Welcome back. We're now continuing with the next video segment on mental health, where I'm going to give you a little bit more information about the most significant of the mental disorders with respect to disability. As well as a very significant prevalent problem for students and in the larger population. So I want to give you or start out by giving you some definitions. So these are the diagnostic criteria as stipulated in the DSM-5. And the couple of points about this are that in order for our diagnosis to be present, we need to have either criterion one or two. So either depressed mood or loss of pleasure, or loss of interest in things that one typically finds enjoyable or pleasurable. Both of these can be present but only one is necessary for the diagnosis. And then we have some combination of any of the others. It's a polythetic format. Meaning, that it's this kind of menu item approach. You need five of them but it can be any of those. And so these are things, and you'll know might notice that they come in different segments with respect to behavioral, either psychomotor agitation or retardation being slowed up or slowed down with respect to behavior. Also sleeping behaviors in there, either not getting enough sleep or the opposite sleeping too much. And then, there are also things that focused on mood and emotion, depressed mood feelings of sadness and then also thought patterns. Things like, difficulty thinking or concentrating, or thoughts of death or suicide. So these are the basic text book, here's what depression is. >> It's interesting because it kind of based on this, it seems like depression can look really different depending on which of the five you present with. >> Absolutely. >> Two people could be depressed and report very different things but still meet criteria for major depression. >> Excellent observation. >> Yeah. >> And so as I just kind of summarized, we talk about the ABCs of depression that's would respect to affect or mood, behavior. Meaning, that you've got these kinds of sleep patterns, emotion patterns and so on. That also might be associated, although for example, drug and alcohol misuse is not a diagnostic criterion with respect to depression. This is an associated behavior pattern that we frequently see when someone is presenting with major depression. And then also cognition certain styles of thinking, difficulty concentrating and so on. >> I have a quick question, Marnie. >> Yeah. >> because I read some of these and you commented on this, I think in an earlier segment, it's about these things are can you see all the time. We all experience kind of periods of sadness or some of these emotional features not enjoying things as much. Now, what differentiates that we see we all experience in a general population, from someone who meet criteria for this? >> Severity, duration and the interference with social occupational functioning. >> Okay. >> Great, absolutely a great point and a great question, I'm glad you asked. Because yes, these are normal experiences in doses and so when they persist, and so the the diagnostic criteria set for depressions that we're looking for consistency for at least two weeks. >> Okay. >> And we're looking for all of these to be present for at least two weeks. And so it remains in a state of depression with very little reprieve. >> Yeah, great. >> Great question. >> So when we look at the ABCs of depression symptoms, you're talking earlier about the menu for the diagnostic criteria. So do any of these necessarily have to be present or is this just short of descriptively what it looks like? >> This is more descriptive than whether we've got depression interfering on these or in these domains. There are kind of associated features of depression. Yeah, so these aren't necessarily the diagnostic criteria. This is just kind of how the symptom clusters fall in these three domains. >> Maybe except with effect, because it did seem like those two you're saying you have to have one of those two. Those were both emotional actually. Maybe that is kind of a characteristic feature of depression. Is that disrupted affect any somewhat? >> Yes, thank you point that out, absolutely. >> Well, there's a lot of things in this part but I was just thinking that's really interesting. >> Yeah. >> The common feature that you see in depression. >> Yeah, thank you. Now, I also want to point out as we already kind of talked about in a previous segment that there are special groups for whom we should point out that we might either see spikes with respect to incidence or prevalence. And so what this I just kind of wanted to talk about of this study, the primary finding or conclusion are that upon entering medical school. And this also applies to graduate school and there's some emerging research also saves the case for college students and other kinds of health professions. Upon entering a school, prevalence looks pretty consistent with the general population, same age band in the general population. But the unique stressors of school and the various behaviors cause a worsening with respect to depression and mental health. And we also see that the effect was even greater for the women in that sample. And that's actually, this is something that the media are talking about more, that grad school tends to foster depression and even just running kind of a Google News run on graduate school and depression, or graduate school and anxiety. And you will see this is something that that is getting more press, and I think because it's a real phenomenon. Unlike the many of the media presentations that I'm showing, the media I think kind of twist some health data based on my own research and on discussions, what we're learning is that this is a genuine phenomenon. >> And it makes sense kind of what you're saying in the earlier segment, Marnie, that I didn't realize it until you put all the picture display. Grad school, undergrad, med school, can be this perfect storm. This conglomeration of so many of these factors coming together. And at any one level, you don't realize slipping into kind of that risk level and then as it starts to happen more and more. >> Yeah. >> You see things like this. >> Absolutely, and then in this particular study, which unfortunately maybe it was not the most current survey. So maybe not as your generation, but still some relatively recent research. I don't think the grad school has changed so significantly since 2004, in terms of the demands that people have a very hard time functioning academically, as well as socially. And very high rates of suicidal ideation as well. >> 10%, that's kind of astonishing to see that. >> Yeah, I mean, I don't have the actual methodology of how they asked the question but that is a striking statistic as well. >> And I was just curious about the gender dimension that you mentioned in the earlier studies. That's something that across multiple studies is observed? >> Absolutely, with respect to women reporting higher levels of depression. Yes, and that's actually another [CROSSTALK] depression is more common among women. And there are biological factors, as well as social factors that have been identified as being kind of underneath this observed difference. As well as potentially reporting biases or treatment seeking issues as well, with respect to more women presenting for treatment than men even when you control for discrepancies in prevalence. So, it's sometimes theorize that for women, these same sorts of mental problems might manifest as depression. Whereas for men, they might be presenting more frequently for substance use or alcohol misuse because of the way that the depression kind of manifests and kinds of attempts that people might make just kind of pull themselves out of it. So there a lot of different theories as to why this might be the case, but currently we do know that at least with respect to the large-scale epidemiologic surveys, more women than men are reporting experiencing depression, so it's a great question. And then also some kind of social or more general factor just with respect to women's roles in society and not even seen and read. Other types of theories talking specifically about kind of power dynamics and culture that when one is in a more submissive role in a relationship or in the greater culture that this tends to cause more depressed types of emotions and cognitions. And then another, as I just kind of alluded that when that men might have been socialized to develop different sorts of coping strategies. So when they might experience depressed mood or effect, or a variety of other things that they might channel these into different types of kind of coping strategies. And so another point that I wanted to highlight, and we mentioned that it's a suicide. In that more women might experience and report suicidal thoughts and might even attempt suicide but more men actually complete the act.