Interventions For Major Depressive Disorder: Culturally Safe Nursing And Educational Strategies

The problem of the major depressive disorder or MDD is one of the most common psychological disorders affecting the people around the world and it is considered as third cause of burden of the disease around the world and it is assumed that by the end of 2030 the disease will be at first position of the overall disease burden. The disease is diagnosed when an individual has the problems of insistently anhedonia or reduced interest in enjoyable activities, low or depressed mood, feelings of worthlessness or guilt, poor concentration, lack of energy, changes in the appetite of the individuals, retardation in the psychomotor abilities or nervousness, disturbances in the sleeping patterns and suicidal thoughts. According to the DSM-5 criteria, it can be reported that for diagnosing the MDD, an individual must have the five symptoms mentioned above including the depressed mood, anhedonia associated with the occupational or social impairment (Bains & Abdijadid, 2021). Along with this, it is also reported that the prevalence rate of the MDD among the women is almost double of the prevalence rate of men and it is estimated that the difference may be due to the hormonal changes, different psychosocial stressors in men and women (Nglazi et al., 2016).

Therefore, in this essay, the interventions for the MDD including a culturally safe nursing intervention and the educational strategy are discussed in brief manner.

While discussing about the culturally safe nursing intervention for the patients of MDD, it can be reported that the use of the mindfulness-based intervention can be recommended as in different studies the researchers had identified the effectiveness of this particular intervention for the African origin women. It is also reported that the use of the mindfulness intervention can be culturally tailored to overcome the barriers in the way of addressing the unique health needs of the African Americans. In this regard, it can be reported that, for making the intervention culturally safe, it is essential to incorporate the culturally responsive alterations in the actual mindfulness interventions and for this the nurses should consider the inclusion of the cultural values associated with the African cultures so that the patients of that particular culture can accept the treatment intervention easily (Watson-Singleton, Black & Spivey, 2019). In this study the researchers also reported that the during providing care to the people of African-American culture, the nurse should use the culturally familiar terminologies, cultural values and beliefs and also should respect and provide cultural resources during delivering the mindfulness intervention to the MDD patients. Apart from that, the nurse should also adhere to the religious considerations of the patients from the particular cultures. It is also recommended to deliver the care in a culturally familiar setting so that the patients feel safe during the delivery of the mindfulness intervention as a part of the holistic care process (Watson-Singleton, Black & Spivey, 2019). The effectiveness of the mindfulness intervention designed with the culturally safe considerations was reported in the study of Burnett-Zeigler et al. (2019). In this study, the researchers mainly aimed to assess the acceptability and the effectiveness of the mindfulness-based intervention among the African-American women from the lower socioeconomic group of people. In this current study the researchers performed a qualitative study to fulfil the aims of the current study. The participants of the study were selected from the urban community health centre (M-Body) and all of the study participants were under the age group of 18-65 years and all of them had developed the symptoms of the major depressive disorders or MDD. Major Depressive Disorder Symptoms And Diagnosis Essay Paper  The study participants were included in 8-week training program aligned with the mindfulness-based intervention and after collecting the data from the participants the data were analysed by using the inductive content analysis approach to identify the themes emerged from the interview transcriptions. The study results reported that all the participants had the limited experiences about the mindfulness-based interventions and after the intervention process the participants reported about the better outcomes in terns of anger management, enhanced control on their thoughts, feeling calmer and more relaxed, controlled emotions and behaviours. However, the researchers also reported about a few barriers in the way of participating in the sessions and they were mainly family responsibilities, transportation, employment and child care. The participants had provided a few inputs in the intervention for the overall improvements such as providing audio in multiple formats, enhancing time in the yoga practicing, modification of the postures and the delivery of orientation sessions as well. Therefore, the researchers reported that the culturally modified mindfulness-based intervention for MDD was acceptable and effective in improving the symptoms of MDD. In another study by Burnett-Zeigler et al. (2019) the researchers again reported the effectiveness of the mindfulness-based interventions for managing the MDD conditions among the African-American women. In this current study the researchers conducted a pilot study to assess the effectiveness of the intervention among the seventy-four adult women under the age group of 18–65 with depressive symptoms enrolled to take part in the 8-week group mindfulness intervention. The study results also reported about the effectiveness of the intervention as the patients’ depressive symptoms and level of stress reduced in a significant manner and along with this the mindfulness of the participants was also increased.

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Culturally Safe Nursing Intervention With Mindfulness-Based Strategies

As a part of the psychoeducation for the management of the MDD problems, the use of the group-based awareness programs for the MDD patients and for the families can be suggested as the family members are the primary care providers for the MDD patients. In a recent study by Meiser et al. (2017) the researchers reported to conduct a pilot study for the betterment of the MDD symptoms among the patients. As a part of this intervention, the researchers tested an online psycho-educational intervention for managing the depressive symptoms of the MDD patients. The patients completed the questionnaire pre-post of the intervention implementation and it was reported that the intervention was effective and 74 per cent of total participants were satisfied with the intervention as well. In another study by Timmerby et al. (2016) the researchers reported about the effectiveness of the family-based psychoeducation for the betterment of the MDD conditions of the patients. In this randomized controlled trial study, the researchers reported to conduct a dual centre, observer-blinded, two-armed randomized controlled trial to assess the effectiveness of the current intervention. The study results reported to provide effective results in terms of lowering the severity of the disease along with the improvements of different other symptoms including stress and anxiety of the patients. The study of Roaldset and Sandberg (2019) also reported the effectiveness of the group psychoeducation program for the betterment of the MDD among the patients. In this study the researchers reported to conduct a systematic review of the existing studies to assess the effectiveness of the intervention compared to the conventional pharmacological treatment process. The researchers aimed to consider the parameters like improvement in the quality of life, mortality (suicide), depression severity, relapse, psychosocial functioning and compliance among the MDD patients. For finding the relevant articles the researchers used the online databases like the Cochrane Library, MEDLINE, Embase, CINAHL, Epistemonikos, PsycINFO and PubMed along with 29 hand searched systematic reviews. The researchers also examined the eligible studies for examining the risk of bias by using the Cochrane risk of bias tool for RCTs. The researchers conducted the meta-analysis by using the selected studies through using the GRADE approach. The results of the current study reported that the implementation of the group-based psychoeducation aligning with the TAU compared to the TAU caused a reduction of the depressive symptoms at the 4 weeks to 6 weeks [SMD= -0.32 (95% CI: -0.59 to -0.04)] and after 6 months as well [SMD= -0.21 (95% CI: -0.38 to -0.04)]. On the contrary to this, it was reported that there was no significant improvement after 12 months after the implementation of the psychoeducation intervention [SMD= 0.22 (95% CI:0.02 to 0.45)]. In case of the family-based psychoeducation intervention, the researchers reported better impact when aligning the intervention with the TAU and it was more prominent at the end of 3 months [SMD= -1.21 (95% CI: -1.64 to -0.78)]. In terms of the improvement in the psychosocial functioning the use of the family psychoeducation in alignment with TAU was more effective compared to the TAU alone at the 3 months follow up period [SMD= 0.98 (95% CI: 0.56 to 1.40)]. Brady, Kangas and McGill in 2017 also identified the effectiveness of the family-based psychoeducation intervention for the betterment of the MDD symptoms of the patients. In this review study, the researchers reported to include 10 studies from the existing literatures based on a few inclusion and exclusion criteria. Among the identified 10 studies, the researchers stated that 4 studies were based on single family, 4 studies were based on multiple family, one study was peer-led mixed-diagnostic study and another one was comparison between single family versus multiple family. The study results reported that among the selected studies 6 studies directly reported about the positive outcomes and 7 studies reported regarding the improvement of the functionality of the patients. On the other hand, along with the improvement of the patients’ condition followed by the intervention, 6 studies reported about the wellbeing of the care providers of the MDD patients and among those articles 4 articles reported about the positive outcomes. The overall study results reported about the family-based psychoeducation improves the outcomes of the patients and their family members responsible for providing care to the MDD. The study findings of Indriani, Hayati and Wihastuti (2020) also supported those findings of above findings associated improvement of the MDD symptoms. Family based psychoeducation is also associated with the improvement of the cognitive abilities of the patients suffering MDD as the therapy helps to improve the knowledge level of the family members about the disease conditions and to teach the procedures that can help the family members to identify the symptoms of MDD as well.  

Conclusion

Hence, from the above analysis, it can be concluded that the issue of the MDD should be addressed so that the conditions of the patients suffering from MDD. The use of the mindfulness intervention can be culturally tailored to overcome the barriers in the way of addressing the unique health needs of the African Americans. The nurse should use the culturally familiar terminologies, cultural values and beliefs and also should respect and provide cultural resources during delivering the mindfulness intervention to the MDD patients. Another intervention for addressing the MDD is associated with the delivery of psychoeducation. Family based psychoeducation is also associated with the improvement of the cognitive abilities of the patients suffering MDD as the therapy helps to improve the knowledge level of the family members about the disease conditions and to teach the procedures that can help the family members to identify the symptoms of MDD as well. The family-based psychoeducation improves the outcomes of the patients and their family members responsible for providing care to the MDD.

References

 Bains, N., & Abdijadid, S. (2021). Major depressive disorder. In StatPearls [Internet]. StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK559078/

Brady, P., Kangas, M., & McGill, K. (2017). “Family matters”: a systematic review of the evidence for family psychoeducation for major depressive disorder. Journal of marital and family therapy, 43(2), 245-263.

https://onlinelibrary.wiley.com/doi/abs/10.1111/jmft.12204

Burnett-Zeigler, I., Hong, S., Waldron, E. M., Maletich, C., Yang, A., & Moskowitz, J. (2019). A mindfulness-based intervention for low-income African American women with depressive symptoms delivered by an experienced instructor versus a novice instructor. The Journal of Alternative and Complementary Medicine, 25(7), 699-708.  https://www.liebertpub.com/doi/abs/10.1089/acm.2018.0393

Burnett-Zeigler, I., Satyshur, M. D., Hong, S., Wisner, K. L., & Moskowitz, J. (2019). Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: A qualitative study. Complementary therapies in Medicine, 45, 19-24. https://www.sciencedirect.com/science/article/pii/S0965229918309749

Indriani, C., Hayati, Y. S., & Wihastuti, T. A. (2020). Family Psychoeducation in Reducing the Occurrence of Depression in Elderly: A Systematic Review. International Journal of Science and Society, 2(3), 100-114.

https://scholar.archive.org/work/cvrmo6su3vebrgfvnlwhfc6bxm/access/wayback/https://ijsoc.goacademica.com/index.php/ijsoc/article/download/130/116/

Meiser, B., Peate, M., Levitan, C., Mitchell, P. B., Trevena, L., Barlow-Stewart, K., … & Schofield, P. R. (2017). A psycho-educational intervention for people with a family history of depression: Pilot results. Journal of genetic counseling, 26(2), 312-321. https://link.springer.com/article/10.1007/s10897-016-0011-5 . Major Depressive Disorder Symptoms And Diagnosis Essay Paper