Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures
prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
A client complains of feeling “down,” or “in the dumps,” or “blue.” Everyone feels sad from time to time as a result of life’s circumstances. Sometimes, these feelings are temporary and transitory. A client may feel sad after the breakup of a relationship or after being passed over for a promotion. In a day or two, the client may feel better and begin to move forward in life. However, when these feelings last longer than a few days and interfere with everyday functioning, the client may be clinically depressed. Depression is referred to by a variety of names: major depression, depressive episode, major depressive episode, and major depressive disorder. At a fundamental level, all these terms mean that the client is experiencing a profound sense of sadness, emptiness, and hopelessness. Fine distinctions among these terms arise in the frequency of occurrences, severity, and features associated with the disorder. Depression can occur at any point in an individual’s life, from childhood to advanced adulthood, and is a global health crisis that deserves multi-level intervention and response (Pasman et al., 2023). It crosses all ethnic, cultural, and racial lines and is present at all socioeconomic levels. Although anyone can experience depression, individuals in some groups are more likely to become clinically depressed than others. Clinicians need to be aware of the different manifestations and symptoms of depression among members of different populations. Equipped with this knowledge and understanding of major depression, clinicians can complete thorough assessments, design comprehensive treatment plans, implement evidence-based practices, monitor client progress, and help prevent future relapses. Clinicians, clients, and other treatment team members can collaborate to bring the client relief from symptoms and a better sense of well-being. A study of national patterns of routine depression screening found a rate of 1.4% for adult
ambulatory care visits (Bhattacharjee et al., 2018). As few as 3% of adults without a diagnosis of depressive disorder are routinely screened for depression in primary care settings (Bhattacharjee et al., 2018). Research indicates that routine depression screenings in primary care settings can lead to better mental health outcomes (Bains & Abdijadid, 2023). The U.S. Preventive Services Task Force (USPSTF) and the Agency for Healthcare Research and Quality have recommended that all adults, including pregnant and postpartum women, receive routine depression screening and evidence-based protocols to ensure adequate diagnosis and treatment (Siniscalchi et al., 2020; Blackstone et al., 2022). Efforts to screen need to focus on populations historically overlooked, notably men, minorities, patients without insurance, and those over 75 years old (Kato et al., 2018). Better screening, along with investment in secondary prevention efforts (Pfoh et al., 2020) and seamless collaboration of mental health resources, are essential. The prevalence of major depressive disorder (MDD) is increasing. Before COVID-19, the U.S. prevalence rate averaged 6-8% of U.S. adults at any given time. During the first year of the COVID-19 pandemic, MDD rates rose from 7% to 27% (MDD with anxiety disorders similarly rose from 11 to 38%) (Proudman et al., 2021; Centers for Disease Control and Prevention, 2023). This basic-level course aims to educate social workers, mental health counselors, marriage and family therapists, and psychologists about major depressive disorder and its distinctions. This course provides necessary information about major depressive disorder, including the epidemiology of major depressive disorder, signs and symptoms in adults (with a very brief overview of major depression in children and adolescents), causal and influential factors, assessment, diagnosis, treatment, relapse prevention, and outcomes evaluation.
EPIDEMIOLOGY
Depression is the leading cause of disability in the world, with the World Health Organization (2023) estimating that 5% of adults suffer from depression globally. The World Health Organization estimates that by 2030, major depressive disorder (MDD) will be ranked first as the highest worldwide disease burden and cause of disability, up from third place since 2008 (Bains & Abdijadid, 2023). Greenberg et al. (2021) estimated the direct and indirect (medication costs, loss of work, etc.) economic burden of U.S. adults with MDD increased from $236.6 billion in 2010 to $326.2 billion in 2018 (in 2020 dollars), an increase of 37.9%. The prevalence of MDD is high, with a lifetime prevalence range of 5-17% and a lifetime average of 12% (Table 1). Women are almost twice as likely to experience MDD during their lifetime, with risk factors including hormonal changes, the impact of childbearing, female-typed psychosocial
stressors, and socially prescribed model of learned helplessness. The age of onset (mean = 40 years) has been trending as rates of depression in younger populations and populations using alcohol and other drugs increase (Bains & Abdijadid, 2023). The development of MDD is multi-factorial, with biopsychosocial risk factors. MDD prevalence rates are higher for people living in rural over urban areas, those with comorbid medical issues, and those not in close interpersonal relationships who are widowed, divorced, or separated. People with MDD are more likely to experience comorbid psychiatric conditions such as anxiety disorders (panic, social anxiety, obsessive-compulsive) and substance use disorders. The presence of comorbid psychiatric illness increases the risk of suicide for people with MDD (Bains & Abdijadid, 2023).
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Book Code: PCIL1525
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