We currently are in National Suicide Prevention Month. Under normal circumstances, estimates are that approximately 8-11% of people over the age of 12 suffer from moderate to severe depression. During the pandemic, there is evidence that the rate of serious depression has increased. A US Census Bureau survey found that 44% of Californians reported levels of anxiety and depression commonly associated with diagnoses of generalized anxiety disorder or major depression. The signs of serious depression are many and include:
Prolonged sadness or irritability
Sleep and appetite disturbances
Loss of energy
Less interest in pleasurable activities
Feelings of guilt and worthlessness
Thoughts of suicide.
Risk factors for suicide include mental health conditions such as depression, substance use problems, bipolar disorder, personality traits of aggression, mood changes and poor relationships, as well as conduct disorders and anxiety disorders. Other risk factors are serious physical health conditions including pain and traumatic brain injury. Environmental risk factors are access to lethal means including firearms and drugs and prolonged stress, such as harassment, bullying, relationship problems or unemployment. As we all know, the COVID pandemic has resulted in high unemployment, worries over health, and financial chanllenges. So it is no wonder that rates of depression are rising. Other environmental risk factors include stressful life events, like rejection, divorce, financial crisis, and other life transitions or loss. Historical factors include previous suicide attempts or family history of suicide as well as a history of childhood abuse, neglect or trauma. We discuss the relationship of depression to stressful life events in our book (I Can’t Take It Anymore: How to Manage Stress so It Doesn’t Manage You; Paul G. Longobardi, Ph.D., and Janice B. Longobardi, R.N., B.S.N., P.H.N.) available on Amazon at https://www.amazon.com/dp/1542458056. For information about the book, authors, and stress, please visit our website at www.manageyourhealthandstress.com.
Regarding suicide, in 2017, there were over 47 thousand recorded suicides, up from over 42 thousand in 2014, according to the CDC's National Center for Health Statistics (NCHS). On average, adjusted for age, the annual U.S. suicide rate increased 24% between 1999 and 2014, from 10.5 to 13.0 suicides per 100,000 people, the highest rate recorded in 28 years. In that year of 2017, suicide claimed the lives of 5,016 males and 1,225 females between 15 and 24 in the United States. The youth suicide rate — 14.6 per 100,000 — appears to be the highest it’s been since the government began collecting such statistics in 1960.
Depression is correlated with problematic medical conditions such as post-stroke recovery and diabetes management, among others. Unfortunately, many people attempt to deal with their depression through problematic alcohol or drug use.
Between 2 to 4% of workers in the US suffer from depression and up to 50% of workers with depression experience short term disability. There are significant financial costs to employers. For example, in studies from the University of Michigan Depression Center, the total annual economic burden of depression is $83 billion and the majority of this cost (62% or $52 billion) is due to lost workplace productivity. It is not uncommon for depressed workers to have poorer on the job performance.
So should we be doing more to screen for depression and suicide? Apparently the medical establishment has decided yes. The U.S. Preventive Services Task Force has recommended that general physicians/primary care physicians screen all adults for depression and treat those affected by it with antidepressant medication, refer them to psychotherapy, or both. The Task Force also recommended that all pregnant and postpartum women be screened for signs of depression as well as older adults. Pregnant women with depression are recommended a range of treatments including cognitive behavior therapy, an evidence based psychotherapy with demonstrated efficacy in treating depression. This policy is a departure from previous recommendations which only had recommended that physicians look for signs of depression periodically when resources to treat were in place. The new recommendations were published in the Journal of the American Medical Association.
So should you seek out screening for depression? Occasional sadness or the "blues" are a part of life for most people. However, if you or a loved one have been suffering from four or more of the symptoms of depression noted earlier and/or have multiple risk factors for suicide, it would be prudent to seek out screening. Your physician healthcare professional is in a position to use several available depression screening tools as well as assess whether any of your physical/medical conditions may be influencing your self-report. Your professional can refer you to a mental health professional, who may be a psychiatrist, psychologist, social worker, or mental health trained registered nurse. But do keep in mind that help is available and ranges from medication to cognitive behavior therapy. The treatment of depression has transitioned into the mainstream of American medical care. There is no excuse for failing to diagnose and treat depression, even during a pandemic. You do not need to continue to suffer. There is help. The National Suicide Prevention hotline number is 800-273-8255.
You can change your life but you must take action. Change your thoughts and change your results.
For additional information on these and related conditions, please consult my website at www.successandmindset.com
Good luck on your journey.
Dr. Paul Longobardi