Epidemiology+Paper

0. Executive Summary (JEFF)
Please develop an executive summary that includes your key findings and specific conclusions, not only a generic description

1. Distribution Patterns and Trends- (JEFF)
Describe the patterns and trends of its distribution in the world, the USA, Florida and Central Florida (including your county and UCF if information is available)

For some, depression is a disease that lacks credibility because it lacks cellular form and structure. Yet, the World Health Organization (WHO) said depression was //__the leading cause of disability worldwide__//. Moreover, according to WHO, the majority of people with depression do not receive even nominally adequate treatment (Pratt, 2008, NCHS Data Brief). For a disease without cellular form or structure, those two statements are astonishing. The epidemiological implications are indisputable.

Typically, depression is indicated by changes in mood; variation in sleep, appetite, and energy levels; diminished levels of daily functioning, devaluation of self-worth, and a contraction of cognitive functioning. CDC research shows depression can produce short-term disability, escalating work absenteeism, and falling productivity. Studies have shown that an important epidemiological consideration concerning depression is the high comorbid correlation between depression and poor health. Depression can adversely affect the outcome of chronic conditions such as arthritis, asthma, cardiovascular disease, cancer diabetes, and obesity. Impaired functioning is commonplace even though not all the requirements for a diagnosis of depression may have been satisfied (CDC, An estimated 1 in 10, n.d.).

In the United States, the prevalence of depression is alarming. The CDC estimates that one adult in ten is affected with depression. To calculate the prevalence of people currently experiencing depression, the CDC analyzed Behavior Risk Factor Surveillance System (BRFSS) survey data from two survey years – 2006 and 2008. “Current” depression is defined as having depressive symptoms during the prior two weeks consistent with the //Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition, (DSM-IV)// Patient Health Questionnaire 8 (PHQ-8). Individuals are considered to have depression if they report meeting at least five of the eight criteria for depression for more than half of the preceding two weeks (CDC, An estimated 1 in 10, n.d.).

Based on Behavioral Risk Factor Surveillance System (BRFSS) data, the CDC reported in //Morbidity and Mortality Weekly Report// (CDC, MMWR, October 1, 2010) that the prevalence of depression is significantly higher in certain socio-demographic groups. For example, persons age 45 to 64 are more likely to meet the criteria for depression; women, blacks, Hispanics, persons with less than a high school education, those previously married, those unemployed or unable to work, and those without health insurance are more likely to meet the criteria for depression (CDC, MMWR, 2010). Researchers Kurt Kronke, Tara Strine, et al, writing in the //Journal of Affective Disorders//, concluded that the PHQ-8 was an exceptionally valid tool for determining rates of depression. Kronke’s research found that the sensitivity (respondents who were depressed and tested positively for depression) was calculated at 88%. PHQ-8 is a statistically valid screening tool for depression.

The 2006 and 2008 BRFSS data analysis was age-standardized to the 2000 United States standard population data. Approximately 7.9% of men and 10.1% of women respondents meet the criteria for depression. Approximately 21.3% of the unemployed and 39.1% of the unable to work respondents meet the criteria for depression, whereas only 6.4% of employed respondents meet the criteria for depression. Approximately 17.1% of respondents without a high school diploma meet the criteria for depression, whereas only 6.6% of respondents with some college meet the criteria for depression. Approximately 14.9% of respondents without health insurance meet the criteria for depression, compared to 7.9% of depressed respondents who maintained health insurance. Approximately 11.6% of previously married respondents meet the criteria for depression, compared to 6.5% of married respondents who are currently depressed. Age groups showed wide disparity of depression: age 18 to 24 – 10.9%; age 25 to 34 – 9.1%; age 35 to 44 – 8.6%: age 45 to 64 – 10.0%; ≥ 65 – 6.8% (CDC, MMWR, October 1, 2010).

The Community Health Assessment Resource Tool Set (CHARTS) provides a county-by-county depression prevalence survey based on BRFSS data. The 2007 Orange County rate of depression is 17.7% compared to the Florida statewide rate of depression of 14.2%. Particularly significant is the 29.0% rate of depression in people over the age 65 in Orange County compared to Florida statewide rate of depression of 19.6% in people over the age of 65. Income also affected prevalence of depression. The rate of depression in a low income (<$25,000) population is 23.4% compared to the rate of just 8.8% for Orange County residents whose income is greater than $50,000 ([|floridacharts.com/charts/],n.d.).

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**2. Risk Factors- (CAITLIN)** Mental health illnesses can be attributed to a number of risk factors that vary greatly among individuals. Depression is when an individual displays prolonged symptoms of the illness for at least two weeks. Typically, when five or more symptoms are prevalent an individual can be characterized as depressed (Smith, Saisan, & Segal, 2011). Symptoms can include fluctuationin weight, agitation, loss of interest in activities once enjoyed, and thoughts of death and/or suicide (Smith, et al., 2011). Individuals who experience more than one risk factor stand a greater chance of developing depression (Scholten, 2010). This chance increases each time an individual has another risk factor. The first mentionable risk factor is smoking. Smoking has been attributed to a higher prevalence rate of depression. Individuals who smoke are 10% more likely to be at an elevated risk of developing depression (Smith, et al., 2011). Further, individuals that have depression have less of a chance of smoking cessation. The next risk factor associated with an increased chance of developing depression is alcohol consumption. Alcohol consumption can lead to a multitude of other problematic issues but depression is one illness that is often associated with drinking. Alcohol acts as a depressant to the brain and is very likely to worsen depression symptoms in individuals who already display those symptoms. The consumption of alcohol, whether in large quantities or not alters the mind and can put an individual at a greater risk for suicidal thoughts and actions (Smith, et al., 2011). Statistically, women are twice as likely to develop depression than men (Scholten, 2010). Women have an elevated risk of depression due to hormones. Women themselves are at a higher risk of depression during periods of time associated with menstruation (Scholten, 2010). Women often experience an increased sensitivity that results in postpartum depression, feelings of guilt, weight loss or gain, and prolonged depressive states (Smith, et al., 2011). Due to the negative connotation that depression often has, the illness tends to affect men differently. Although men are not as likely to be depressed they are at a greater risk for the chance of suicide (Smith, et al., 2011). Men are more likely to exhibit signs of anger, frustration, or reckless behavior (Smith, et al., 2011). The combination of these three characteristics represents a risk factor for depression in men. Stress is a large risk factor associate with depression. Stress is not unique to any one subset of individuals within society. Different socioeconomic classes display different types of stress. For example, these stressors can be financial in nature, associated with personal life issues, or attributed to a multitude of other things. Stress is a common denominator for problems with depression. The incidence of depression and stress can be a co-morbidity to many other health problems. Individuals that are not as economically well off as others have a risk factor for depression. Those in low socioeconomic groups are at an increased risk due to the association of a low social status, increased stress in daily life, and cultural factors (Scholten, 2011). These individuals also experience more financial problems living in a lower social class. Family history is another risk factor that plays a role in depression. Individuals with a family history of mental health issues or mood disorders are at a higher risk of developing depression than those without it in their family history (Scholten, 2011). Also, individuals who have sleep problems have a risk for developing depression. Those who experience sleep disturbances throughout their life span report higher prevalence rates of depression (Scholten, 2011). Individuals who do not seek treatment for sleep disturbances not long have a greater chance of depression but also run the risk of depression becoming a chronic disease. Physical inactivity highly correlates with obesity. Obesity is a risk factor for depression as well, but it is considered a modifiable risk factor. A modifiable risk factor is a risk factor in which an individual has the ability to change. For example, weight or diet are items that an individual can alter to reduce their risk of certain diseases (Scholten, 2011).

3. Preventive Strategies- (SASHA)
Evaluate preventive strategies or efforts (also make reference to Central Florida, your county and UCF if applicable)

The healthcare industry has studied many illnesses and has been able to conduct research identifying preventative strategies. Unfortunately, depression is a disease that exists in our populations (Rogge and Zieve, 2008). The key factor in preventing depression is receiving medical attention at the earliest stage possible in order to take action right away. Today there are preventative strategies being practiced directly at home, in schools, and in the place of employment. In order to prevent depression one of the first steps an individual needs to take is to control stress. When a person feels under stress it is important to avoid drugs and alcohol, find social support, and take steps to take care of their health (Center for Disease Control and Prevention, 2011). According to the Community Partner in Care (2011) two additional steps that could be taken to prevent depression are: planning ahead for major life changes (i.e. retirement or moving) and regular exercise including walking, gardening or dancing. An individual suffering from stress often has the impression that drugs and alcohol can help with the feeling of depression; however, they must realize that this is a temporary relief being provided by the affects of the substances and must rely on the alternative activities named above. Reliance of these substances will only lead to future problems and possible addictions (Center for Disease Control and Prevention, 2011). Finding social support is a proactive approach to controlling stress. Depression-Elderly in the New York Times identifies social support as "group outings, volunteer work, or having regular visitors” and presents the importance of "talking through problems (psychotherapy) with a psychologist, psychiatrist, or other therapist" (Rogge and Zieve, 2008). Preventing depression in schools, such as Universities, takes an effort both on the student, their family and the staff. Burnsed (2010) shares that the most common time for students in college to encounter signs of depression is during their freshman year, while experiencing homesickness and going through their first college level final examinations. In a study released by the American College Health Association in the spring of 2010 showed that 6.2 percent of college students thought of committing suicide and 1.3 percent actually attempted it (Burnsed, 2010). Students that are beginning to feel depression usually have the usual symptoms of being sad, hopeless, and increased level of crying and substance usage. A student can take three steps to prevent falling into depression while in school, especially during their first year: 1) being social and networking; 2) using counseling services; and 3) using technology (Burnsed, 2010). At the University of Central Florida students can take advantage of several resources: 1) Join some of the 350 clubs and organizations; 2) utilize the free counseling center; 3) and communicate with family by using technology found in computer labs throughout the campus (University of Central Florida, 2011). An employee’s state of depression could affect their level of disability, attendance, alertness, and productivity in the work place. According to CDC, workplace health programs should have metrics for an employee’s productivity, the cost of healthcare, the outcome of the services received, and organizational change. The measurements are not always easily collected, but categories that relate to the population of the company should be studied through employee group assessments (Workplace Health Promotion, 2011). Employees can be offered programs to enhance their coping and stress management skills. This could be achieved through providing workshops or group interventions within the office staff. Having internal clinics conducting surveys and screening caters to employees who need evaluation and assists in the early detection of depression. Employers can also provide literacy on work-life balance to prevent stress. These methods provided by employers will increase employee moral and prevent depression from triggering from the workplace (Challenges and Opportunities, 2008). Overall, depression could be prevented by following methods in the home, school, or workplace. On a national level the CDC, utilizes the Behavioral Risk Factor Surveillance System (BRFSS) to conduct a telephone survey identifying “emerging health problems, establish and track health objectives, and develop and evaluate public health policies and programs” (BRFSS, 2011). Individuals should also be aware of the services that are available in their state. For example, in Florida the Florida Department of Children and Families is a family-driven system that provides prevention or "Help Promote Hope" for suicide prevention (American Foundation of Suicide Prevention, 2011). Addressing the issue of depression at an early stage will prevent a person from falling into chronic depression or a relapse, both having preventative methods readily available.

American Foundation of Suicide Prevention. (2011). Retrieved from http://www.afsp.org Behavioral Risk Factor Surveillance System. (2011). Retrieved on July 8, 2011 from http://www.cdc.gov/brfss/index.htm Burnsed, B. (2010). 5 Tips to Avoid Depression in College. US News: EducationI. Retrieved from http://www.usnews.com/education/articles/2010/11/19/5-tips-to-avoid-depression-in-college Centers for Disease Control and Prevention. (2011). Coping With Stress. Retrieved from http://www.cdc.gov/violenceprevention/pub/coping_with_stress_tips.html Centers for Disease Control and Prevention. (2011). Workplace Health. Retrieved from http://www.cdc.gov/violenceprevention/pub/coping_with_stress_tips.html Challenges and opportunities for preventing depression in the workplace. Journal of Occupational and Environmental Medicine, 50 (4):411-27. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18404014 Preventing Depression. (2011). Community Partners in Care. Retrieved from http://www.communitypartnersincare.org/depression/preventing-depression/ Rogge and Zieve. (2008). Depression-Elderly. The New York Times. Retrieved from http://health.nytimes.com/health/guides/disease/depression-elderly/overview.html University of Central Florida. (2011). Retrieved from http://www.ucf.edu.

4. Public Health Interventions- (SASHA, CAITLIN)
In healthcare, administrator and executives "work collaboratively with communities to create environments that promote health and prevent disease and disability" (Public Health Nursing, 2011). The Intervention Wheel (see Appendix B) illustrates the methods of Public Health Interventions used throughout many different levels of practice. The model introduces 17 Public Health Interventions such as outreach, screening, counseling, and consultation (Strohschein and Margitan, 2006). In Public Health Nursing, the Wisconsin Department of Health Services also defines the importance of public health. Administrators throughout the field develop interventions for five principal reasons: 1) prevention of injury and illness; 2) creating a healthy environment; 3) promote mental health; 4) assist communities in recovery; and 5) ensure high quality health service is available for patients (Public Health Nursing, 2011). Providing services that are built on these five principals will ensure programs are developed to assist the young, adults, and elderly of our communities. Public Health Interventions with Definitions (2001) provides detailed information on each intervention listed in the Intervention Wheel. For example, an outreach program focuses on a population that is interested in depression or a population that is at high risk of depression (i.e. the elderly). This program would provide information about the nature of depression, prevention methods, and where services could be obtained. Administrators can also incorporate depression screenings in their facilities. This screening allows patients with unclear risk factors to be identified and begin necessary services; as mentioned earlier, the Patient Health Questionnaire 8 could be utilized. In addition to screening and outreach public health interventions also includes direct contact with patients through counseling and consultation. Counseling enhances a person’s self-care and coping levels. Counseling develops “an interpersonal relationship with a community, a system, family or individual” (Public Health Intervention with Definitions, 2001). On the other hand, consultation provides the patient with a variety of solution options. This method allows patients to choose the treatment that is best suited for their state of depression (Public Health Intervention with Definitions, 2001).

The state of Florida utilizes a suicide hotline number as a resource for those coping with depression. The information is easily accessible online and broken down into different service areas. For example, LifeLine of Central Florida services Orange, Osceola and Seminole counties (Florida Suicide & Crisis Hotline, 2005). This help line is 24 hours a day and seven days a week in order to always be able to provide assistance with suicidal thoughts that an individual within the community might be experiencing. The suicide intervention website for Florida also offers text help for individuals who have not yet called in. The text on their website offers encouragement to live and to seek help.

The Total Life Counseling Center (TLC) serves individuals in the Central Florida area. TLC provides group and individual counseling sessions to members of the community. TLC also strives to educate individuals, especially those who are undiagnosed (Total Life Counseling Center, 2011). Most individuals in the community do not seek out the treatment that they need, TLC is an organization that puts much of their effort into urging individuals to seek treatment if they show symptoms of depression (Total Life Counseling Center, 2011). TLC has office locations in Waterford Lakes to service East Orlando near the UCF community and in Winter Park, FL (Total Life Counseling Center, 2011).

TMS Centers for Florida located in Lakeland, FL offers treatment for depressive disorders. They use Transcranial Magnetic Stimulation (TMS) as an aid for therapy. TMS is a noninvasive therapy that depolarizes neurons in the brain by using electromagnetic induction to produce electric currents that cause a change in the magnetic field. This type of therapy allows for different functions to be studied along with the interconnections that occur in the brain. TMS services the Central Florida community by being easily accessible. TMS works more with treatment intervention than crisis intervention (TMS Centers of Florida, 2011). The University of Central Florida houses its own counseling center to aid students in many areas of care. The counseling center has its own website online as a way for students to have easy access to their resources. On the website students are able to schedule appointments and find out more information about their services. The counseling center offers help with depression and those who have had suicidal thoughts. The counseling center offers a safe and confidential place for students to access the help they need if dealing depression, among other things. UCF also offers counseling sessions to those who do not have issues with depression but might know someone who is. Depression is responsible for the second highest reason for death among college students (University of Central Florida Counseling Center, 2011). UCF offers a suicide-training program for students looking to be proactive if a suicide situation should occur with a friend or loved one. The suicide training class is designed to educate individuals as to what actions can be taken to prevent suicide. The presentation is only one hour but educates individuals on the risk factors, symptoms of suicide, and intervention tactics in order to possibly save a life (University of Central Florida Counseling Center, 2011) .

Resources: Public Health Nursing: The Intervention Wheel. (2011). Wisconsin Department of Health Services. Retrieved on July 12, 2011 from http://www.dhs.wisconsin.gov Strohschein, S. and Margitan, M. (2006). Wheel of Public Health Interventions. Retrieved on July 11, 2011 from http://www.health.state.mn.us Public Health Interventions with Definitions. (2001). Minnesota Department of Health Section of Public Health Nursing. Retrieved on July 12, 2011 from http://www.health.state.mn.us/divs/cfh/ophp/resources/docs/phinterventions_definitions.pdf

Total Life Counseling Center. (2011). //Depression//. Retrieved July 9, 2011 from Total Life Counseling Center Web Site: [].

Florida Suicide & Crisis Hotlines. (2005). Retrieved June 29, 2011 from http://suicidehotlines.com/florida.html. TMS Centers of Florida. (2011). Retrieved July 1, 2011 from TMS Centers of Florida Web Site: []

University of Central Florida Counseling Center. (2011). Retrieved July 2, 2011 from UCF Web Site: http://counseling.sdes.ucf.edu/qpr.

5. References
Use APA style for all your references; when they are Internet links please link to the specific reference, not on the general webpage. Make parenthetical citations in APA style for all your references and do not use URLs in the text; do not include references that are not cited in your paper. Please consult the guide that has been provided for APA references in the main page of WebCourses under "Epidemiology Paper". Note that in the Wiki you can use Hyperlinks to your references also or include graphics or videos, but in your paper include all those extra resources if necessary in the appendixes.

Centers for Disease Control and Prevention. (2010). Current depression among adults - united states, 2006 and 2008. //Morbidity and Mortality Weekly Report (MMWR)//. Vol. 59/No. 38. October 1, 2010.

Centers for Disease Control and Prevention. (n.d.) An estimated 1 in 10 u.s. adults report depression. Retrieved on June 30, 2011 from http: [|www.cdc.gov.ezproxy.lib.ucf.edu/Features]

Florida CHARTS (//Community Health Assessment Resource Tool Set//). (n.d.). Adults whose poor physical or mental health kept them from doing usual activities on 14 or more of the past 30 days. Retrieved July 7, 2011 from [].

Pratt, L.A., Brody, D.J., (2008). Depresssion in the united states population, 2005-2007.//Center for Disease Control//. NCHS Data Brief, No.7, September 2008.

6. Appendixes (SASHA, CAITLIN)
Your first appendix should be a two-page justification of the benefits and synergy of your team containing also a detailed description of the sections and contributions of each one of the students to the paper.

Group work can often pose a challenge for those with busy schedules and prior obligations, especially at the graduate level. Our group knew that going into the project that scheduling would be one of our challenges. By determining a preset schedule we were able to have a better idea of what days we needed to meet in person so that each of our schedules could be arranged enough in advanced. Our schedule had to be adjusted often and meetings updated as needed. Our group worked very well together to ensure that meetings took place face-to-face. We were all willing to accommodate the complexity of each other’s schedules. Our group was fortunate enough that each of our members brought individual strengths to the group. These individual strengths complemented each other very well; because of our complementing strengths we were able to produce a stronger final project. Sasha’s biggest strength that she brought to the project was resourcefulness. Sasha provided several links to key information websites on depression. Caitlin brought to the group a high degree of organization. Jeff brought to the group an ability to find supplemental research that included statistics to make our paper stronger**.** We each had individual responsibilities but worked with each other to complete the final paper. We went through the final paper together and edited it to make it one seamless project. Our main goal was to make all three of our writing styles come together to form one complete cohesive project. Jeff and Caitlin had met after the first week of class to discuss the Epidemiology paper and plan an action course on how best to proceed. Shortly after that our group was expanded with the addition of Sasha. We were able to quickly change our plan of attack to accommodate Sasha. One of the ways we were able to accommodate was by switching the locations that we met at. We frequently met at the Panera Bread in Winter Park, closer to where Jeff lived and to where Caitlin worked. The next meeting took place at a Panera Bread closer to UCF so that Sasha would not have to make the drive out to Winter Park. The biggest asset that our team had was flexibility and the willingness to accommodate each other. We communicated effectively through email in Webcourses, phone conversations, face-to-face meetings and through our Wiki. Learning and adapting to Wiki was challenging at first, as Sasha and Caitlin had never been exposed to it. One of our first team meetings was to establish how the information needed to be set up in Wiki in order to meet the criteria as established by Dr. Driscoll. As the semester progressed we became more efficient with Wiki and utilizing the discussion board in Wiki. We took turns summarizing our group meetings and posting those updates into the Webcourses discussion board. We distributed each of the main sections up in order to keep the paper organized. At the end of the project we reviewed the document in its entirety to ensure that it was one seamless paper. Jeff’s main responsibilities included the executive summary, section one of the paper and providing supplemental graphs as needed for the appendix. Jeff had the responsibility of researching information on depression in order to complete section one. Section one covered the patterns and trends associated with depression. Jeff had to put a lot of focus into the data in order to find trends that were applicable. He was able to state and compare depression trends across the US, Florida and Central Florida. Sasha’s main responsibilities included section three and a portion of section four of the paper. Sasha and Caitlin had to work together to complete section four. Caitlin and Sasha were able to work as individuals to research information for section four. After both of them completed their research they worked together to mesh their individual work into one cohesive section. Sasha was also in charge of implementing supplemental information in the appendix. Sasha was able to research information on depression to find applicable preventive strategies in place for depression. Sasha was able to focus her efforts into providing relative information regarding preventive strategies in each of the different communities. Sasha was able to differentiate between the different preventative strategies and establish what is being done in our local community. Caitlin’s primary responsibilities included completion of section two, co-writing section four with Sasha and completing the team synergy. Caitlin had to research different risk factors associated with depression and narrow the information down to the most relevant risk factors. As referenced above, Caitlin and Sasha worked together to complete the public health intervention portion of the paper. Caitlin focused on the health interventions that were specific to Florida, Central Florida and to the UCF community.

You can include as appendixes any other graphics or documents that support your paper discussion.

The appendixes do not count in the 10-page limit of the document in word. All the appendixes that you include in here in the Wiki, do not have to be transferred to your final Word paper, only those that you think are of critical importance to understand your paper.