education communication is carried out to enhance the lives of well being and to prevent ill health through the influence of knowledge and practice, while health Prevention involves reducing or avoiding the risk of diseases and ill health primarily through medical interventions and health protection focuses on safeguarding polpulation health through legislative fiscal or through social measures. All these approaches are interrelated and reflect distinctive ways of looking at health issues.

Also I am discussing the social rank theory of depression which I underlie to the social intervention /approach and One area, in particular, that is pervasively linked to depression is socio-economic status .The social rank theory (SRT), originally the social competition hypothesis, of depression is an evolutionary theory that endeavours to account for the social rank–mental health relationship; which, unlike other evolutionary theories, accounts for the inferiority and submissiveness that is typical of depression .Social Rank Theory proposes that low mood and submissive behaviour are involuntary yielding responses to defeating competitive situations ( in the competition for resources, such as for food or mates, with dominant others), and these responses are as a means of inhibiting an aggressive ‘comeback’, communicating a ‘no threat’ status and facilitating acceptance of the situation . This is reflected in the submissiveness, withdrawal and self-criticism that are indicative of depression state. Importantly, these symptoms occur when the subordination is involuntary, as there will be situations were subordination is voluntary or desired ( with parents or watching sports). When an individual lacks social power, they may want to challenge or change their situation, but are inhibited to do so by automatic physiological shut-down responses .

This adaptive reaction leads to a stress response in the subordinate individual, with elevations in the stress hormone cortisol as the hypothalamic–pituitary–adrenal axis (HPA) is activated (Abbott et al., 2003). This stress response may be modulated by the social environment, in particular exacerbated with isolation from others, or lessened with increased social support (Abbott et al., 2003). Evidence suggests subordinate male baboons have a hyper-cortisol response, activated by the aggressive behaviour and personalities of so-called dominants, leading to a loss of control for the subordinate, and perpetuated through a feedback resistance in the brain caused by higher stress. Social defeat effects may also impact additional physiological processes, such as reduction in the neurotransmitter dopamine's transporter (DAT) binding (Isovich et al., 2001) and the dysregulation of innate immune responses (Ambrée et al., 2018). . Additionally, mood variation in patients with bipolar has been closely linked to social rank evaluations, and this may be evidence of a maladaptive instability in social rank .These adaptive mechanisms evolved outwith the modern world, and they may underpin depression, but with the human context having changed significantly there are more triggers for a maladaptive depressive response (e.g., abusive relationships). Indeed, unlike any other animal, humans can self-subordinate by engaging in self-critical thinking . For humans the need to succeed in social arenas may be particularly pertinent, as perceptions of lower rank may impact upon finding a partner, having a successful career and forming friendships, and therefore the need to be accepted, feel attractive and be valued by others are the modern day ‘competition for resources’. Psychological factors such as external shame (perception of feeling inferior in the minds of others), self-criticism, striving to avoid inferiority and rumination about feeling inferior are associated with perception of lower social rank ,this implies that internal thinking may be a crucial factor in the activation and maintenance of the dysregulation of these defensive strategies . Indeed, entrapment can manifest itself in the desire to escape from our internal thoughts, memories, or worries; and therefore we can stimulate the physiological flight mode within the internal world.

Yes the type of interventions/approaches to depression fits in perfectly well, with the main causes of depression mentioned in my background.

ETHICS

• Protection of safety, taking into account risks alongside expected benefits.
• Promotion of autonomy (both in the sense of supporting people’s capacity to make their own decisions and in the sense of protecting their sense of who they are).
• Protection of people’s privacy, bearing in mind that some devices may collect sensitive personal data.
• Promotion of equity both in terms of access to innovative products, and in addressing social stigma and discrimination.
• Promoting public understanding and trust

Virtues

In describing the kinds of behaviours and approaches that are needed to protect and promote these interests, the following are therefore expected- Inventiveness ,Humility and Responsibility .

POLICIES ON DEPRESSION

While 23% of the total burden of disease is attributable to mental health problems, only 13% of NHS health expenditure is spent on mental health . Health economic analyses of the cost of depression in the UK suggest a cost of £17 billion or 1.5% of the UK gross domestic product. Without effective treatment, people suffering recurrent depression have a high risk of repeated lifetime depressive episodes. The substantial health burden attributable to depression could be offset through making accessible evidence-based interventions that prevent depressive relapse among people at high risk of recurrent episodes . To stay well, the recently re-named National Institute for Health and Care Excellence (NICE) recommends that people with a history of recurrent depression continue antidepressants for at least two years . However, there are many drivers for the use of psychosocial interventions that provide long-term protection against relapse .The majority of patients express a preference for psychosocial approaches that can help them and to address this need, mindfulness-based cognitive therapy was developed as a psychosocial intervention intended to teach people with a history of depression the skills to stay well in the long term]

. Mindfulness-based cognitive therapy is a manualized psychosocial, group-based relapse prevention programme for people with a history of depression who wish to learn long-term skills for staying well . It combines systematic mindfulness training with elements from cognitive-behavioural therapy. It is taught in classes of 8 to 15 people over eight weeks. Through the mindfulness course, people learn new ways of responding that are more self-compassionate, nourishing and constructive. This is especially helpful at times of potential depressive relapse, when patients learn to recognise habitual ways of thinking and behaving that tend to increase the likelihood of relapse and can choose instead to respond adaptively.

The NHS England has made ‘improving access to psychological therapies’ a priority in order to focus effort and resources on improving clinical services and health outcomes . The recently launched Parity of Esteem programme has ‘a national ambition to increase access so that at least 15% of those with anxiety or depression have access to a clinically proven talking therapy services, and that those services will achieve 50% recovery rates’. Similar policy pledges in other UK countries aim at improving access to psychological therapies with a specific focus on prevention, like amongst the six high level outcomes in the Welsh Strategy ‘Together for Mental Health’, one is: ‘Access to, and the quality of preventative measures, early intervention and treatment services are improved and more people recover as a result. There is a growing commitment amongst policy makers, commissioners, and those delivering services to ensuring that people with mental health problems receive the evidence-based treatments they need, this is mirrored in patient advocacy groups calling for greater access to and choice in psychosocial treatments.

CONCLUSION

Globally, more than 300 million people suffer from depression (WHO, 2017). It is the most prevalent mental health problem worldwide (GBD, 2015), with the incidence of depressive disorders notably higher in women than in men . Depression is often described as an overwhelming sadness, despair and hopelessness that can last for months or years. Examples of symptoms include, a loss of energy, appetite and self-confidence (Mental Health Foundation, 2018). It can be debilitating, with findings from the Global Burden of Disease Study indicating that depression is the second leading cause of years lived with a disability (Ferrari et al., 2013). Depressed individuals are at an elevated risk of suicide, with more than 90% of those who die by suicide estimated to have a diagnosable psychiatric disorder, and a history of self-harm (defined as non-fatal self-injury) being a strong predictor of dying by suicide. Due to the debilitating nature of depression, much research has been employed to identify factors contributing to its aetiology; these include biological, environmental, social and psychological variables , which has been explained in my background of depression.

REFERENCES

1. Bembnowska .M, Jodwiga J.O (2015), What Causes Depression In Adults, vol.125, pp 116-120.
2. Irene L.G, Hervas .G, Vazquez .C, (2019) The Integrative Positive Psychological Intervention For Depression, pp 1-9.
3. Nagy .E, Moore .S, (2017) Social Interventions: An Effective Approach To Reduce Adult Depression, vol.218, pp 131-152.
4. Wetherall .K, Rory C.O, (2019), Social Rank Theory Of Depression, vol. 246, pp 300-319.
5. Willis .N. Foundations For Health Promotions, (3) pp 79-80.