Biological symptoms of depression include, for instance, sleep disturbance, loss of appetite, and weight loss. In many cases, fatigue, constipation, and various aches and pain are experienced (Gournay, 2009). If the episode of depression persists, there is usually a marked reduction in libido, and in women who normally menstruate, amenorrhea may occur (Gelder et al., 2001; Puri, Laking, & Treasaden, 2002). In most individuals, reduced appetite leads to weight loss, which is usually defined as a loss of at least 5% of body weight in one month (Puri & Hall, 2004; Puri et al., 2002). Moreover, abnormal sleep is one of the most common symptoms of depression, and the most frequent cause of sleep disorders in individuals evaluated at sleep centres is depression (Dubovsky et al., 2004). People with depression commonly complain of sleep disturbance, with characteristic early morning wakening (Gournay, 2009).
2.2.5.2 Emotional manifestations
Emotional symptoms include low self-esteem, ideas of guilt and worthlessness, and pessimistic thoughts. There is a characteristically low and sad mood with feelings of hopelessness, while anxiety, irritability and agitation may also occur (Gournay, 2009; Puri & Hall, 2004). The person may complain of reduced energy and drive, an inability to feel enjoyment, and may sometimes speak of a
black cloud pervading all mental activities (Gelder et al., 2001; Puri et al., 2002).
2.2.5.3 Cognitive manifestations
There are many types of cognitive symptoms in depression, including reduced self-esteem and motivation, and impaired decision-making, memory and concentration (Gournay, 2009). Negative thoughts are important symptoms and can be divided into three types: worthlessness, pessimistic thoughts, and guilt (Gelder et al., 2001). Additionally, depression adversely affects attention and concentration, which may lead affected individuals to think their memory is impaired. Speech may be slow, with long delays before answering questions (Puri et al., 2002). In turn, cognitive symptoms in depression may result in varying behavioural problems, including aggressiveness, tearfulness, withdrawal from others, and a reduction in self-care activities (Gournay, 2009).
2.2.5.4Psychological distress
Psychological distress is defined as the unique discomforting, emotional state experienced by an individual in response to a specific stressor or demand that results in harm, either temporary or permanent, to the person (Ridner, 2004). There are five antecedents for psychological distress to occur in individuals: (1) experiencing physical, psychological and social adversity; (2) a perceived stressor; (3) perception that the stressor is a personal threat; (4) loss of ability to deal with problems; and (5) ineffective coping. The consequences of psychological distress may be viewed on a continuum from negative to positive (Ridner, 2004). Massee (2000) conducted qualitative studies of psychological
distress in France to develop validated culturally sensitive and multidimensional scales to assess psychological distress. The results identified six features of distress: pessimism toward the future, anguish and stress, self depreciation, isolation, somatisation, and withdrawal into oneself.
Kilkkinen et al. (2007) conducted a study in Australia to describe the prevalence of psychological distress, depression, and anxiety in people living in three rural settings. The authors concluded that a third of the participants in these settings reported psychological distress, with the highest prevalence observed in middle-aged men and women. According to the Australian Bureau of Statistics (2003), the 2001 National Health Survey showed that the adult
prevalence of very high levels of psychological distress in Australia increased for all age groups and both genders, except for males aged 65 to 74 years, in comparison with results from the 1997 National Survey of Mental Health and
Wellbeing.
Talala, Huurre, Aro, Martelin, and Prattala (2008) conducted a study to assess socio-demographic characteristic differences in psychological distress among adults in Finland. They found socio-demographic factors, such as having a partner and employment status, were related to psychological distress, highlighting the importance of social and economic factors for psychological well-being. Furthermore, Jorm et al. (2005) carried out a study in Australia, surveying anxiety, depression, and psychological distress in 7485 persons aged 20–24, 40–44 or 60–64 years. They found psychological distress generally declined across the age range from 20 to 64 years, and differential exposure to
risk factors explained some, but not all of the age group differences. Moreover, a study in Finland by Lemmens, Buysse, Heene, Eisler, & Demyttenaere (2007) compared couples with a depressed partner and those without a depressed partner, to identify differences in marital satisfaction, attachment style, psychological distress, and conflict communication. The authors found people with depression reported more psychological distress and attachment difficulties than their non-depressed partners and the couples without depression. In addition, females with depression reported higher levels of psychological distress symptoms than males.
2.2.5.5Depression and suicide
Depressive symptoms may lead to feelings of hopelessness and helplessness, and a belief life is not worth living. As a result, suicidal thoughts may occur (Chittawon, 2003; Puri & Hall, 2004). Suicide remains a common and often avoidable outcome of depression. About one million suicides are reported every year. A majority of those committing suicide are known to have suffered from depression (World Health Organization, 2006a). Approximately 13% of all inpatients with depression commit suicide (Gournay, 2009). Worldwide, about 877,000 people die by suicide every year (World Health Organization, 2007). In the USA in 2003, 10.5 per 100,000 people died from suicide (Hoyert, Kung, & Smith, 2005). In Australia in 2006, suicide was ranked fifteenth of all causes of death, with a suicide rate of 10 per 100,000 population (Australian Bureau of Statistics, 2006). In South-East Asia, Sri Lanka has the highest suicide rate (37 per 100,000 population) (World Health Organization, 2006a),
while in Thailand, the Department of Mental Health (2007b) reported a considerably lower suicide rate of 5.96 per 100.000 population.