the likelihood of depression. Researchers in England
have found that individualized postpartum care with
home visits by nurses significantly lowered the inci-
dence of postpartum depression (Boyles, 2002).
Borowsky, Ireland and Resnick (2001) studied
more than 13,000 adolescents in an attempt to iden-
tify factors that predicted future suicide attempts.
They suggest that promotion of protective factors
(those factors associated with a reduction in suicide
risk) would improve the mental health of adoles-
cents. The protective factors include close parent-
child relationships, academic achievement, family life
stability, and connectedness with peers and others
outside the family. Likewise, screening for early de-
tection of risk factors, such as family strife, parental
alcoholism or mental illness, history of fighting, and
access to weapons in the home, can lead to referral and
early intervention.
SELF-AWARENESS ISSUES
Nurses working with clients who are
depressed often empathize with them and begin also
to feel sad or agitated. They may unconsciously start
to avoid contact with these clients to escape such
feelings. The nurse must monitor his or her feelings
and reactions closely when dealing with clients with
depression to make sure he or she fulfills the re-
sponsibility to establish a therapeutic nurse–client
relationship.
People with depression are usually negative, pes-
simistic, and unable to generate new ideas easily. They
feel hopeless and incompetent. The nurse easily can
become consumed with suggesting ways to fix the prob-
lems. Most clients find some reason why the nurse’s
solutions will not work: “I have tried that,” “It would
never work,” “I don’t have the time to do that,” or “You
just don’t understand.” Rejection of suggestions can
make the nurse feel incompetent and question his or
her professional skill. Unless a client is suicidal or is
experiencing a crisis, the nurse does not try to solve
the client’s problems. Instead, the nurse uses thera-
peutic techniques to encourage clients to generate
their own solutions. Studies have shown that clients
tend to act on plans or solutions they generate rather
than those that others offer (Schultz & Videbeck,
2002). Finding and acting on their own solutions gives
clients renewed competence and self-worth.
Working with clients who are manic can be ex-
hausting. They are so hyperactive that the nurse may
feel spent or tired after caring for them. The nurse
may feel frustrated because these clients engage in
the same behaviors repeatedly, such as intrusiveness
with others,undressing, singing, rhyming, and danc-
ing. It takes hard work to remain patient and calm
with the manic client, but it is essential for the
nurse to provide limits and redirection in a calm
manner until the client can control his or her own
behavior independently.
Some health care professionals consider suicidal
people to be failures, immoral, or unworthy of care.
These negative attitudes may result from several fac-
tors. They may reflect society’s negative view of sui-
cide: many states still have laws against suicide al-
though they rarely enforce these laws. Health care
professionals may feel inadequate and anxious deal-
ing with suicidal clients, or they may be uncomfort-
able about their own mortality. Many people have
had thoughts about “ending it all,” even if for a fleet-
ing moment when life is not going well. The scariness
of remembering such flirtations with suicide causes
anxiety. If this anxiety is not resolved, the staff per-
son can demonstrate avoidance, demeaning behav-
ior, and superiority to suicidal clients. Therefore, to
be effective the nurse must be aware of his or her own
feelings and beliefs about suicide.Points to Consider When Working
With Clients With Mood Disorders- Remember that clients with mania may
seem happy, but they are suffering inside. - For clients with mania, delay client teaching
until the acute manic phase is resolving. - Schedule specific short periods with depressed
or agitated clients to eliminate unconscious
avoidance of them. - Do not try to fix a client’s problems. Use
therapeutic techniques to help him or her
find solutions. - Use a journal to deal with frustration, anger,
or personal needs. - If a particular client’s care is troubling, talk
with another professional about the plan of
care, how it is being carried out, and how it
is working.
➤ KEY POINTS
- Studies have found a genetic component to
mood disorders. The incidence of depression
is up to three times greater in first-degree
relatives of people with diagnosed depres-
sion. People with bipolar disorder usually
have a blood relative with bipolar disorder. - Only 9% of people with mood disorders ex-
hibit psychosis. - Major depression is a mood disorder that
robs the person of joy, self-esteem, and
energy. It interferes with relationships and
occupational productivity. - Symptoms of depression include sadness, dis-
interest in previously pleasurable activities,
15 MOODDISORDERS ANDSUICIDE 367