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Keeping the black dog at bay: Remaining vigilant against depression
An exploration into depressive mental health and why the world cannot afford to ignore the dangers of disorders, such as depression, regardless of the current health crisis.
The world cannot afford to ignore the dangers of mental health disorders such as depression, regardless of the current health crisis.
Given our preoccupation with COVID-19 these days, it’s easy to forget that there are other health issues, especially pertaining to mental health, which continue to afflict a significant section of the population in Australia and around the world. Indeed, they may be exacerbated by the pandemic.
Over 264 million people are affected worldwide by depression, which is a major health concern in Australia as well, according to Jaimie Bloch, a clinical psychologist and founder of Mindmovers Psychology in New South Wales.
In Australia, more than one million adults currently experience depression, and in their lifetimes, as many as one in seven people in the country will be depressed, according to some estimates. Further, looking at the overall state of mental health in the country, another report has found that 20 percent of Australians in the 16 to 85 age group suffer from a mental illness in any given year, with depressive, anxiety and substance use disorders being the most common.
Why are numbers on the rise?
There are a number of factors commonly linked to depression, according to mental health experts who note that it is usually triggered by "a combination of recent events and other longer-term or personal factors, rather than one immediate issue or event".
Contributing factors include long-term issues, such as extended unemployment or prolonged work stress, physical or mental abuse in a relationship, or continued isolation or loneliness. Stress-inducing life events, such as losing a job or death of a close friend or relative, and drug or alcohol abuse can also trigger depression. Family history can play a part as well, with up to 40 percent of the risk for developing depression possibly due to genetic factors, according to the Australian Psychological Society.
Meanwhile, the coronavirus pandemic is contributing to the problem with growing numbers of Australians suffering from depression, as widespread lockdowns and associated job losses affect mental health.
"COVID-19 has created this lack of uncertainty and people who were already suffering from mental health challenges are definitely being impacted the most, especially in lower socio-economic groups and minority groups," says Jaimie. Amid the lockdown, psychologists are "seeing even more isolation", she says, adding that contributing factors like domestic violence have also increased.
But the pandemic has also forced people to pay more attention to mental health. This is a positive development because the key to staying on the front foot against conditions like depression, Jaimie says, is to recognise the problem early by being at the forefront of assessment and analysis – a focus area for Pearson Clinical.
"Pearson Clinical provides such amazing equipment and psychological assessment tools. They really provide great objective measures without which it would be impossible to get baselines and to figure out where a patient might be."
Culture plays a major role
The number of Australians who are diagnosed with depression and anxiety disorders is on the rise and this trend may have its roots in the larger cultural environment that many Australians, and others in the West, find themselves in, says Jaimie.
Many across the developed world have cut themselves off from traditional support networks and living conditions in Australia are also seen worsening feelings of isolation and loneliness more so than in other countries and cultures.
"Unfortunately, Australia [and] a lot of Western countries have very high rates of depression and suicide. There are always many reasons, but a lot of it is due to Western culture and the way that mental health is viewed and looked at," Jaimie says. "There is a lot of stigmatisation around having mental health challenges, which means that people are less likely to reach out for support."
In countries like Australia, a large number of people live within their nuclear families, meaning that there is less familial support structure – from grandparents, cousins, aunts and uncles, for example, than there would be in cultures where multigenerational living is more common. As a result, Jaimie says, there is "less community, less focus around that altruistic connection and more focus on self", noting that research suggests that “the more self-focused you are, the more negative and critical you are and the more depressed you’ll be”.
She also notes that the data presents a surprising dichotomy – Western countries have shown to have both the highest happiness levels, and the highest depression rates.
"There definitely could be this factor of chasing this dream which could make you really happy, but at the same time extremely stressed out and burnt out," she observes.
"Especially in Australia, you have so much stress at home, this never-ending, constant rat race, this cycle that people are stuck on. Because of that you’re going to have moments of happiness and you’re going to have these really deep moments of loneliness and sadness too."
In the Harvard Study of Adult Development, one of the longest-running studies of its kind, researchers are continuing to find that in developed, Western countries "where minimum material living conditions are?often satisfied, people may struggle to become happier because they are targeting material rather than social goals".
An unequal affliction
While depression can hit anyone at any time, Jaimie says that young people – her key clinical group – are at high risk and numbers are on the rise, with one in four adolescents experiencing a mental disorder. Further, early onset of the condition can lay the foundations of depression for later in life, she says.
“There’s plenty of research that shows all mental health disorders are created and the foundations implemented before the age of 25. It’s definitely more prevalent once you hit adulthood but the underpinnings of it are in youth.”
It is a growing concern for Australia’s young people. Mission Australia’s 2019 Youth Survey found that over a third of respondents cited "mental health" as one of the top three issues affecting Australia today, and a similar percentage cited mental health as a top-three personal concern.
More than 40 percent of Year 12 students report symptoms of anxiety and depression, which is higher than the normal range for their age group, and suicide is the leading cause of death for people aged 5-17 years old, according to the Black Dog Institute. Socioeconomic factors also unquestionably play a role, according to Jaimie, with Aboriginal and Torres Straits Islander people having the highest suicide rate among the Australian population.
Prioritising mental health
In response to the scale of the problem, the field of psychology has "exploded" in the last few decades, according to Jaimie. And growing accessibility to a psychologist, awareness in the community to the importance of mental health, and research around the outcomes when people can access support, have been hugely positive steps for Australians.
She sees reason to be hopeful, but adds: "I think that for all mental health it takes time and…obviously there is more work to be done." For her and her peers, finding the right diagnostic material and assessment tools are part of the battle, but she hopes that there is a growing recognition of the need for a cohesive strategy across the board, from the national level down.
Indeed national support has been forthcoming in the age of the coronavirus. With caseloads growing even as assessments become challenging due to the need for social distancing, psychologists and other health professionals are having to innovate rapidly – including with telehealth solutions – to limit in-person appointments to minimise risk.
The government’s support has been invaluable here, Jaimie says, and programmes like Australia’s e-mental health strategy have come into their own. With funds flowing into e-mental health, getting accessibility to people has been prioritised.
"This strategy is obviously a long-term vision, developing accessibility and a high-quality e-mental healthcare system for people."
It is also crucial to involve multiple stakeholders. "People don't change by themselves or in a vacuum and we need community support, so getting everyone in line and onto the same page is crucial," Jaimie says, emphasising the need to help everyone to understand the science and data we have around to understand thoughts and emotions.
Particularly given Australia’s cultural background and the predilection for isolation and stigmatism of mental health, there needs to be much more awareness in the community about the importance of investment in mental health, especially early on.
“I think that a lot of people might not prioritise their mental health until they’re in a crisis, and crisis work is always unhelpful. We want preventative work - so people accessing services or connecting to someone before something becomes really bad."
Continue reading: Placing a lens on depression
Placing a lens on depression
Unpacking the key statistics surrounding depression, probable causes, and the role of culture in depressive mental health conditions.
In this infographic, we investigate key statistics, the probable causes of depression and the role of culture in depressive mental health conditions.
View the exclusive insights below.
Continue reading: Episode 2 — Confronting institutional gaps: Investigating mental health policy and depression
PODCAST: Episode 2 — Confronting institutional gaps: Investigating mental health policy and depression
A discussion on whether current policies and public funding models are equipped to support depression treatment, and the prospects for short-term progress with Jaimie Bloch, Clinical Director and Founder of MindMovers Psychology. Listen now.
Welcome to episode 2 of the Psychology Digest podcast.
We’re joined by Jaimie Bloch, Clinical Director and Founder of MindMovers Psychology, to discuss how current policies and public funding models are equipped to support depression treatment, and the prospects for short-term progress.
We discuss the ethos of MindMovers Psychology (0:45), Jaimie’s experience as a clinical psychologist and in depression treatment (1:34), bridging the gap between psychology, science and human understanding (2:10), how Australian depression rates compare to those in other Western countries, as well as in comparison to Eastern countries (3:49), depression rates among specific Australian demographics (7:42), impact of COVID-19 on depression rates and whether the pandemic has changed the perception of depressive mental health conditions (9:05), Australia’s mental health policy (11:27), whether telehealth and eHealth solutions can supplement face-to-face treatment (13:10), preventative versus reactive depression treatment approaches (14:02), the adequacy of Australia’s mental health funding (14:59), the impact of digital devices and social media on mental health (16:00), the research into digital dependency (17:47), the evolution of depression treatment and the importance of a holistic approach (19:24), and more.
Continue reading: Bringing certainty to the battle against depression
Bringing certainty to the battle against depression
An exploration of the gold-standard assessment tools used to facilitate accurate depression diagnosis and tailored approaches to treatment. Read now.
A century ago, depression wasn't considered to be particularly widespread, with less than 1 percent of the population diagnosed with the condition. But thanks to factors like an improved understanding of mental health, better access to mental healthcare and a growing willingness to seek assessment and treatment, it is now considered by the World Health Organization (WHO) to be a common condition.
The WHO estimates that more than 264 million people are affected worldwide and says depression is "a leading cause of disability worldwide and is a major contributor to the overall global burden of disease". Given how common the condition has become, diagnosing depression accurately and swiftly is key.
However, the assessment and identification of depression can be "quite complex" because mental health conditions can arise from several factors, according to Valorie O’Keefe, Consultant Psychologist at Pearson Clinical.
"The onset of depression can be triggered by a situation or life event for some individuals, while others can experience more chronic mental health issues," Valorie says. "This could be because they have major depression, or they might have co-morbidities such as anxiety or PTSD alongside the depression, or they might have a more complex personality disorder, which adds complexity to the treatment plan."
Depression: A growing concern for Australians
While depression is a global issue and, as the WHO notes is on the rise, in Australia too its impact is being felt around the country. As many as three million adults experience either anxiety or depression in any given year and nearly half the population, it is estimated, will be affected by a mental health condition at some point.
Compounding the problem is the advent of COVID-19, which has changed both the prevalence of, and approach to treating, depression, Valorie says, with the increase in loneliness and anxiety brought on by the drastic changes in our lives – such as social distancing, isolation at home and remote-working measures put in place to limit the coronavirus outbreak – meaning "there's more and more need for assessment and intervention".
And because the pandemic is preventing psychologists and counsellors from assessing clients in person, "there has been a need to develop more and more telehealth assessments", Valorie says.
Assessments: Key tools in the battle against depression
At the same time, because of the complexity of the underlying conditions, the tests for assessing depression need to be comprehensive.
"The most popular assessment tools are ones that are easy to administer and score, are not too difficult or lengthy for the client to complete, and that are affordable for the practitioner," she says. "It is also vital that the diagnosis be made with the help of a “reliable, valid, and well researched tool".
The Beck Depression Inventory (BDI), for example, measures the presence or absence of depression. If present, it grades the severity level of the condition on a scale from mild through moderate and onto severe, Valorie explains. The self-administered questionnaire determines this in about 25 questions, and often an assessor will use the BDI alongside other Beck Scales, such as the Beck Anxiety Inventory, the Beck Hopelessness Scale and the Beck Scale for Suicide Ideation.
According to Valorie, Pearson Clinical provides several tools that mental health professionals can use effectively. These range from quick screeners, which are able to assess "what is most likely a very straightforward depression that requires treatment", but also tools that measure more complex mental health presentations, such as various aspects of psychopathology, which would require in-depth long-term intervention.
Pearson also offers mental health assessments for children and teenagers, including the BASC 3, Beck Youth Inventories and MACI II, and provides the option of digital assessments through its Q-global online platform, allowing assessors to administer these questionnaires online from their office or practice. They can also deliver the tests to their patients via email using a Q-global feature called Remote OnScreen Administration, allowing questionnaires to be completed at home – a feature that has proven hugely beneficial amid the pandemic.
MMPI: A widely used measure of psychopathology
Pearson also offers other, more in-depth assessments that determine depression alongside a range of psychopathologies. The MMPI-2-RF (Minnesota Multiphasic Personality Inventory), for example, is a questionnaire-based assessment developed by Pearson's US-based team, alongside the University of Minnesota. The MMPI is "one of the most widely researched and used psychological assessment instruments", according to the American Psychological Association.
The test is a "very complex measure of psychopathology, which would include depression and anxiety but also things like PTSD and a variety of personality disorders", Valorie says.
On the horizon is the MMPI-3, the updated version of the MMPI-2-RF, which has been redeveloped, modernised and reformed. It will be available for use by psychologists and psychiatrists around September.
To make the assessment more user-friendly for both assessor and the client, the number of questions has been reduced by half from the original version, from around 600 to 300. The rationale is that the smaller number of questions will be less taxing for anyone with mental health issues, Valorie says, but by refining the focus of the questions, the validity and reliability of the measure is retained, while making it quicker and easier to administer.
With improved testing capabilities, psychologists in Australia and the world over can better diagnose mental health issues – and to do so quickly, enabling earlier intervention. This is especially crucial amid the current global health crisis, which provides all the right conditions for exacerbating an already daunting mental health situation.
But with the right tools, a sense of urgency and the compassion that the field of mental healthcare is known for, practitioners can stay one step ahead and mitigate some of its worst effects.
PODCAST: Episode 1 — Overcoming roadblocks and taking control of career progression in psychology
Dr Tae Hee Jung, Consultant Psychologist at Pearson Clinical Assessment, discusses the importance of career progression, how to overcome periods of stagnation and more on episode 1 of the Psychology Digest podcast.
Welcome to episode 1 of the Psychology Digest podcast, brought to you by Pearson Clinical Assessment.
In this episode, we’re joined by Dr Tae Hee Jung, one of Pearson Clinical Assessment’s Consultant Psychologists, to discuss the importance of career progression and how to overcome periods of stagnation in psychology.
We dive into Dr Jung’s background as an organisational psychologist (0:45), how COVID-19 has affected work habits and its impact on psychology (1:35), the stages of professional development for psychologists (5:01), tips for psychologists on enabling career progression (6:35), how psychologists can navigate through periods of stagnation (8:16), insights on the approach to upskilling and the importance of business literacy in psychology (10:19), how psychologists can structure their practices to achieve positive outcomes (15:01), advice for psychologists looking to specialise in different areas of organisational psychology (16:30), and Dr Jung provides perspective on the key trends to look out for in psychology (17:55).
Continue reading: Navigating professional development in today’s world of psychology
Navigating professional development in today’s world of psychology
From keeping up with the latest research to learning about developments in the field, professional associations offer psychologists an effective means of continuous education. Learn how to navigate professional development in psychology today.
The field of clinical assessment is developing at a rapid pace, with stakeholders across the professional spectrum, from policymakers and educators to practitioners and industry associations, getting to grips with a wealth of new research into fields such as eating disorders, depression, dementia and autism.
For psychologists practicing today, developments in technology, paired with a huge support network through professional bodies, mean that taking advantage of these developments has never been easier or more fruitful.
Testing, for example, has seen a shift online from a time-consuming paper-based environment. Meanwhile, the growth of telehealth has been rapid – and necessary – given the unprecedented changes to patient assessments amid the COVID-19 pandemic, which is challenging established ways of working and highlighting the importance of remote yet secure online assessments, says Valorie O’Keefe, Consultant Psychologist at Pearson.
As an industry leader, Pearson Clinical has over 200 assessments, many of which can be administered and scored digitally through telehealth platforms such as Coviu, as well as through Pearson's Q-interactive and Q-global, which are two of the most popular online platforms currently in use. The company is also constantly developing its library of tests to deliver products of the highest standards, backed by first-class research and underwritten by a global, renowned team of clinical practitioners.
The organisation provides a wealth of training for psychology professionals at every stage of their careers, the majority of which is run at no cost. For instance, Pearson has made Q-global’s digital library free for psychologists to access during the current health crisis. Meanwhile, practitioners in Pearson’s network are constantly training fellow psychologists in the proper use of assessments through private training courses and the Pearson Academy.
“That is the part of the job that brings me the most joy, helping psychologists do their best work,” Valorie says.
The power of the professional association
While Pearson Clinical provides psychologists the cutting-edge tools necessary to address some of the most challenging aspects of modern-day mental health, professional associations are a key component of the equation. From keeping up with the latest research to learning about major trends and developments in the field, professional associations offer practicing psychologists an effective means of continuous education as well as a venue to meet and exchange ideas with counterparts from around the world.
Becoming a member of an industry association is a sound move for psychologists on every step of the professional ladder, and being an active member of the professional community offer practicing psychologists a range of benefits.
For instance, according to Valorie, being part of an association has enabled her to actively participate in industry initiatives, such as the Australian Psychological Society (APS) Test and Testing Expert Group, attend national and local industry conferences to keep up with the latest industry trends and network with peers, while also offering practical workday advantages.
“The APS provides psychologists with an easy way to monitor and record their Continuing Professional Development hours,” she says. “This might sound like a simple thing, but… the benefit of using the APS system is that it helps you understand the requirements and provides an easy way of recording your activity, your goals, and keeping track of hours.”
The APS is Australia’s most subscribed-to body, with over 24,000 members who are represented regionally and by state, with chapters providing local support and continuing professional development. There are also around 50 interest groups bringing together members from certain fields or with specific interests. These range from Psychology and the Environment to belief-based interests such as Buddhism and Psychology, or group-specific topics, such as Aboriginal and TSI Peoples Psychology. In addition, APS colleges represent practitioners working in specialist areas, maintaining practice standards in those fields.
Associations like the APS are also on hand to offer professional advice to their members. “They're there to help you,” says Valorie. “If you have an ethical question, if you have a legal question. They're there to help members with those tricky situations.”
For Pearson Clinical, a main driver of testing in Australia, association events are ideal venues to presents its research to a wide audience of industry professionals. The publisher, Valorie says, is also working to conduct webinars in partnership with the APS - which also produces its own training materials - to help practitioners keep up with professional development opportunities.
Associate membership also provides opportunities internationally, with Australian psychologists invited to be involved from afar in some of the world’s most influential industry bodies, such as the American Psychological Association. Until recently, members typically attended renowned conferences around the world – and hopefully will do so again once the pandemic is behind us.
In the meantime, both the APS and sister organisations across the globe are adapting more and more to distance and virtual conferencing. As well as a chance to engage with some of the most influential figures working in psychology today, Valorie says international conferences are “great networking opportunities as well.”
Additionally, associations like the APS allow psychologists to advertise their own events or be listed on their website to help people who are looking for a psychologist with a particular specialisation to easily find them.
For fellow psychologists looking to make the most of professional associations, Valorie recommends becoming actively involved by attending local branch meetings, joining committees or interest groups, and signing up for courses, such as those organised by the APS Institute, to expand their skill set.
“It’s really about making the most of what your professional association has to offer,” she says.
A world of digital opportunities with Pearson Clinical and Talent Assessment (PCTA)
A breakdown of the PCTA footprint servicing psychologists: 100+ webinars, 200+ resources, plus more. Access the insights here.
Pearson Clinical and Talent Assessment offers psychologists a world of digital opportunities to upskill and remain at the forefront of their field.
As one of the world’s largest commercial developers and distributors of psychological testing, here’s a breakdown of PCTA’s footprint.
Continue reading: From a pub to a private practice – a unique journey to psychology
From a pub to a private practice: a unique journey to psychology
A story about an educational psychologist’s distinctive journey to owning her own private practice. Read the case study now.
The journey to becoming a psychologist is typically linear. With years of tertiary study underpinned by work experience and practice supervision, there is a lot that goes into becoming a psychologist and then determining your discipline. But for some, the journey to becoming a registered psychologist can involve many twists and turns.
Robyn Stead, Educational Psychologist and Founder of Educational Psychology Services (or EDPSYCH for short), is one of the professionals whose journey was unique. While she’s currently running her New Zealand-based private practice, the journey to arrive where she is today was far from conventional.
The offbeat path to psychology
Robyn initially graduated with a Bachelor of Arts and despite her interest in education she didn’t feel ready to settle in a career, so she took off overseas and gained experience in all sorts of roles: she worked as a nanny, she worked in pubs, and then in admin for a pharmaceutical company.
After a couple of years in Europe, Robyn decided the time was right to train as a teacher, so she trained to become an English teacher in the United States and taught for several years, but quickly realised that her passion was in special education. So, Robyn did further study to develop her expertise in special education and added another qualification to her resume.
After years in the United States, Robyn moved back to New Zealand and ran into a professional hurdle. At that time, special education was yet to become an in-demand role, so she went back to mainstream teaching and it was at that moment that Robyn encountered the possibility of becoming a psychologist.
“I was working with a psychologist who was working with one of my students and she said, ‘you should train to be a psychologist.’ And I thought, ‘oh no, I've already done enough university training.’
“But I did go on to train to become a psychologist, and I went into a service called the Resource Teachers of Learning and Behaviour, which is a service that works with kids that have mild-to-moderate disabilities. So, I worked there and became a practice leader. And then about two and a half years ago, I started my private practice.”
Importance of staying current
Robyn says that there are a lot of things about her role as an Educational Psychologist that gets her out of bed every morning, but if she was to nominate one thing that stands out above the rest, it’s the privilege of being able to interact with young people and their families, as to support them to ensure they get what they want out of their education journey.
And given the commitment and obligation to continuing professional development (CPD), staying across the latest research, and innovations in assessments and resources is what Robyn says is integral to her work as a psychologist.
“We owe it to all our clients to remain current with what is best practice in the moment and that changes so much depending on what research is coming through. So, it's critical for all of us in our profession to continue to learn - you can't just rest on your laurels as a psychologist.
“I've always thought that if you ever get to the point where you think you know it all, then that is the time to step away and retire. You need to have some degree of uncertainty that sits with you throughout, perhaps an awareness that there's always more to learn.”
Why Pearson Clinical?
Robyn says that Pearson Clinical is a reliable resource that helps her knowledge remain current and has worked closely with Melissa Stephens for over 10 years, who is one of Pearson Clinical’s Consultant Psychologists, to upskill on assessment resources. Psychology assessments are inherently detailed and technical, so for Robyn, this is where her relationship with Pearson Clinical (and namely Melissa) is all-important.
“Melissa gets to the point and understands what you're asking - it’s extremely helpful. I can send Melissa an email about an assessment and she will respond and provide a clear explanation, and she'll even cite the research if it's appropriate.”
For Robyn, Q-interactive is a tool she uses frequently in her work as an Educational Psychologist, and highlights the value of the training videos, which she often references to ensure she’s getting the most out of the platform. She adds that the availability of recommended books helps to contextualise assessment tools, too.
“I can quickly go into the Q-interactive training videos and cross check things, such as: am I handing the blocks to the kids correctly or am I clicking the timer at the right moment? I find that resource really helpful. And that’s true for Pearson’s manuals and book recommendations – they’re an asset that ensures you’re always on the right track.”
Robyn’s message to psychologists seeking assessment solutions is clear: Pearson Clinical’s resources are “easy to access” and “high quality”, and their Consultant Psychologists are a great asset to have to ensure you’re getting the most out of your initiatives.
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