Introduction

Mood disorders refer to a group of psychiatric conditions that share the essential features of a disturbance in mood that is not due to any other mental or physical disorder, medication or substance abuse. ‘Mood’ refers to the internal and sustained emotional state of an individual and ‘affect’ to the external expression of emotional content. The American Psychiatric Association (APA 2013) addresses mood disorders in two sections: depressive disorders and bipolar and related disorders. Nowadays, depression and mania are household terms, perhaps because most people have some idea of what it feels like to be ‘down in the dumps’ and ‘blue’ or ‘hyper’, ‘speedy’ and ‘in a frenzy’. However, there is a distinct difference between these symptoms being a sign of normal human emotion and being a sign of a mood disorder. The distinction lies in the type, intensity and duration of the symptoms; the amount of distress they cause to the person and those around them; and the extent to which the symptoms affect functioning and participation in everyday life.

While a focus on the medical aspects of mental illness is necessary, given the significant role that hospitalisation, medication and treatment play in recovery, care should be taken not to reduce occupational therapy to a procedural process aimed at ‘fixing’ the performance component impairments (i.e. symptoms) associated with mood disorders. The term ‘person’ rather than ‘patient’ or ‘client’ is therefore used in this chapter. The person’s behaviour and functioning is best understood, assessed and addressed in occupational therapy by taking into consideration the participation demands of his/her environment. What people are able to do every day and how they go about performing their various life tasks and activities depend as much on their mental and physical state as it does on the environments in which they live, work, play and socialise. For example, poverty, poor living conditions, violence and unemployment require particular forms of coping and adaptation. The occupational therapy proposed must therefore be adjusted with due consideration of the setting within which the service is rendered.

Depressive disorders

By 2020, depressive disorders are expected to be the second biggest cause of disease burden worldwide (Reddy 2010). Given its prevalence, depression has been called the common cold of mental health problems. The term can apply to a transient mood, a sustained change in affect, a symptom, a syndrome or a psychiatric disorder (Checkly 1998). While the causes of depressive disorders are unknown, the complex interaction of multiple factors such as genetic transmission, biochemical imbalance, temperament, emotional trauma and adverse socio-environmental conditions are considered to play a role. Females are more vulnerable to develop depression than males due to hormonal differences, as well as childbirth and social conditions related to women’s roles and stressors (Sadock et al. 2009). One in five women are likely to experience a depressive episode at some point in their lives, with 1 in 10 men being affected (Harkness et al. 2010). Although depression is three times more common in relatives, many professionals do not follow the ‘genetic’ school of thought. They believe that the intergenerational presence of depression within families is the result of ‘a learnt pattern of behaviour’ in which unhealthy coping mechanisms are used to resolve life stressors. Irrespective of its causes, a depressive disorder can be a debilitating mental illness that causes considerable distress and impairment in all areas of functioning. Affected persons report a deep sense of despair and hopelessness beyond their normal emotional experience. These feelings may lead some depressed people to become withdrawn and passive, while others may become irritable and agitated. While some forms of depression may lead to delusional or suicidal thoughts, the cognitions of depressed individuals are usually marked by distortions in ways of explaining things, self-evaluations and information processing. The depressed person’s thoughts are dominated by a view of self as worthless, the world as bleak and the future as hopeless. Through this negative view of the world, they distort experiences and display information processing errors such as overgeneralising and making predictions of poor outcomes. They exaggerate the implications of minor life events, blaming themselves when things go wrong. No matter how bright the day is, how many goals are accomplished or how many compliments are received, the individual tends to find a flaw or a reason for self-criticism. Depressive thinking has a self-sustaining, self-defeating quality that curtails role functioning and occupational performance.