Mental Health Matters: Why don’t depressed people seek help?
February 24, 2016
Depression is ubiquitous. It befalls all demographic groups — black and white, rich and poor alike. It's also a treatable mental illness. Should any of that matter?
The Center For Disease Control and Prevention (CDC) reports that in any given year, 18.8 million American adults, or 9.5% of the adult population, will suffer a depressive illness.
Moreover, some 80% of those with depression report functional impairment, to include missed work days and decreased productivity.
The resultant cost to employers is estimated to be between 20 and 40 billion dollars annually. And that's without monetizing the costs in individual suffering and its contagion effects in family and friends.
“Depression negatively impacts quality of life for the individual sufferer and for those around them. Yet, fewer than 30% of depressed people contact a mental health provider in any given year.”
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Depression negatively impacts quality of life for the individual sufferer and for those around them. Yet, fewer than 30% of depressed people contact a mental health provider in any given year. Why?
There are a host of reasons. Emotional stigma for one; you know you're depressed, but you don't want others to know it. The embarrassment. A mistaken belief that only emotionally weak or stunted people become depressed.
Depression is also one of the medical "masqueraders." Many depressed people don't "feel depressed," but instead experience depressive equivalent symptoms of fatigue, weakness, lassitude, disturbed sleep, change in eating habits, pain, and/or inattention.
In family medicine practices, for example, up to 1/3 of adult patients present with a primary complaint of fatigue. Many of these adults have occult or hidden depression, rather than any physical explanation for their symptoms.
Others with Depression go untreated because you don't have to "look depressed" to be depressed.
Irritability, impatience, or short-temper are other commonly missed symptoms of depression. So is feeling emotionally "numbed" or the loss of ability to respond to others gestures or words of affection.
Still others, those with mild, chronic, and energy-depleting depression may have long forgotten that life was once better. They have no interest or incentive to change because, "My life has always been like this."
Cost is yet another barrier to treatment. It's a travesty, but mental health providers have been systematically cut out of adequate insurance reimbursement for much of the last 40 years.
Want to make a decent living as a mental health provider? Find a well-healed clientele and don't accept insurance payments. End of discussion.
Putting cost issues aside for now, how best to at least identify people with depression problems in hopes that you can find adequate treatment resources?
In an average year, 82.1% of adults have contact with a health care professional, as do 92.8% of children.
Older generations will recall their primary care physician as someone who got to know you over the course of years, even decades. They practiced the "healing arts," and were confidants, even friends.
"Taking a history" was central to the doctor-patient encounter and frequently took over a half hour. Enough time to assess emotional well being and, if indicated, offer a treatment plan.
Such opportunities, for many reasons, are now vanishingly small; corporate medicine, impersonal data collection forms, and computer interfaces are as likely as not to have you in and out of the office in 15 minutes. No time to develop rapport and assess your emotional status. Not enough time to explore your emotional life.
So, if health care contacts offer a potential early assessment opportunity for emotional ailments, how, given the time, if not skill limitations of medical staff, can we improve the likelihood of correctly diagnosing a depressive disorder?
Recently, the United States Preventive Health Task Force had a really good idea. They issued a call to arms in addressing the under diagnosis of depressive disorders in medical practices by suggesting that screening all patients for Depression can bring enormous health benefits.
A great concept — create a simple screening tool that will "capture" most patients who might be depressed, and, if indicated, collect more information.
Turns out there are already several reliable test instruments out there. Probably the most efficient is the Patient Health Questionnaire-2, a simple two-item questionnaire: Over a 2-week period, have you been bothered by (1) little interest or pleasure in doing things; or (2) feeling down, depressed, or hopeless? Answer "yes" to either item and you should be more fully evaluated.
You can even try it at home. Ask your loved ones the two questions. I'm serious. If the answer to either question is "yes," you might want to consult your physician or a mental health provider to discuss the matter in more depth.
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.