Common

Mental Disorders

Dr Bethany Wainwright

psy6004d@arden.ac.uk
Today
Common Mental Disorders (CMDs):

• Children and adolescents

• Maternal mental health (& Paternal)
Learning Outcomes

• To understand the presentation and predictors of CMDs in children and young people

• To understand and evaluate theories of maternal mental health

Trigger warning

Self harm, suicide (including in children), depression, substance use,

postnatal depression

If at any point in the session you feel uncomfortable, please feel free to
leave the session and contact me on psy6004d@arden.ac.uk

If you would like me to find an alternative for any of the papers, please
let me know.
Common Mental Disorders (CMDs)
 Common Mental Disorders (CMDs)
• Common mental disorders (CMDs) comprise different types of
depression and anxiety

• Cause marked emotional distress and interfere with daily function

• Can have profound impact on people’s lives

• Although usually less disabling than major psychiatric disorders,

their higher prevalence means the cumulative cost of CMDs to
society is great
 Common Mental Disorders

*Prevalence: number of people with condition/disorder

Link to survey: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-
and-wellbeing-england-2014
Prevalence
Comorbidities of CMDs
• Anxiety & Depressive disorders often co-occur (high rates of comorbidities)

• Having one type of depressive/anxiety disorder also makes it more likely to have
additional types & MH conditions

• Estimated 3/4s of people with Major Depressive Disorder (MDD) meet criteria for another
disorder – most commonly an anxiety disorder

• Suggested that anxiety precedes development of comorbid depression

• CMDs highly comorbid with chronic health conditions

Adams, G. C., Balbuena, L., Meng, X., & Asmundson, G. J. (2016). When social anxiety and depression go together: A population study of comorbidity and
associated consequences. Journal of affective disorders, 206, 48-54.
CMDs in children & young people
CMDs in Children & Young People (CYP)
• Growing concern about MH & well-being of children &
young people (CYP; 0-24 years)

• Increasing referrals to services, admissions for self-

harm, and demand for counselling services

• Increasing rates of anxiety, depression, and decrease in

well-being

• Very concerning because 3/4s of lifetime MH problems

occur before the age of 24

• MH disorders are key cause of morbidity and years of

life lost in CYP
 CMDs in Children & Young People

• Analysed data from 140,830 participants in 36 national surveys in England, Scotland, Wales
(1995 – 2014)

• Consistent increase in MH conditions over time across all age groups

High Risk Groups of CYP
NHS England 2017 Survey
Young women

• 1 in 4 young women 17-19 years old had a mental

health disorder (23.9%)

• Of these, emotional disorders (inc. self-harm) was very

high (22.4%)

• 1 in 18 (5.6%) had body dysmorphic disorder (anxiety

characterized by obsessive idea that aspect of
appearance is flawed)

https://dera.ioe.ac.uk/32622/1/MHCYP
%202017%20Summary.pdf
High Risk Groups of CYP
Non-heterosexual identity

• Young people who identified as non-heterosexual were more likely to have a mental
health disorder (34.9%) than those who identified as heterosexual (13.2%)

Social & family context

• Children living with a parent with mental illness

• Children living with parent in receipt of disability allowance
• Children who had experienced adversity (financial crisis, parental separation…)
• Those with low levels of social support NHS England 2017 Survey
• CYP living in families with family functioning problems
https://dera.ioe.ac.uk/32622/1/MHCYP
%202017%20Summary.pdf
 Discussion -
What do you think are risk factors
for CMDs in CYP?
Modern Predictors / Risk factors
• 'Timeless’ risk factors: Adverse Childhood Experiences, complex
environments, prenatal adversity, biology…

Problems in Recent Decades

CYP growing up in recent decades have seen rise

of social media, cyber bullying, increase in blue
light (smartphones), great recession 2008, growth
of family breakdown, growth of terrorism, student
debt, gaps in prosperity, academic / school
pressures, pandemic - all which can adversely
affect the MH of CYP, directly or indirectly
Modern Predictors / Risk factors
Kelly et al., 2018 – Social Media

• Aims: is social media use is associated with adolescents’ depressive symptoms, and
ii) investigates multiple potential explanatory pathways via online harassment,
sleep, self-esteem and body image.

• Methods: population-based data from the UK Millennium Cohort Study on 10,904

14-year-olds.

RESULTS:
• Greater social media use related to online harassment, poor sleep, low self-esteem
and poor body image; in turn these related to higher depressive symptom scores
• Effect especially strong in girls
Modern Risk Factors
 John, A., Glendenning, A. C.,
Marchant, A., Montgomery, P.,
Stewart, A., Wood, S., ... & Hawton,

Modern Predictors/ Risk Factors K. (2018). Self-harm, suicidal

behaviours, and cyberbullying in
children and young people:
Systematic review. Journal of
medical internet research, 20(4),
John et al., 2018 Meta analysis - Cyber Bullying e129.

A total of 33 eligible articles included, covering a population of 156,384 CYP

Negative influences between cybervictimization and self-harm or suicidal behaviours

or between perpetrating cyberbullying and suicidal behaviours

Victims were 2.35 times as likely to self-harm, 2.10 times as likely to exhibit suicidal
behaviours, 2.57 times more likely to attempt suicide, and 2.15 times more likely to
have suicidal thoughts

Perpetrators were 1.21 times more likely to exhibit suicidal behaviours and 1.23 times
more likely to experience suicidal ideation than non perpetrators
Risk Factors of Suicide in CYP

• Academic (especially exam) pressures [27%]

• Bullying [22%] Trigger warning –
• Bereavement [28%] this paper
• Suicide in family or friends [13%] discusses suicide
• Physical health conditions [36%] methods
• Family problems [34%]
• Social isolation or withdrawal [25%]
• Child abuse or neglect [15%]
• Excessive drinking [26%]
• Illicit drug use [29%]
BBC News-
Instagram helped kill my daughter
BBC NEWS

https://www.bbc.co.uk/news/av/uk-46966009

Molly Russel, 14, took her own life in 2017

Distressing content found on her Instagram history
Treatment
• Psychological therapies first line of treatment for
CYP

• Non-pharmacological treatment first: supported by

a considerable and growing evidence base and is
recommended by many evidence-based guidelines
for a broad range of disorders.

• Several disorders where it is now agreed that a

pharmacological approach can legitimately be
considered as a first-line treatment approach (not
CMDs):

Coghill, D. (2020). Pharmacological

• Attention deficit hyperactivity disorder Approaches in Child and Adolescent
(ADHD), bipolar disorder, and Mental Health. Mental Health and Illness of

schizophrenia Children and Adolescents, 1-31 .

Treatment
• A number of meta-analyses supports the effectiveness of psychological therapies for various
MH difficulties in CYP

• Some issues surrounding methodology

• Variations in therapy type

• Evidence for School’s based psychological interventions is lacking

• Digital interventions (apps, computer assisted therapy) may provide promising route, but
evidence of effectiveness currently inconclusive due to methodological issues

Coghill, D. (2020). Pharmacological Approaches in Child and Adolescent

Mental Health. Mental Health and Illness of Children and Adolescents, 1-
31.
Maternal & paternal MH

Perinatal mental illness
• Significant complication of pregnancy & postpartum period
Prenatal: Before the birth of the child
Perinatal: before and after the birth of a child
(during pregnancy + 1 year)
Postnatal/postpartum: After the birth of the
child

• Range from mild to severe

• Including: depression, anxiety, psychosis, mania

• Some disorders emerge during pregnancy, soon after childbirth, or

later

• Maternal mental illness complicates early parenting, and can affect

development of fetus

• 10% postpartum deaths from suicide, 12% from psychiatric causes

(accidental overdose, medical conditions related to substance use,
violent deaths)
Perinatal Anxiety Disorders
• Wide range: Generalised anxiety (GAD), Obsessive-
Compulsive (OCD), social anxiety, panic disorder

• Typically anxiety symptoms do not rise to severity of

diagnosis

• Major risk factor: History of anxiety

• After delivery rates of:

• GAD 6.1 – 7.7% O'Hara, M. W., &
• OCD 4% Wisner, K. L. (2014).
Perinatal mental
• Panic disorder 0.5 – 2.9% illness: definition,
• Social anxiety 0.2 – 6.5% description and
aetiology. Best practice
& research Clinical
obstetrics &
gynaecology, 28(1), 3-
12.
 Postpartum Depression (PPD)
• One of most common and disabling childbearing complications -
Often underdiagnosed & under treated

• Prevalence: 9 – 19%

• Shares same diagnostic criteria as Major Depressive Disorder

• Depressed mood, loss of interest, anhedonia, sleep disturbances,

appetite disturbances, feelings of guilt & worthlessness, suicidal
thoughts

Specifier: With peripartum onset

• Onset occurs during pregnancy or 4 weeks after delivery (clinically- 1 O'hara, M. W., & McCabe, J. E. (2013).
year) Postpartum depression: current status and
future directions. Annual review of clinical
psychology, 9, 379-407.
Postpartum Depression (PPD)
•Postpartum
PPD depression
symptoms may also include:

• Difficulty bonding with baby, or indifference

• Irritability
• Overwhelmed
• Suicidal thoughts (affecting 20% of women with PPD)
• Thoughts of harming child (no intention to act on it)
• Obsessional worries about baby’s health
Pathophysiology & Risk Factors
Complex pathophysiology - has bio-psycho-social elements
Environmental & Psychological Factors
• Adverse life experiences (childhood & adult)
• History of mental health difficulties
• Impaired infant-mother interactions
• Lack of social support
• Financial &/or marital stress
• Low socio-economic status/poverty
• Stress > increased risk of PPD > symptom severity
(Swendsen & Mazure, 2000)
• Women who experienced ALEs (e.g. sexual abuse) 3
times more like to develop PPD (Guintivano et al., 2018)
STRESS
Swendsen, J. D., & Mazure, C. M.
(2000). Life stress as a risk factor for
postpartum depression: Current
research and methodological
issues. Clinical Psychology: Science
and Practice, 7(1), 17-31.
Guintivano, J., Sullivan, P. F.,
Stuebe, A. M., Penders, T., Thorp,
J., Rubinow, D. R., & Meltzer-Brody,
S. (2018). Adverse life events,
psychiatric history, and biological
predictors of postpartum depression
in an ethnically diverse sample of
postpartum women. Psychological
medicine, 48(7), 1190-1200.
Pathophysiology & Risk Factors

Cognitive Behaviour Model (O’Hara et al., 1982)

Psychological vulnerabilities (e.g. negative attributional style) predict

depression symptoms following stressful live events such as childbirth

Past history of depression leaves people vulnerable to further

depression during postpartum period

Joint effects of depression vulnerability + stressful life events is

significant predictor of PPD diagnosis and severity
O'Hara, M. W., Rehm, L. P., &
Campbell, S. B. (1982). Predicting
depressive symptomatology:
cognitive-behavioral models and
postpartum depression. Journal of
abnormal psychology, 91(6), 457.
 Payne, J. L., & Maguire, J. (2019).
Pathophysiological mechanisms

Pathophysiology & Risk Factors implicated in postpartum

depression. Frontiers in
neuroendocrinology, 52, 165-180

Biological Factors
Pathophysiology & Risk

Hormone Withdrawal

• Dramatic decreases in ovarian steroid hormones (estradiol, progesterone, cortisol,

oxytocin, prolactin)

• Estradiol & progesterone modulate neurotransmitter systems, including serotonin &

dopamine

• All women experience these hormone shifts, but not all women experience
postpartum blues or PPD

• Sub-set of women who are vulnerable to mood-destabalazing effects

 Payne, J. L., & Maguire, J. (2019).
Pathophysiological mechanisms
implicated in postpartum
Pathophysiology & Risk Factors depression. Frontiers in
neuroendocrinology, 52, 165-180.

Stewart, D. E., & Vigod, S. N. (2019).

Pathophysiology & Risk Postpartum depression:
Genetic vulnerability pathophysiology, treatment, and
emerging therapeutics. Annual
Review of Medicine, 70, 183-196.
• Family & twin studies show that PPD clusters in families

• Genome wide association studies identified candidate genes

• E.g. Estrogen receptor alpha gene (role in mediating hormonal changes during
peripartum)

• Serotonin transporter gene (key hormone for mood, & bodily functions such as
eating, sleeping….) . Predictive of PDD when in combination with life events

• Epigenetic factors- change in gene expression via environmental influences

Payne, J. L., & Maguire, J. (2019). Pathophysiological
mechanisms implicated in postpartum
depression. Frontiers in neuroendocrinology, 52, 165-180
Pathophysiology & Risk Factors
Treatment Approaches
• Multidisciplinary approach required

• Medical & psychiatric problems addressed

• Psychological interventions, psychosocial strategies,

increased self-care, practical & emotional support

• If severe – pharmacology
 Molyneaux, E., Howard, L. M.,
McGeown, H. R., Karia, A. M., &
Trevillion, K. (2014).
Pharmacological Treatment Antidepressant treatment for
postnatal depression. Cochrane
Database of Systematic Reviews,
(9).
• For severe PPD antidepressant medication may be
prescribed

• Most commonly SSRIs (selective serotonin reuptake

inhibitors)

• Effective for symptom remission (compared to

placebo)

• Many studies limited by methodological quality

• Don’t appear to have effect on breast milk – but

evidence of long-term adverse effects are
inconclusive
Psychological Treatment
• Psychological treatments shown to have positive effects
Letourneau, N. L., Dennis, C. L., Cosic,
N., & Linder, J. (2017). The effect of
perinatal depression treatment for mothers
• Cognitive Behaviour Therapy, Interpersonal Therapy, counseling (listening on parenting and child development: A
systematic review. Depression and
visits), psychodynamic therapy anxiety, 34(10), 928-966.

• Typically brief (6 – 12 sessions) – variability in delivery and evaluation

 Psychosocial Support
• E.g. Peer support & non-directive counselling

• Provider has experiential knowledge of PPD

• Acceptable, & can reduce symptoms

• Can be delivered virtually

Stewart, D. E., & Vigod, S. N. (2019). Postpartum depression:

pathophysiology, treatment, and emerging therapeutics. Annual
Review of Medicine, 70, 183-196.
 Stewart, D. E., & Vigod, S. N. (2019).
Postpartum depression: pathophysiology,
treatment, and emerging therapeutics. Annual
Review of Medicine, 70, 183-196

Treatment Approaches
 Glasser, S., & Lerner-Geva, L.
(2019). Focus on fathers: paternal
depression in the perinatal

Paternal Perinatal Depression period. Perspectives in public

health, 139(4), 195-198.

• Approx. 10% Prevalence (high variability, reported rates higher in

USA)

• Risk factors: Maternal PPD (esp. early onset), history of mental

illness, relationship issues, socio-economic factors (younger age,
unemployment, education level)

• Hormonal changes: lower testosterone, cortisol changes

• Paternal PPD associated with children’s behavioural, emotional,

social functioning, & psychiatric disorders
Additional info
 Coming up!

Next – Drop-in and chat

(Tuesday 28th of February at 6pm UK time)
Thank you for listening ☺

Any questions?