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Wellness Across the Lifespan

This is the case of Kathy, a 21-year-old woman living in a rural and remote area of Queensland town. She has a family history of depression and fears if she might develop one. She has presented to the doctor who asks the community nurse to educate the patient on reducing her risk factors that may play an important role in developing depression. This essay is a health promotion piece for the promotion of mental health disorder, named depression. This essay aims to describe the impact of depression in Australian females and also describes the social determinants that may contribute to the increased risk of depression development in Kathy. This essay also describes the behavioural determinants that will have an impact on increasing the risk of depression in Kathy and the principles of motivational interviewing are also outlined. These principles of motivational interviewing are connected with health promotion and depression in this essay for making Kathy aware of her mental health.

Australia is one amongst those few countries that have higher rates of depression among the females (Rich et al., 2013). The current prevalence of depression states that females are more likely to experience depression as compared to males and in Australia, one in six females are more likely to experience depression as compared to one in eight men. One in every 16 Australians is currently suffering from depression and 1.16 million people have depression as of 2019 and these are the people of 16 to 85 years (BeyondBlue, 2020). The statistics also reveal that around one million adults of Australia experience depression every year and out of these 1 million people, there are more females suffering from depression as compared to males.

In Australia, suicide is the leading cause of death and in 2018, 3,046 people died by suicide. In Australia, in 2018 self- harm was ranked as 14th leading cause of death (Australian Bureau of Statistics, 2019). As per the Australian Government data, depression is the second leading mental health disorder that is experienced by the people of Australia (Australian Institute of Health and Welfare, 2020). The mental and substance use disorder primarily depression is an important driver of disability and morbidity. The impact of depression on the health of these people is such that it causes disability. The impact of depression is not only on the mood and affect but also on the physical health of the patients.

It causes insomnia, weight loss due to the loss of appetite, increased risk of heart disease and headaches and fatigue are quite common. There may be unexpected chronic pain in the muscles, breast tenderness and headaches (Kang et al., 2017). Chronic stress and depression are also associated with inflammation that results in the changes in the immune system (Stubbs et al., 2017). The mortality rates due to depression are accounted for as the mortality rates of suicide because depression is one of the leading causes of death due to suicide.

The development of depression in the people is contributed by various risk factors. These risk factors can be dominantly the social determinants that may lead to the development of depression in the people. The living in Australia is complex and the social determinants play a very important role in deciding the individual's quality of life. The social determinants such as age, gender, income, education and socio-demographic factors explain the variability in the prevalence of depression (Shen et al., 2018). Certain population subgroups are at highest risk of developing depression due to greater exposure and vulnerability, to unfavorable social and economic circumstances.

The report of WHO states that the poor and disadvantaged people are more likely to suffer from depression as it is distributed according to a gradient of economic disadvantage (World Health Organization, 2014). Kathy lives in a rural and remote area of Queensland and has no job thus this proves her being at higher risk of developing depression. She gets welfare payment for her to buy the food and pay rent. Thus, she is poor and does not have money to buy her own house. The people who are young and are not working are also at very high risk of developing depression.

The social determinants related to Kathy that increases her chances of developing depression are she lives alone, she has no job, she gets payment from welfare department to buy food and give rent and she lives in a rural and remote Queensland town. She also has a family history of depression and this also contributes to her developing depression. The evidence from the report of WHO states that poor mental health is more common in women, those who have weak social support and are poor economically (Lund et al., 2018). These social determinants thus increase the risk of Kathy of developing depression.

The risk factors are also the behavioural determinants that increase the risk of developing depression in the patients. The behavioural determinants increase the risk of development of major depression in the people that includes lifestyle behaviour and health behaviour. The behavioural determinants that increase the risk of development of depression include smoking, unhealthy eating, less healthy diet, obesity and restricted physical activity (Barros et al., 2017). These risk factors are strongly linked to depression among the people of age 12- 36 years.

Kathy has a poor pattern of sleeping and only sleeps a few hours each day. She does not exercise at all and does not eat healthy food. She does not have a healthy diet and she occasionally drinks recreational drugs. She has a habit of intaking alcohol and drinks four standard drinks daily. These behavioural determinants increase the risk of development of depression and also for other chronic diseases. There is a strong relationship between behaviour such as excessive alcohol consumption, cigarette smoking and physical inactivity and the development of depression.

The leisure-time physical activity and healthy eating behaviour are associated with the lower risk of development of depression in the people (Bishwajit et al., 2017). As per the study, the people who drink more than two standard units of alcohol, are at higher risk of development of depression because it is considered as excessive alcohol consumption. The health behaviour of an individual has a direct impact on the development of the chronic diseases and depression is one of those mental health chronic diseases that are commonly developed in the people who have bad health behaviours.

Health promotion aims to enhance the awareness of the people so that they can have better control of their health. The health promotional activity can be best carried out by the health care professionals by conducting motivational interviews. The motivational interviewing (MI) is the patient-centred style of interaction that helps people in exploring and resolving their ambivalence about their health, lifestyle and substance use behaviour that has a direct impact on the development of chronic condition (Madson et al., 2019).

This counselling style for addressing the common issue of the ambivalence about change is highly effective. The spirit of MI is the use of technical interventions that is characterized by the particular "way of being". MI is a motivational conversation that is collaborative and evocative that will motivate Kathy to bring about the changes in her health-related behaviour so that better health outcomes can be achieved. The health care professional conducting health promotion activity must have the core communication skills that are the ability to ask open questions, affirming, reflecting listening and summarizing.

The RN must have these core communication skills that will facilitate a successful motivational interview with the client. This is based on four core principles that are expressing empathy, developing discrepancy, rolling with resistance and supporting self- efficacy (DiClemente et al., 2017). The health care professional must always create an empathic environment where they are non- judgmental and they use reflective listening to hear out the patients to move towards positive change. The second principle is developing discrepancy in which the discrepancy between the behaviour and the person's goals are created so that they get own motivation to change. The third principle is rolling with resistance in which the nurses use collaborative manner to help the patient develop their arguments for change and the fourth principle is supporting self- efficacy in which the nurses believe that the patient's confidence and belief to change is a key piece of motivation change (Magill et al., 2018).

The conclusion drawn is that the patient Kathy is at higher chances of developing depression due to her behavioural determinants and the social determinants. She lives a rural and remote area, lives alone, has no job and receives welfare payments for food. These social determinants have a significant impact on the development of depression and behavioural impacts such as drinking four standards of alcohol daily, taking recreational drugs, not eating healthy and not exercising. The health promotion activity for Kathy can be conducted through motivational interviewing. In motivational interviewing, the nurses must ask an open question, be affirmative, reflective listening and must summarize so that the clients can get motivated for a change.

References for Wellness Across the Lifespan

Australian Bureau of Statistics. (2019). Causes of death, Australia, 2018.

Australian Institute of Health and Welfare. (2020). Mental health services in Australia. Retrieved from https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/summary/prevalence-and-policies

Barros, M. B. D. A., Lima, M. G., Azevedo, R. C. S. D., Medina, L. B. D. P., Lopes, C. D. S., Menezes, P. R., & Malta, D. C. (2017). Depression and health behaviors in Brazilian adults–PNS 2013. Revista de SaudePublica, 51, 8s.

BeyondBlue. (2020). Statistics. Retrieved from https://www.beyondblue.org.au/media/statistics

Bishwajit, G., O’Leary, D. P., Ghosh, S., Yaya, S., Shangfeng, T., & Feng, Z. (2017). Physical inactivity and self-reported depression among middle-and older-aged population in South Asia: World health survey. BMC Geriatrics, 17(1), 100.

DiClemente, C. C., Corno, C. M., Graydon, M. M., Wiprovnick, A. E., &Knoblach, D. J. (2017). Motivational interviewing, enhancement, and brief interventions over the last decade: A review of reviews of efficacy and effectiveness. Psychology of Addictive Behaviors, 31(8), 862.

Kang, H. J., Bae, K. Y., Kim, S. W., Shin, H. Y., Shin, I. S., Yoon, J. S., & Kim, J. M. (2017). Impact of anxiety and depression on physical health condition and disability in an elderly Korean population. Psychiatry Investigation, 14(3), 240.

Lund, C., Brooke-Sumner, C., Baingana, F., Baron, E. C., Breuer, E., Chandra, P., ... & Medina-Mora, M. E. (2018). Social determinants of mental disorders and the Sustainable Development Goals: A systematic review of reviews. The Lancet Psychiatry, 5(4), 357-369.

Madson, M. B., Villarosa-Hurlocker, M. C., Schumacher, J. A., Williams, D. C., & Gauthier, J. M. (2019). Motivational interviewing training of substance use treatment professionals: A systematic review. Substance Abuse, 40(1), 43-51.

Magill, M., Apodaca, T. R., Borsari, B., Gaume, J., Hoadley, A., Gordon, R. E., ... & Moyers, T. (2018). A meta-analysis of motivational interviewing process: Technical,

relational, and conditional process models of change. Journal of Consulting and Clinical Psychology, 86(2), 140.

Rich, J. L., Byrne, J. M., Curryer, C., Byles, J. E., & Loxton, D. (2013). Prevalence and correlates of depression among Australian women: A systematic literature review, January 1999-January 2010. BMC Research Notes, 6(1), 424.

Shen, Y. T., Radford, K., Daylight, G., Cumming, R., Broe, T. G., & Draper, B. (2018). Depression, suicidal behaviour, and mental disorders in older Aboriginal Australians. International Journal of Environmental Research and Public Health, 15(3), 447.

Stubbs, B., Vancampfort, D., Veronese, N., Kahl, K. G., Mitchell, A. J., Lin, P. Y., ... &Koyanagi, A. (2017). Depression and physical health multimorbidity: Primary data and country-wide meta-analysis of population data from 190 593 people across 43 low-and middle-income countries. Psychological Medicine, 47(12), 2107-2117.

World Health Organisation. (2014). Social determinants of mental health. 

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