Depression is a widespread mental health condition in Australia – according to Beyondblue , the national depression initiative, over 1,000,000 Australians live with depression. To check if you or someone you know has depression complete the following checklist – this is the same checklist sent to every household in NSW as part of the national depression initiative – beyondblue.

Count the number of YES ANSWERS to the following questions.

For more than TWO WEEKS have you:

1. Felt sad, down or miserable most of the time?
YES/NO

2. Lost interest or pleasure in most of your usual activities?
YES/NO

If you answered ‘YES’ to either of these questions, complete the symptom checklist below. If you did not answer ‘YES’ to either of these questions, it is unlikely that you have a depressive illness.

3. Lost or gained a lot of weight? OR Had a decrease or increase in appetite?
YES/NO

4. Sleep disturbance?
YES/NO

5. Felt slowed down, restless or excessively busy?
YES/NO

6. Felt tired or had no energy?
YES/NO

7. Felt worthless? OR Felt excessively guilty?
YES/NO

8. Had poor concentration? OR Had difficulties thinking? OR Were very indecisive?
YES/NO

9. Had recurrent thoughts of death?
YES/NO

Add up the number of YES answers for your total score.

What does your score mean?
Assuming you answered ‘YES’ to question 1 and/or question 2, count up all the YES answers for questions 1 to 9. If your score is,

4 or less: Unlikely to have a depressive illness
5 or more: Likely to have a depressive illness

Most of us have suffered the loss of a loved one, and as we age, it is likely that all of us will. Relationships are an essential part of what we, as humans, need to survive, and as we go through life, we will develop strong and significant connections with not just people, but also places and possessions we encounter along the way.

Grief is the emotion we feel when an important relationship ends (or is interrupted). Commonly the ending is caused by death, but grief can also be felt when a relationship is lost as a result of divorce, relocation, fire or theft. We don’t grieve for all lost relationships; only those that have, for one reason or another, become meaningful to us over time – people we love or admire (family, partners, friends, teachers), and places or things we treasure (a house you grew up in, a photo, a family heirloom). When these people or things are gone, we often feel grief.

People grieve in different ways. Some people grieve publicly and openly with great shows of emotion, others grieve silently and keep their emotions hidden from others. For some people, grief is easily overcome, for others it takes a long time to pass through the grieving process. Each individual grieves in a way which suits them, their emotions and the extent of their loss.
Grief begins when someone or something we care about is lost to us. Grief ends when we have recovered from the heightened sense of loss for the other person or thing, and we find that we are again able to function normally without them. This does not mean that we stop missing the person or feeling sad when we think about the loss we have experienced; it simply means that we are able to get on with our lives without feeling crippled by that loss.

The stages of loss

Grief can present in the following stages:

Outcry: When the loss if first discovered or acknowledged, people generally experience a feeling of initial outcry – they may scream or yell, cry or collapse, or they may suppress the ‘outcry’ and keep it inside. The outcry is a feeling of intense devastation and shock. It is generally difficult to sustain and does not last long.

Denial & intrusion: After the initial outcry, people experiencing grief will often enter a period where their emotions alternate between feelings of ‘denial’ (where they do not think about the loss) and ‘intrusion’ (where the loss is strongly felt). In this stage, people often find that their feelings of acute grief are distracted by other thoughts or activities which stop them from thinking about their loss for short periods or moments. These are usually everyday thoughts or activities, like watching TV or dressing a child. These periods are often interspersed with periods where the loss is recalled and the grief returns in an intensely felt manner. It is very normal for people to rotate between these two extremes – engaged with their grief and loss at one moment, disengaged the next. This is an important stage of the process, because the distraction and disengagement helps to break up the devastating nature of the grief being experienced.

Working through: Over time, the oscillating between denial and intrusion slows down and people spend less time thinking about the loss, and less time experiencing a profound sense of grief over that loss. During this stage, people feel less and less overwhelmed by their loss (this might take days, weeks or months to happen). Most importantly during this stage, people start to work out ways to manage without their lost relationship – they might start dating again, make new friendships, find new hobbies or spend more time with their family or friends.

Completion: At some point in the process, the grieving completes itself enough so that life starts to feel normal again. Memories of what has been lost stay, but the feelings associated with that loss are less painful and less intense – they stop interfering with normal life. Talking through your loss and grief with a professional bereavement counsellor or psychologist can be beneficial to the grief process, helping you to process the grief and reach completion.

Prolonged grief (or pathological grief)

Sometimes a person finds it difficult to successfully ‘complete’ the grieving process. A sudden loss might mean the grief is more difficult to resolve because there has been no time to prepare for that loss. The loss of a principal relationship (such as a spouse, partner, child, parent or best friend) is generally more critical and felt more deeply than the loss of someone less close or relevant to one’s life.

The fairness of the loss is also relevant to the grieving process – it is easier to accept the loss of an aged parent than the loss of a child. Death by disease seems easier to comprehend than death by some random incident. Losses that confront a person’s sense of fairness in the world are generally harder to manage.

The amount of support received by a grieving person is also highly relevant to the ability of a grieving person to ‘complete’ their grief. Indeed people who are without close social networks often have a much harder time getting over their grief. Talking to a grief or bereavement counsellor can be an excellent way to seek extra support during your grieving process.

Sometimes many years have gone by and the grief from a significant loss is still unresolved. This unresolved grief may not be obvious to others, but the grieving person might still feel that the loss is impacting their lives – it might be stopping you from forming new relationships, or making you feel overwhelmed with sadness. In these situations it is important to seek professional help.

Approximately one in five people experience a depressive episode during their lifetime. Depression is a very difficult illness for people to cope with and is most often characterised by:

• Markedly reduced mood
• Loss of interest or enjoyment in previously enjoyed activities
• Reduced concentration and memory ability
• Sleep difficulties
• Appetite disturbance (either increased or reduced appetite)
• Feelings of hopelessness regarding your future
• Feelings of worthlessness and reduced self-esteem
• Ideas or acts of self-harm or suicide
• Reduced libido

A number of people experiencing a depressive illness can also experience co- occurring anxiety or anger management difficulties.

Depending on the severity of the depressed mood, treatment can often involve both medication and psychological therapy. International studies suggest that the standard psychological treatment for depression is cognitive behavioural therapy (CBT) that involves learning a number of strategies to minimise and manage the depressive symptoms. Some strategies will focus on things that the person can do behaviourally to get things on track and cognitive strategies are aimed at challenging the negative and unrealistic/unhelpful thinking styles that tend to cause and reinforce the depressed mood.

Your GP and/or psychiatrist will be able to provide information about available antidepressants to assist with the management of depressed mood.

Top 5 Top Tips at Managing Depressed Mood

1. Talk to Someone. It is important for a person experiencing depression to seek support. Some people find that the support that they can access from family and friends is adequate while other require more intensive support from a trained professional.

2. Schedule Activities into your day. While your interest and motivation to engage in previously enjoyed activities will be very low, isolating yourself and staying at home will make the depressive symptoms worse.

3.Set Goals for Yourself. Depression can often result in reduced motivation and direction. Set some short-term goals that you would like to achieve within the next month and write down a plan to help you achieve those goals.

4. Think Realistically and Positively. Negative thinking and depressed mood go hand in hand. Be aware of the way in which your thinking is affecting your mood and try to see a more positive perspective.

5. Consult your GP. If your mood is very low and you have self-harming or suicidal thoughts, see your GP as soon as possible to discuss the possibility of medication and get referral to see a psychologist.

While experiencing small amounts of anxiety is actually very normal (and, in fact, quite helpful to improved performance), severe levels of anxiety can be very debilitating for a person. Anxiety can occur in response to a variety of situations and also presents with a range of symptoms that can be both physiological and cognitive (i.e. anxious and worried thoughts).

The most common presenting anxiety disorders include:

Panic Disorder: The experience of recurrent panic attacks involving a number of physiological symptoms such as dizziness, racing heart, breathlessness, sweating and confusion. These panic attacks can occur either in response to specific stressors or unexpectedly and are extremely overwhelming and concerning to the person experiencing them.

Generalised Anxiety Disorder (GAD): Characterised by excessive and persistent worry about a number of areas of the individual’s life including health, family, job, finances, and friendships.

Specific Phobia: Individuals with specific phobia have an irrational fear of a particular situation or object. People experiencing a specific phobia will often experience physiological and cognitive (thinking) symptoms when exposed to the stressor and their fear typically leads to an active avoidance of the situation or object.

Obsessive Compulsive Disorder (OCD): Characterised by unpleasant and intrusive obsessional thoughts that are difficult for the individual to control (e.g. concerns about cleanliness or something bad happening to a loved one). The obsessional thoughts can often lead into the practice of compulsive rituals (e.g. cleaning, counting, checking) that help to reduce the immediate anxiety for the individual.

Post-Traumatic Stress Disorder (PTSD): In response to the experience of a severe traumatic event, an individual with PTSD can experience significant anxiety regarding the memory of that event and will often experience recurrent flashbacks or nightmares of the incident. It is typical that people experiencing PTSD will actively avoid cues that trigger a recollection of the traumatic incident.

Treatment of anxiety disorders often involves medication and psychological therapy. There are a number of anti-anxiety medications that can help reduce symptoms of anxiety and this can be discussed with your GP. The most effective type of psychological therapy for treatment of an anxiety disorder is cognitive behavioural therapy that aims to improve the individual’s ability to manage both physiological symptoms and worried thinking through the implementation of a number of different strategies.

Top 5 Tips for Management of Anxiety

1. Access Support. It is important to access support from your family and friends if you are experiencing anxiety. Individuals experiencing severe levels of anxiety may need to access more specialised support from their GP or a psychologist.

2. Deep Breathing. While it may sound a little cliché to suggest ‘deep breathing’, panic symptoms are most often greatly exacerbated by an increase in one’s breathing rate and can be the cause of symptoms such as light-headedness or dizziness. Focusing on taking deep breaths can also help to distract you from the stressor that triggered the anxiety.

3. Challenge Irrational Thoughts. Catastrophic thinking (and other types of irrational thoughts) usually works hand in hand with anxiety disorders. Identify your anxious thoughts and challenge them to ensure that your perspective is realistic and rational.

4. Don’t Avoid. Avoidance of the stressor that makes you anxious can often reinforce the anxiety. It is important to note, however, that individuals experiencing severe levels of anxiety should seek a specialist to manage avoidance more effectively.

5. See your GP. Your GP will be able to help with the prescription of medication and/or a referral to a psychologist if you are having difficulty managing your anxiety.

We recommend the following links, and may provide you with more support and information.

• The Australian Psychological Society
• Authentic Happiness
• Beyond Blue
• Black Dog Institute
• Butterfly Foundation
• Centre for Eating and Dieting Disorders
• Centre for Clinical Interventions
• Kids Helpline
• Lifeline
• Reach Out
• Raising Children Network