1. Shades of Blue Grief and Depression in Chronic Illness Ramita Bonadonna, PhD, RN

2. Grief Is a normal emotional response to a loss of someone/something valued Is a normal emotional response to a loss of someone/something valued A person living with IPF has experienced many losses A person living with IPF has experienced many losses –“Healthy” self-image: medical care becomes central –Decreased ability to engage in physical, social activities –Altered social, economic status

3. Grief can look like Anger, irritability, impatience Anger, irritability, impatience Sadness, tearfulness Sadness, tearfulness Exhaustion, fatigue, heaviness Exhaustion, fatigue, heaviness Poor concentration/memory Poor concentration/memory Yearning for what has been lost, preoccupation with past Yearning for what has been lost, preoccupation with past

4. Grief can become complicated Absence of any emotion may indicate delayed grief response Absence of any emotion may indicate delayed grief response Depression is one type of “distorted” grief reaction Depression is one type of “distorted” grief reaction

5. “Of course I’m depressed...” Depression affects 1 in 10 people with chronic medical illness Depression affects 1 in 10 people with chronic medical illness Depression is one of the most “treat- able” of mental disorders Depression is one of the most “treat- able” of mental disorders Untreated depression impacts the immune system and can complicate recovery from acute episodes of illness Untreated depression impacts the immune system and can complicate recovery from acute episodes of illness

6. Criteria for Major Depressive Disorder Either depressed mood or loss of interest/pleasure for 2 wks, plus 4 of the following Either depressed mood or loss of interest/pleasure for 2 wks, plus 4 of the following –Weight loss/gain –Insomnia/hypersomnia –Restlessness/lethargy –Fatigue –Worthlessness –Diminished ability to think –Recurrent thoughts of death/suicide

7. Factors that increase risk of Depressive Disorder Prior episodes, family hx of depression Prior episodes, family hx of depression Female gender Female gender Lack of social support Lack of social support Stressful life events Stressful life events Personal hx of abuse Personal hx of abuse Current substance abuse Current substance abuse

8. If you suspect you might be depressed… Seek help! Discuss your concerns with your primary care provider or a mental health professional. Seek help! Discuss your concerns with your primary care provider or a mental health professional. The combination of psychotherapy and medication is the most effective treatment for depression. The combination of psychotherapy and medication is the most effective treatment for depression.

9. If someone you care about seems depressed… Let them know you are concerned about their mood. Let them know you are concerned about their mood. Ask about suicidal thoughts. Ask about suicidal thoughts. Listen. Listen. Use the 211 Hotline in crisis situations and to identify mental health resources in your community. Use the 211 Hotline in crisis situations and to identify mental health resources in your community.

10. And in the end, it's not the years in your life that count. It's the life in your years. And in the end, it's not the years in your life that count. It's the life in your years. Abraham Lincoln