Stanley J. J. Freeman

Help-seeking behaviour of depressed students

Depression, the most common form of psychological distress among university students, is often serious enough to warrant professional help but only a minority of depressed students seek formal help. This paper reports on the characteristics which differentiate two groups of depressed students--the help-seekers from the non-help-seekers. A university psychiatric clinic population (N = 183) was compared with a non-clinic sample (N = 55). Data about depressive symptoms, social supports, the use of medical, psychiatric and other helping services, sources of referral and the usual demographic and sociocultural information were obtained. The Beck Depression Inventory was used as the measure of depression. Severity of depression was the single most important predictor of use of the psychiatric service. In addition, being female was also an important predictor. After controlling for severity and sex, the demographic factors which distinguished help-seekers from non-help-seekers were as follows: The help-seekers were more likely to be graduate students, older, living away from family and/or to use a non-psychiatric physician. Contrary to expectation, having a confidant was not related to help-seeking, suggesting that the presence of a confidant may be preventive but does not necessarily decrease the need for professional help once a student has become depressed. A depressed students decision to seek help may be influenced by four factors: the severity of the problem; the individuals propensity to seek help; the availability of alternate resources; and the accessibility of psychiatric services. The findings are discussed in the light of these factors.

From hospital to community: Six-month and two-year outcomes for 505 patients.

The authors have completed a large descriptive study of the system of psychiatric aftercare in Metropolitan Toronto. This article describes the relevant 6-month and 2-year postdischarge outcome in each of five aftercare components for 505 subjects in a traditional system of service delivery. Provincial hospital, research institute, and general hospital subgroups are compared. For the total group, recidivism and employment rates are similar to those found in previous studies. Symptoms and distress levels are high. Considerable numbers of subjects live in inadequate and unsatisfactory housing. Social isolation, inadequate income, and difficulties with instrumental role functioning are persistent problems with little improvement between 6 months and 2 years postdischarge. Differences among the subgroups vary according to type of outcome and, for the most part, can be explained by differences in the characteristics of the patients served by the three types of inpatient treatment settings. These findings provide additional information about serious deficiencies in discharge planning and aftercare service delivery that is focused primarily upon the treatment of illness. The authors conclude that a more balanced system of aftercare requires a shift in resources to rehabilitation programs in the community.

Sex differences in depressed university students

SummaryDepressed males and females selected from a consecutive sample of students attending a university psychiatric service (N=183) and a sample from the general student population (n=55) were compared to determine why more females (ratio 2∶1) seek help for depression. It was found that this sex difference was due neither to differential prevalence of depression nor to differences in symptom expression or social behavior, but rather to contrasting attitudes toward emotional problems and psychiatric help. Women recognize physical concomitants of depression as indicative of emotional problems and more readily accept the need for psychiatric help. Men appear not to connect physical symptoms with emotional difficulties.

Social support and post hospital outcome for depressed women.

In a larger follow-up study of discharged patients, a subgroup of 87 women with non-psychotic disorders had an unexpectedly poor outcome at six months with regard to readmissions, symptoms and social adjustment. The only factor which distinguished those who had been readmitted was lack of social support. Lack of social support was also related to poor symptom and social adjustment outcomes. There were considerable difficulties with social functioning independent of high symptoms. The adequacy of aftercare services is questioned in the light of these findings.

Loss and depression. A controversial link.

Inconsistent findings in studies of loss and depression arise from methodological differences, lack of common definitions of depression and loss, and the failure to consider the interaction hypothesis: the effect of early loss on depression is partly conditional on the presence of a current loss. Data were collected from 744 university students. Only 15% of subjects without loss vs. 44% with both types of loss had Beck Depression Inventory scores indicative of moderate depression. Analysis of variance confirmed this strong interaction effect. These results provide empirical support for Freuds view that a recent loss can reactivate depressive feelings associated with earlier loss.

Psychosocial factors and depressive symptoms.

The relationship of four psychosocial factors (family history of psychiatric illness, early loss of a nurturing relationship, stressful life events, and low social support) to depressive symptoms was investigated in university students using a cross-sectional design. A depressed group (N - 160), selected from a consecutive sample of students diagnosed depressed and attending a university psychiatric service, was contrasted with a nondepressed group (N=206) randomly selected from the general university population within three strata (sex, academic level, and month of the year) to match the clinic group. Depression was measured by the Beck Depression Inventory. It was found that family history of psychiatric illness, stressful life events, and lack of a confidant all had a significant, independent direct effect on the occurrence of depressive symptoms, but early loss was not associated. An interaction effect among the psychosocial factors was not demonstrated.

Psychiatric aftercare in a metropolitan setting.

In the face of the trend toward brief hospitalization, rising re-admission rates and other indices of poor community adjustment, concern has developed about the adequacy of psychiatric aftercare services. The authors report on a comprehensive study of psychiatric aftercare in a large metropolitan area (population 2.5 million). The study followed prospectively a group of 747 patients, representative of a significant proportion of patients in the care system. The findings document inadequacies in hospital-based discharge planning, unbalanced use of aftercare services and poor patient outcomes six months and two years post-discharge. The study found heavy reliance on medical/therapeutic aftercare services with a relative neglect of housing, vocational/educational, financial and social/recreational services. Despite the large volume of medical/therapeutic service use, the patient group had a high readmission rate, high levels of symptomatology and poor social adjustment on follow-up. The authors suggest that community-based practitioners with specialized training in psychiatric rehabilitation would improve the system of aftercare.

Psychosocial factors in the rehabilitation of elderly amputees.

Abstract Fifty amputation patients, primarily elderly, were interviewed on admission to, and discharge from, an amputee rehabilitation unit. The patients were found to experience regular stages of psychological reaction to amputation. The authors draw several implications for intervention, including the need for realistic communication, provision of emotional and peer support at a time when patients are receptive to such help, and attention to practical concerns of the amputee.

A Psychosocial Analysis of Risk of Psychological Impairment Following Bereavement

A multiple regression analysis was used to investigate the explanatory potential of a multidimensional approach to risk of psychological impairment. Information from a study of bereavement in Canadian women included meaning of the event to the individual, personality attributes, social supports available following bereavement and sociodemographic data. Risk of psychological impairment was estimated by score on the General Health Questionnaire (GHQ). Sixty-four per cent of the variance in GHQ scores at one month postbereavement was accounted for. The authors hypothesize that the addition of a measure of coping styles and more comprehensive measures of the other dimensions studied would increase the power of the technique. It seems critical to take into account the possible large effects of sociodemographic factors.

The Use of Group Meetings with Cancer Patients and Their Families

A diagnosis of cancer confronts the patient and his family with a major life crisis. With few exceptions, an extended period of uncertainty follows the initial treatment while all await the eventual outcome of the disease. Some authors have documented this period of uncertainty (1–3) but only a few attempts have been made to intervene in a systematic manner with groups of patients and family members to provide support and improve coping techniques during this period (4–7) Still less systematic research has been attempted with patients and family members who are living with the knowledge that the cancer is disseminated and therefore control of the disease is the best that can be hoped for. (8)