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Depression: Who's nursing the nurses?

Photo: Depression: Who's nursing the nurses?
There is no denying that nursing can be a difficult, fast-paced, stressful job, requiring a lot of focus, energy and responsibility. Such a job can make a person more prone to struggling with major depression, a condition that is increasing worldwide, with an estimated lifetime prevalence of 18% in developed nations. It has a higher prevalence in females (about two times higher than in males), and appears more common in younger than older adults. (However, depression is common in older adults who suffer from significant medical conditions, or who are less capable of caring for themselves.)

Daily Challenges For Nurses
Nursing culture certainly has the potential to be detrimental to one’s mental health. Some wards have a “culture of survival” where nurse managers take pride in running a difficult work environment. Some nurses thrive in being able to cope with the stressful aspects of the job, but those who struggle to do so can feel a sense of failure, and, ultimately experience depression.
In the course of their everyday lives, nurses may encounter patients who behave rudely and seem to lack gratitude for the care that they provide. They are also faced with situations that are simply out of their control, such as patients that become sicker under their watch, or even lose their lives. This can be incredibly difficult for many to cope with.

Depression is a condition that is particularly important to address in the nursing profession, as, apart from the suffering it causes to the nurse in question, it can also directly affect the quality of patient care and the workload of fellow coworkers.

Nurses may find it difficult to concentrate at work, manage their time effectively, and may become more prone to making mistakes when it comes to things like calculating drug doses. Yet it can be very hard for afflicted nurses to seek treatment – many may fear the stigma of mental illness, and worry that they will be seen as less capable of looking after patients if they are struggling with mental illness themselves.

What causes depression?
The aetiology of depression is multifactorial, and can include some of the following:

● Genetics – for example, twin studies have shown a concordance rate of 37-38% for depression in monozygotic twins. On a side note, studies have shown that people that have a certain expression of the serotonin transporter gene, respond better to SSRI antidepressants.

● Past history of major depression

● Anxiety disorders

● Low self-esteem

● Substance misuse

● Trauma or other stressful life events

● Poor education

● Poor parental warmth

● Early childhood adversity

● Parental substance misuse, mental illness or criminality

● Poor social support

What are some of the symptoms of someone with depression?

● Less motivation to go out/be productive at work/see friends and family

● Not enjoying hobbies as much as you used to

● Difficulty concentrating

● Drinking alcohol to cope

● Low mood

● Feeling guilty

● Feeling overwhelmed

● Low self-esteem

● Thinking you wouldn’t mind if you didn’t wake up the next day, or even having thoughts of suicide

● Not looking forward to anything in life

● Feeling tired and run down

● Insomnia, or oversleeping

● Significantly decreased OR increased appetite, with weight loss or gain

An online quiz such as this one from Beyond Blue may help you identify if you have significant symptoms of depression: https://www.beyondblue.org.au/the-facts/anxiety-and-depression-checklist-k10

What to do
It is important to make an appointment to see a doctor, to ensure you are diagnosed properly. A diagnosis of depression can facilitate treatments such as prescriptions of antidepressants and referrals to clinical psychologists. The earlier you receive such treatment, the more likely you are to avoid escalation of your depressive symptoms to greater levels of severity.

Additionally, it is important to see a doctor to ensure you aren’t suffering from an altogether different kind of disease – diseases like diabetes mellitus, hypothyroidism, and anaemia, share similar symptoms with depression.
How do antidepressants work?

Antidepressants essentially affect the level of certain chemicals/neurotransmitters in the brain. They don’t affect your personality, but they help you react better emotionally towards things that make you stressed or depressed. They can take up to 6-8 weeks to begin working effectively, so it is important to continue taking them daily. However, if you develop side effects you should make an appointment to see your GP or psychiatrist.

Common side effects include weight gain, dry mouth, diarrhoea, constipation, decreased libido and nausea.

Where you can get help:
● If you are having current, strong thoughts of suicide, please ring the police or present to the emergency department of your nearest hospital, for psychiatric assistance and assessment. You may be offered an admission to a mental health ward to assist in your recovery from depression.

● If wanting to try antidepressants or therapy, try visiting your GP for a prescription or a referral to a clinical psychologist.

● Additionally, an ED psychiatric doctor or your GP may refer you to a community mental health service that can provide outpatient clinic appointments, follow-up and treatment.

● Ring a mental health emergency phone number for over-the-phone counselling, support and advice. These numbers differ from state to state, and include Lifeline, Crisis Care, and various mental health and suicide help lines.

You can find specific mental health crisis phone numbers for each state in Australia at the following Lifeline link: https://www.lifeline.org.au/Get-Help/Facts—-Information/What-is-crisis-support

Sources
http://www.uptodate.com/contents/unipolar-depression-in-adults-epidemiology-pathogenesis-and-neurobiology
http://dailynurse.com/nurses-and-depression-a-silent-epidemic/
http://www.nurseuncut.com.au/are-nurses-prone-to-depression/
https://www.beyondblue.org.au/the-facts/depression/signs-and-symptoms
http://minoritynurse.com/depression-in-nurses-the-unspoken-epidemic/
https://www.sane.org/mental-health-and-illness/facts-and-guides/antidepressant-medication
https://www.lifeline.org.au/Get-Help/Facts—-Information/What-is-crisis-support

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