Concept analysis is critical in yielding a conceptual framework of concept elements constituting a research question. One familiar concept that nurse researchers and clinicians are interested in is depression. This research paper makes a concept analysis of depression by presenting a conceptual definition of the concept, and identifying the criteria of the concept including its uses, attributes, antecedents, and consequences. It examines depression from major theoretical perspectives and illustrates it relevance to nursing activity from the organizational context.
Definition of Depression
Clinically, depression is a mood disorder in which the patient endures mood disorder for a minimum of two weeks. Depression may occur either as a primary disorder or in conjunction with cardiovascular disease. Depression raises the chances of morbidity and mortality in patients with cardiovascular disease. Findings from studies have indicated that depression is a major predictor of adverse patient outcomes such as heart failure, coronary artery disease, stroke and myocardial infarction (Gump et al., 2005; Penninx et al., 2001; Rutledge et al., 2006; Williams et al., 2002). It has been found that persons with major depression are on higher risk for cardiac mortality compared to persons with minor depression.
According to the WHO report (2016), more than 350 million of people globally are affected by depression that costs billions of dollars in treatment and lost productivity. Depression among older people is a serious health problem due to its negative consequences in terms of functional disability, higher morbidity and mortality, poorer quality of life, and increased health care costs (Ferrari et al., 2013) Depressive disorders (DD)are much higher in women than men. Uncontrolled and/or excessive stressors, cognitive schemas, and gonadal hormones are involved in the etiology of women’s DD (Abramson & Alloy, 2006; Brummelte & Galea, 2010; Hammen, 2003). A woman-centered treatment for DD is a holistic approach to achieve long-term well-being for women.
Conceptual and operational definitions of depression have been depicted by Coleman (2017) after identifying Wilson and Cleary’s (1995) model of health-related quality of life (HRQOL). His concept or variable of the study’s framework was HRQOL. His conceptual definition of depression is “one’s ability to function physically and emotionally, and their overall perception of well-being (Coleman, 2017, p. 139). The operational definition is expressed by the Medical Outcome Study (MOS) 36-Item Short Form Health Survey (SF-36) measuring “eight health concepts of HRQOL: physical functioning, bodily pain, role limitations due to emotional problems, emotional well-being, social functioning, energy/fatigue, and general health” (Coleman, 2017, p. 139). The conceptual definition of depression here provides a basis for its operational definition.
Criteria of Depression
The diagnostic criteria for depressive disorder were developed by the American Psychiatric Association (APA) and are published in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM consists of a list of subjective and bodily experiences.
Uses of the Concept of Depression
The criteria of DSM have been established through an impartial enquiry by experts in the field of depression. They suggest a framework for professional judgments. The criteria recommend professionals to reflect on other explanations to justify individuals’ symptoms before approaching a diagnosis of depressive disorder. Stoppard (2014) maintained that the criteria “are primarily descriptive, intended to facilitate identification of the disorder by professionals, rather than promoting a particular theory of depression” (31). This narrative character of DSM makes it compatible with other theoretical approaches in mental health domains.
Criteria for major depressive episode continued for two weeks identified include five or more symptoms associated with depressed mood or loss of interest or pleasure. Depressed mood is discernible most of the day or every day with a feeling of sadness or emptiness; noticeably diminished interest or pleasure in almost all activities is the second symptom for most of the day; there is significant weight loss without dieting or weight gain; insomnia or hypersomnia nearly every day; psychomotor agitation or retardation; fatigue; feelings of worthlessness or guilt; decreased ability to think or concentrate; and suicidal ideas (Stoppard, 2014). Professional judgment is needed to arrive at a diagnosis of depressive disorder.
Antecedents and consequences.
Psychosocial antecedents to depressive disorder include socioenvironmental variables such as negative life incidents and expressed emotion (Butzlaff & Hooley, 1998). Personality traits and cognitive styles are also considered predictors of depressive disorder (Gotlib & Hammen, 2008). Depressive symptoms are strongly correlated with chronic stress in family and interpersonal relationships. Limited studies on personality predictions for depression suggest neuroticism being increased in people with bipolar depressive symptoms (Gotlib & Hammen, 2008). Bipolar disorder and depressive disorder tend to have common grounds regarding symptoms and neurobiology. Low social support, neuroticism, negative cognitive styles, and low self-esteem are significant predictors of depressive disorder.
The treatment and associated cost of depression is huge. Rogers et al. (2012) specified that the annual economic burden of depression was $70 billion. Depression interferes with an individual’s functioning depending on its severity. Poor physical health, absence from work, and impaired family relationship are the consequences of depressive disorder. Depression can have a negative effect on parenting, marital relations and family dynamics. It is one of the leading causes of disability worldwide. Suicide is the most severe consequence of depression. However, all the negative consequences of depression van be eliminated with proper treatment of the person.
Theoretical Perspectives of Depression
Several theoretical perspectives have offered explanations about depression. Among them the psychoanalytic, behavioral, existential, and social cognitive approaches are predominant. There is also the self-efficacy theory to contribute to our understanding of depression.
Neurobiological theories such as genetic, neurotransmitter, neurhormonal, and biological rhythm theories attribute depression to genetics, chemicals in the brain, hormonal imbalances, and abnormalities in biological rhythms. However, more research findings are sought to validate biological theories of depression
Freud’s theoretical clarification of depression is the despair from the real or imagined loss of an esteemed or dear object through death, separation, or rejection. The anger at the loss is turned inward into depression causing guild and self-loathing (Downing-Orr, 2013).
Cognitive theory has recently gained much popularity of which the helplessness/hopelessness model and Beck’s cognitive model are important. Beck focused on the behavioral aspects of depression and detailed the role of distorted information processing in the pathogenesis of depression (Alladin, 2007). He suggests that depression is an obdurate biopsychosocial disorder that originates from maladaptive beliefs during childhood. Mineka et al.’s (1998) model combines hopelessness theory and uncontrollability related to anxiety. It proposes that individuals who are sure of helplessness and negative outcomes will confront hopelessness of depression (Alloy et al., 1990).
The existential model does not emphasize on the negative aspects or issues of loss and rejection rather it explores every aspect of life and their impact on clients’ feelings of depression. Existentialism takes a holistic view of depression by incorporating the positive aspects in terms of improved realism and empathy.
The behavioral perspective holds depression as the outcome of decreased degree of effective positive reinforcement from the environment leading to depression. The fall in the degree of effective positive reinforcement may be caused by the individual’s behavior that triggered negative feedback from others, or the low level of reinforcement offered by others (Downing-Orr, 2013).
Self-efficacy theory finds a correlation between feelings of self-evaluation and coping failure to understand the maintenance of depression. Three self-efficacy beliefs that encourage depression are people’s feeling of incapacity to attain standards of achievement or performance resulting in personal satisfaction; people’s belief of their incompetency to develop satisfying and supportive relationships with others; and their lack of control on their depressive ruminations (Maddux, 2013). Low self-efficacy to bypass generic negative life events add to depression.
Importance of Depression in Nursing Practice
Whether depression literacy is central to reducing depression or not is a pertinent question to understand its implications in nursing practice. An educational intervention could be minimally effective in lessening the depression symptoms in clinical setting. McCarter‐Spaulding and Shea (2015) investigated the usefulness of educational intervention in decreasing the postpartum depression (PPD) during postpartum hospitalization by measuring the indications on the Edinburg Postnatal Depression Scale (EPDS) at 6weeks, 3-months, and 6-months postpartum. Participants submitted written questionnaires covering demographic, delivery, infant feeding information, and Postpartum Depression Predictors Inventory (PDPI). They were given instructions verbally and in written form about PPD in treatment group by a research team member according to the fact sheet prepared by the U.S. Department of Health and Human Services named “Depression during and after Pregnancy.” Follow-up was conducted via mail and telephone at 6weeks, 3-months, and 6-months postpartum. The results showed that intervention did not significantly affect the EPDS scores and that the history of depression and anxiety was the main predictor of depressive symptoms.
The findings of the study indicate that postpartum period is crucial for identifying women at risk for depression even though education would be of little help during this period. Further study is required to design appropriate time and method of intervening for maximizing adequate care. The authors concluded that incomplete nursing time during hospitalization might have been utilized by implementing a system for ensuring adequate follow-up after discharge for women at risk. Postpartum depression research is a much needed academic field for nursing setup and practice to identify the particular risks of loneliness, isolation, and depression for women at risk. Screening for depression and post-traumatic disorder once postpartum are care options for postpartum depression.
The concept analysis of depression yields important revelations about depression dimensions. The definition and criteria of depression illuminate depression from a conceptual viewpoint, and recognize its characteristics, predictors, and consequences. Theoretical accounts elaborate our knowledge of depression and the organizational context of depression draws our attention to explore the care opportunities.
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