Discussion of the Population
Description of the Population
Iranian women are at a higher risk of depression than other population segments. Iran is a relatively populous Muslim country of 80 million people of different ethnicities, including the Azari, Kurdish, Arab, and Fars, among others (Fathi-Ashtiani, Ahmadi, Ghobari-Bonab, Azizi, & Saheb-Alzamani, 2015). Over a half of the population is under 35 years. It is characterized by diverse cultures, lifestyles, and income groups, which result in disparities in health outcomes. For example, according to Fathi-Ashtiani et al. (2015), depression is reported more in Iranian women than in men. This disparity could be attributed to the psychological pressures females face in developing countries.
Overview of the Presenting Problem
Depression is a comorbid mood disorder that is highly prevalent in resource-poor populations due to a range of risk factors. It is a major health problem in Iran and it accounts for 35-45% of psychiatric clinical presentations in Iran (Fathi-Ashtiani et al., 2015). Its aggregated prevalence in Iranian women is 25.3%, and as high as 49% in elderly females with unwanted pregnancy, low literacy levels, aging, marital conflicts, cultural beliefs, and infertility being the main predictors (Fathi-Ashtiani et al., 2015). Depressive disorders are associated with a reduced quality of life, increased healthcare costs, and mortality.
Historical Treatment Process
Psychological treatments for postpartum depression (PPD) and other depressive disorders affecting Iranian women are limited by social and religious structures (Fathi-Ashtiani et al., 2015). Iran is a predominantly Islamic nation where social life is structured around religion. Thus, religious beliefs may suppress help-seeking attitudes and impede the diagnosis of depression. Psychosocial support comes from religion and cultural expectations. Historically, this approach can be said to be a hindrance to early screening for depressive symptoms and preventive interventions, resulting in the current high prevalence of depression among women.
Current Needs of the Population
Depression is relatively common in Iranian women. Evidence-based interventions are required to address the unmet needs of this population. Iranian women require early screening for depressive symptoms, health promotion, and culturally sensitive psychosocial support and CBT to help them deal with depression.
Diagnosis
Criteria for Diagnosis
Based on DSM-V criteria, depression is diagnosed if more than five symptoms are present in a patient. They include depressed mood, disinterest in hobbies, weight gain or slimming, sleeplessness, cognitive impairment, low energy, difficulty concentrating, and a feeling of worthlessness (American Psychiatric Association [APA], 2013). These symptoms must persist for over two weeks for a diagnosis to be made.
Challenges with Diagnosis
Psychotherapists may under-diagnose, misdiagnose, or fail to diagnose depression in Iranian women because of related comorbidities. Anxiety disorders – PTSD and social phobia – often co-occur with depressive symptoms in a patient. Other challenges with the diagnosis of depression may be related to cultural factors and gender difference. In Iran, women are expected to be happy in the postnatal period (Fathi-Ashtiani et al., 2015). Thus, they may not seek interventions for emotional suffering. Patients may also seek medical screening for depressive symptoms, not psychosocial assessments.
Policy
Local Policies Impacting the Population
Socioeconomic policies in Iran account for the disproportionate disease burden in women. Among the social determinants of depression in Iran are religion and Islamic culture (Fathi-Ashtiani et al., 2015). The religious beliefs and norms may not favor health-promoting lifestyles that lead to better mental health outcomes. Thus, local economic empowerment policies to improve women’s control over individual health are limited. As a result, illiteracy, housewifery, and unwanted delivery are the leading causes of depression in this population (Fathi-Ashtiani et al., 2015).
Federal Policies Impacting the Population
It is important for the federal health department to prioritize mental health diagnosis and treatment. In Iran, the risk factors for depressive disorders are not identified in time, leading to delayed interventions (Fathi-Ashtiani et al., 2015). Therefore, the high depression burden in Iranian women may be attributed to a limited federal budgetary allocation for screening for mental health problems and treatment.
Current Advocacy
Health promotion initiatives have been adopted to foster mental health-seeking behavior among adolescents. Local authorities use trained peers to support healthier practices in matters considered personal as psychological health. The cost-effective peer-led initiatives encompass needs assessment, interventions, and life skills training (Fathi-Ashtiani et al., 2015).
Evidence-based Treatment
The major evidence-based treatment modalities used with depression include pharmacological agents. Evidence from three articles indicates that certain FDA-approved drugs can be used to treat this disorder. Antidepressant treatments used in combination with cognitive therapy have also been shown to achieve significant remission of depressive symptoms (Carvalho, Berk, Hyphantis, & Mclntyre, 2014). Different classes of drugs can be used to treat chronic depression. They include selective-serotonin reuptake inhibitors (SSRIs) and monoamine oxidase blockers (Ionescu, Rosenbaum, & Alpert, 2015). Antidepressant monotherapy may not be effective against depressive symptoms. Adjunctive antipsychotics, such as quetiapine, can be used in combination with other formulations to reduce depression (Tundo, de Filippis, & Proietti, 2015). Although pharmacotherapy can help achieve symptom remission, it does not reinforce coping strategies.
Interventions
Evidence-based Interventions
Cognitive behavioral therapy (CBT) has been utilized with Iranian mothers to treat postpartum depression (PPD) (Fathi-Ashtiani et al., 2015). The intervention sought to reconfigure negative attitudes, guilt feelings, and coping limitations that lead to PPD. Another evidence-based approach that can be used with this population is culture-sensitive interpersonal or group therapy. It entails peer or family support to improve psychological health.
Overview of Each Intervention
CBT is an intervention offered in multiple 40-60 minute individual sessions. A trained psychologist delivers this program through direct interactions with the client and a set of workbook tasks designed to reduce depression. Group CBT is offered to a number of people at the same time. The members engage in behavioral tasks, share experiences, and serve as co-therapists.
Strengths and Limitations
CBT is a clinically effective intervention for depression. It involves practical strategies and can be delivered within a short period. However, without adequate client commitment, the intervention may not work. It is also highly structured and inflexible. Group CBT is cost-effective, builds team cohesion, and promotes social/peer support. However, it may not be acceptable to some patients and it does not support individualized interventions.
Strengths and Limitations
Strengths
Iranian women exhibit a high level of religiosity and spirituality that have protective effects against postpartum depression (Fathi-Ashtiani et al., 2015). Family stability and the spouse’s satisfaction with a newborn’s sex are also associated with symptom remission. Thus, religion and social cohesion constitute the key strengths of this population.
Challenges
Certain cultural and religious beliefs affect help-seeking attitudes of Iranian women with depression (Fathi-Ashtiani et al., 2015). Thus, culture and religion are a challenge to timely screening and treatment of depressive disorders in this population. Low educational levels among Iranian women and male child preference by husbands increase depression.
Learning Activity
A psycho-educational program grounded in the CBT model is the proposed learning activity. It will entail peer involvement in health education on strategies for managing stress. The program will be delivered in a group format and each participant will share factors that predispose him or her to depression. Additionally, members will learn how to screen for depressive symptoms using the DSM-V criteria and provide peer support and counseling.
References
Carvalho, A. F., Berk, M., Hyphantis, T. N., & Mclntyre, R. S. (2014). The integrative management of treatment-resistant depression: A comprehensive review and perspectives. Psychotherapy and Psychosomatics,83(2), 70–88. wEB.
Fathi-Ashtiani, A., Ahmadi, A., Ghobari-Bonab, B., Azizi, M. P., & Saheb-Alzamani, S. (2015). Randomized trial of psychological interventions to preventing postpartum depression among Iranian first-time mothers. International Journal of Preventive Medicine, 6(9), 109-114. wEB.
Ionescu, D. F., Rosenbaum, J. F., & Alpert, J. E. (2015). Pharmacological approaches to the challenge of treatment-resistant depression.Dialogues Clinical Neuroscience, 17, 111–126. Web.
Tundo, A., de Filippis, R., & Proietti, L. (2015). Pharmacologic approaches to treatment resistant depression: Evidences and personal experience. World Journal of Psychiatry, 5(3), 330-341. Web.