Question 1. Prevalence/ Incidence of Depression and Suicide in Australia
Depression is common in Australia with over 1 million adults in the country experiencing the condition every year. If left unattended, depression may profoundly lead to suicidal behaviors and even result to individuals committing suicide and hence the need to address the symptoms. The incidence and prevalence of suicide and depression vary with factors such as age, gender
On average at least one in every eight men while one in five women and one in six people in Australia experience depression at one phase in their lives. Statistics indicate that between 10 to 15 percent of seniors experience depression (ABS, 2015). The depression rates for the aged that live within the residential aged-care facilities are bound to be higher with statistics indicating that they may are between 34% to 45%. Among the young people, depression is a significant mental health issue that faces the age group. At least one in every four Australian youths aged between 16 to 24 experiences a mental health problem significantly being depression (DoHA, 2013). Depression is, however, highly treatable and the sooner an individual is treated the sooner that they recover from the illness that increases the risk to other conditions such as Anxiety and also suicide.
Australian Bureau of Statistics (ABS), in 2014, states that 75% of the people that died from suicide were the males while the females had a 25% rate of suicide (ABS, 2015). The statistics further indicates that the incidence of suicide in the country is at 1.9% of all the deaths reported in the country. Among the men, 2.8% of deaths are attributed to suicide while among the females 0.9% of all deaths are suicide related (ABS, 2015).
Specific risk of groups
Every year there are over 157,000 people that are homeless in Canada (Munn-Rivard, 2014). Those that remain homeless for more than three months leading to chronic homelessness, there is an increased level of depression, substance use and also suicide. There are higher rates of reported suicidal thoughts and also actual suicides among the homeless than the nonhomeless. Studies indicate that 30 to 35% of homeless individuals have a mental illness. There are also indications of up to 75% of specifically homeless women having a mental illness mostly depression being the first indication (Munn-Rivard, 2014). A study carried out by the Public Health Agency of Canada; it indicated that 12% of males aged 15 to 24 and 19% of females aged 15 to 24 report experiencing suicidal thoughts at a point in their life. It further indicated that 2% of males and 6% of females aged 15 to 24, reported ever having attempted suicide (Munn-Rivard, 2014).
Depression among the aboriginals in Canada is twice the rate experienced by the rest of Canadians. A survey by The First Nations Regional Longitudinal Health Survey conducted in 2002/03, indicated that 25.7% of First Nations men and 34.5% of women living on reserves re-counted they either felt depressed or sad for two weeks or more in previous one year (National Aboriginal Health Organization [NAHO], 2012). Up to 16% of aboriginals as compared to the 8% of the rest of the populace in the country experience chronic depression among the adults (Khan, 2016). It is this that has resulted to even higher rate in suicide rates among the natives of the country. The suicide rates are highest among the males and are even higher among the youths between the ages of 15 to 24 years (Khan, 2016). Females attempt suicide more than the females among the aboriginals as is the case with the rest of the Canadian populace. The suicide attempt rate among the aboriginals is reported at 19% among the females and 13% among the males (Khan, 2016).
Hospitalization and Recovery
In 1998, 3.8 % of all hospital admissions were as a result of depression cases and also other related conditions such as suicide attempts and anxiety disorders (Smetanin, 2011). The majority of the hospitalizations as a result of suicide attempts are higher among the females in Canada more than the males. It is because; more females attempt suicide than the males. The males have higher rates of completed suicides and hence are not hospitalized (Smetanin, 2011). In Canada, the age standardization rate for females hospitalization as a result of suicide attempts is at 108 per 100,000 females in Canada for those older than ten years old. The males ratio was at 70 for every 100,000 males (Smetanin, 2011). The rate of hospitalization for females aged between 15 to 19 is very high. The girls of the age group have twice higher the chances of attempting suicide than their male counterparts. Out of all the hospitalizations as a result of suicide attempts, only 2% of such patients die. Over 98 % of such hospitalization, cases lead to recovery (Smetanin, 2011).
Question 2: factors leading to the client’s presentation of mental health concerns and risks
Depression may not result from a single event or risk factor but may be a product of cumulative risk factors. The two principal causes of the mental health issues facing Edward are:
Research into depression and another mental health distresses indicate that the continued experiencing difficulties over an extended period in a person’s life may significantly lead to the mental health issues (Thapar et. al., 2012). Edward as an individual that had been going through trauma and also effects of his life. Since the moment that he left his mother country and went to Australia, he is an individual that lived on the edge with so many unplanned changes occurring in his life. It started when he moved from Malta with no intention of staying for long in Australia, but he soon settled in Australia, he missed his home country which was an indication of some form of stress. Later his father died, but because he could not afford to travel, he did not even go home to pay his last respects and attend the burial. He carried the guilt and also has indications of having not moved on from the loss that he experienced. Having further not attended his mother’s funeral later, it is a show that he relieved the pain that he suffered for having not buried his father. He continues to raise his two sons on the farm but later experiences a double loss. He loses his son Thomas to suicide and his other son Colin moving away and not wanting anything to do with the farm that he so much hopes that one of his sons would take over from him, he totally experiences distress. He has lost the energy typo continues working on the farm and even the farm that he had worked so hard to buy and keep is on the verge of being lost since he and his wife cannot maintain and keep it moving. It the losses and disappointments in his life that resulted in feelings of hopelessness and despair to the extent of considering suicide.
Edward is an individual that is not able to let go of the past or rather work past previous, disappointments, losses and has also not been able to grief in the right way right from the loss of his parents to his son. He holds on to the pain and also the guilty of not attending his father’s burial and is also lonely in some way since he is far away from his other siblings. According to American Psychiatric Association. (2013) age may be a risk factor and therefore, Edward at the age of 62, is predisposed to more risk factors to depression, and it is this that further results to mental health problems that he is facing. His personality of self-criticisms, holding on guilt and also worrying a lot is what lead to the mental health distress he is facing.
Question 3. Ethical and legal issues related to the scenario
As a nurse/ midwife, one is obliged to respect the client’s autonomy which is a very fundamental ethical principle. It is imperative that as a nurse or midwife, one not to in any case influence the decision or the way of thinking of Edward as the client but should only offer the guidance and then leave it to him to make the independent decision (McDonald, & Then, 2014). The ethical principle dictates that one provides the right information to him and then let him make the decision even on the possible treatment plan and also that they are expected to engage in and then let them accept or disagree. However, in the case of depression and also the suicidal tendencies as is the case with Edward, the patient may be incapacitated to make sound decisions since it may tamper with the decision-making processes and also their ability to make the right choices. If Edward turns out to be a hostile patient that is not willing to go through with the required treatment plan, it may present a challenge to the nurse/ midwife who may feel as though they know what is best for Edward and hence present an ethical issue of wanting to influence him to accept the treatment.
The nurse/ midwife has a duty to protect the client while at the same time upholding the ethical principle of autonomy and also confidentiality of the patient (McDonald, & Then, 2014). However, since Edward is a patient that presents some symptoms and also indications of suicidal thoughts, the nurse may be a dilemma at what point they are supposed to turn him in if he poses a threat to himself or others. It presents a legal issue in that if the nurse exposes the condition that Edward is at without being sure that he may commit harm to either himself or others, they may face legal consequences. It is also a requirement of the law that the practitioner notifies the authorities if they prove beyond doubt that the patient is bound to harm him or others. Therefore, if the nurse failed to notify the authorities of the fact that Edward had suicidal thoughts, then he hurts himself while still going through treatment, then some legal actions may be taken against them. On the other hand exposing such information without the consent of Edward may be unethical, and hence Edward and his family may take legal action against a nurse that reveals information about his condition if they prove that they were not about to cause harm to themselves or others.
Question 4. Nursing/ Midwifery needs and concerns for the client
The significant nursing/ midwifery concern is the potential for Edward to commit suicide. Edward is has suicidal thoughts that are a source of concern even though he is yet to think about the method to use to end his life. He is thinking of suicide because he feels guilty for many things including his failure to attend his father’s burial and also the death of his son. He is also highly feeling isolated and also since his family is far away in his home country and also the loss of his son and the departure of the other to Sydney. He feels as though he has lost his entire world since he has lost his children one to death while the other has fled the farm with no plans of returning. Furthermore, the farm’s condition is fast deteriorating as they are unable to keep it running as it used to run in the past and they even have to lay off their employees remaining with only one. He feels that soon after losing his family; he has now lost his livelihood, and it is these feelings of loss and desperation that make him feel the need to end them through suicide. The situation is made worse by the fact that he lost his son through suicide which makes the suicidal ideation real to him as well.
Another significant midwifery, nursing concern is Insomnia that he is experiencing. Edward is experiencing the loss of sleep as his sleeping patterns have changed and he reports being unable to sleep well any longer. It is a symptom indicating depression but also poses a threat to the proper functioning of his body which may lead to risks of developing other physiological issues. Insomnia is a major concern to the nurse/ midwife since it may result in slower recovery and also may result in the development of other complications that may further complicate and worsen the condition that he is experiencing. He reports having begun losing sleep for over six months which as triggered by the death of his son.
Question 5. Interventions to the nursing/midwifery concerns
Interventions to suicidal thoughts
• Building interpersonal relations for Edward (Ellis et al., 2012). It can be achieved through engaging the family members including his mother and possibly his son in Sydney to participate with him so as to make him feel accepted, wanted and also that there is still some people to inspire him to remain alive. It is also important that as the nurse, I create a good rapport with him to offer emotional, social and psychological support that is necessary to make him feel that he is no longer alone.
• Creating awareness and also educating Edward about the issues he is going through. It is imperative that Edward understands that he is going through a depressive moment in his life and that he is not alone. Getting the information will help him understand and have a grip on the feelings and impulses he is experiencing that he may not be in a position to comprehend on his own. Getting the information may also help him realize that there have been others that have gone through the same losses and also experiences and came up strong and better and that there is still hope for him (Ellis et al., 2012).
Interventions to insomnia
• Adopting Cognitive behavioral therapy (CBT) (Mayoclinic.org., 2016). Edward is not able to sleep due to the emotional and psychological distress that he is undergoing as an individual as a result of the depressive state that he is experiencing. It is, therefore, imperative that as a nurse, takes the nurse through a process of encouraging him to go through realistic and also positive thought processes that may ease up on the emotional pain he may be experiencing hence resulting to better sleeping.
• Encouraging Edward to have regular and proper sleeping patterns. It is imperative that Edward adopts healthy sleeping habits such as going to bed the same time and also leaving bed the same time in the morning so as to ensure that he can establish a pattern of sleep (Ellis et al., 2012). He should also be advised to avoid taking late dinners and also to avoid caffeine hours before going to bed which may further increase the sleeplessness that he may experience. As a nurse changing the perception of sleep for Edward to perceive it as an a opportunity to relax may also help at easing his mind that may be preoccupied with negative thoughts overnight that may be keeping him awake.