1. Nurturing Children: Coping With Chronic Illness Lara R. Krawchuk, MSW, LSW, MPH Conill Institute for Chronic Illness Helen Egger MD Duke University Medical Center June 4, 2005 MSSA Workshop Orlando, Florida

2. Objectives Impact of Depression in MS Patients Effect of Parental Depression on Children Understanding Childhood Depression Assessment of Depression in Health Care Settings Appropriate Referrals Professional Boundaries

3. Please hold your questions until the end..Thank you.

4. Prevalence of Depression In US Annual Prevalence- 10 % of American adults (about 19 million people) experience some form of depression every year – About 6.7% of women have a major depressive disorder in the US (National Institute of Mental Health, NIH) – About 3.3% of men have a major depressive disorder in the US (National Institute of Mental Health, NIH) Increased risk of depression with a number of illnesses including MS, heart disease, diabetes, and strokes

5. MS and Depression MS Patients-higher depression rates than other chronic illnesses Annual prevalence-20% Lifetime prevalence-50%

6. Suicide Higher risk Suicide rate-2-7.5 % greater than general population Greatest risk factors-males, severe major depression, living alone, & alcohol abuse No connection with cognitive dysfunction NO psychological care-1/3 suicidal patients (140) NO antidepressant medication-2/3 patients

7. Recognizing Depression Depressed mood Diminished interest in formerly pleasurable activities Feelings of worthlessness/guilt Persistent physical symptoms that do not respond to treatment (headaches, digestive disorders, and chronic pain) Hopelessness Suicidal ideation/thoughts of death Insomnia Psychomotor agitation/retardation Fatigue Diminished ability to think/concentrate

8. Caregivers Count Too Considerable variance in adaptation Unstable disease course Hours of Care Perceived stress Social Support

9. Why Depression? Multiple Losses Physical Uncertainty Intrusiveness on Daily Living Altered Roles Social Isolation Coping styles Relationship Strain Financial Devastation Brain Lesions Autoimmune Effect Medications Fatigue (mental/physical)

10. Impact of Depression Quality of life Relationship satisfaction Medication adherence Immune response Physical health outcomes Health care utilization Suicide

11. Treating Depression Treatment highly effective Many MS patients report never having mental health issues addressed by medical team Over ¼ MS patients report receiving no psychological services

12. Challenges to Assessment Confounding symptoms* Unique symptoms-anger, irritability, worry & discouragement Patient reluctance to disclose emotional distress Reluctance by health professionals to inquire about emotional functioning Time constraints Overshadowing Lack of routine assessment plan

13. Impact of Treatment Both psychotherapy and medication very effective in reducing depression Teaching coping skills and CBT quite effective Passive, avoidant, emotion-focused coping strategies not effective Support Groups (particularly using CBT principles) effective at decreasing depression Receiving NO treatment results in worsening depression

14. Address the Depressed Encourage sharing of information about emotions Explain impact of depression Create a routine screening tool Re-asses routinely Get patients and families actively involved Share information regarding treatment Emphasize importance of early treatment Address concerns regarding treatment Utilize multidisciplinary approach Build and sustain referral relationships

15. YOUR SLIDES HERE!!!!!!!!!!!!!!!!!!!!

16. Professional Excellence Focus on Assessment Build a Treatment Team/Network Make Quality Referrals Make Time for Emotional Well-Being Commit to Cultural Competence Respect Differences of Opinion Create an action plan for Suicidal/Homicidal patients Remember Mandated Reporting re: Harm to Children Respect your limits

17. Professionals Matter Too! Professionals also experience depression Stress is the norm in healthcare Compassion fatigue is a NORMAL experience in helping professions Compassion Fatigue is reversible Burnout is BAD

18. Commit to Self-Care Self-Care buffers the impact of stress & compassion fatigue Personal and organizational commitment Create a self-care plan today