The National Institute of Mental Health estimates that “more than two million of the 34 million Americans age 65 and older suffer from some form of depression.”  Results from a Mental Health America Survey reported in 1996 that only 38% of adults aged 65 and over believe that depression is a “health” problem and about 58% of people aged 65 and older believe that it is “normal” for people to get depressed as they grow older.

It is National Mental Health Month and a very good opportunity to learn what depression is, how to prevent it, and how to manage the symptoms if you experience depression.

Some important questions to answer are:

• How do I know if I am depressed? What are the characteristics?
• What are the risk factors for developing depression? What can protect me from depression?
• Where can I find resources in my community that offer help for depression?

Resources

• A Short Story: Applying Our Knowledge About Depression to a Real Life Scenario
• Resources for Help with Depression and Other Mental Health Issues (Word|PDF)
• Depression: Risk and Protective Factors in Later Life (Word|PDF)
• Geriatric Depression Scale, or GDS (Word|PDF)

How do I know if I am depressed? What are the characteristics?

The two main hallmarks of depression are a loss of interest in normal daily activities, where people lose interest or pleasure from activities they used to enjoy, and depressed mood, where a person feels sad, helpless or hopeless, and may have crying spells.  A doctor or other health professional also will look for other signs that have been present for at least two weeks, such as sleep disturbances, impaired thinking or concentration, significant changes in weight, agitation, fatigue or slowing of body movements, low self-esteem, or thoughts of death.

Many of you may recognize these symptoms as symptoms of depression, but some people might think that depression is not really an illness or that it may be normal.  Well, clinical depression is serious and if you feel you or your loved one may be clinically depressed, then you should seek the help and advice of a qualified health care provider. 

Here are a few startling facts about depression in older adults: 

• Depression can cause personal suffering and family disruption. 
• Depression often affects those with chronic illnesses, cognitive impairment, or disability.
• About 25% of older people have depressive symptoms and of these, 1% to 9% meet the criteria for major depression.
• Caregivers of elderly disabled people are twice as likely as non-caregivers to have symptoms of depression.
• 17% of people with Alzheimer’s Disease also have depression.
• In hospitalized elderly, the prevalence of depression is about 36% to 46%.
• In those in long-term care facilities, the prevalence of depression is about 10% to 22%.
• In the first 10 days after a heart attack, the prevalence of minor and major depression are 27% and 18%, respectively.
• By the third month post heart attack, the overall prevalence has dropped to 33%.
• Depressive syndromes are present in 80% of older people who commit suicide. 

So depression is something we really need to be concerned about.  If you or someone you know has the signs of depression, such as little interest in activities you or your loved one once enjoyed, or feeling sad, helpless, tired or worthless, or having large changes in eating or sleeping habits, then seek professional help from a doctor or other professional. 

There are many different types of depression and treatments.  Depression is treatable with medications and/or therapy. 

What are the risk factors for developing depression? What can protect me from depression?

Because the prevalence of depression is so high and the consequences are so severe, it is important that we all know some ways we can help people get the help they need if they have depression or are at risk for depression. 

Some of the most encouraging facts are that older people are somewhat protected from depression through the “wisdom” they have accumulated through their lives.  They are also protected by their “socio-emotional selectivity,” which means that they often select to focus more on the positive aspects of their life and less on the negative aspects of their life.  According to Drs. Blazer II and Hybels from the Duke University Medical Center, compared to younger adults, older adults are “more likely to selectively optimize the positive in their social experience.  This in turn could blunt the harsh reality of some of the more negative experiences among the elderly, and, therefore, protect against the onset of depressive symptoms.”

Where can I find resources in my community that offer help for depression?

Consider at least one way that we can help others who may be at risk for depression.  For instance, you could visit someone who is isolated or lonely, or make a lunch date with a friend going through a difficult time.  Also, since we are mainly focusing on older people, another way is to review the “Geriatric Depression Scale” with someone you feel is at risk.  Although only a health professional is qualified to screen for and diagnose depression, this scale can help us learn about the possible signs and symptoms of depression among our family and friends.  Also, we can encourage people to seek professional help and let them know that help is available. 

If you think you are at risk for depression, then talk to your health care provider as soon as you can.  Remember that people get depressed due to catastrophic life events, but this may not qualify as clinical depression.  If you find yourself feeling down in the dumps, talk to someone about it and get help. 

A Short Story: Applying Our Knowledge About Depression to a Real Life Scenario
The following story is about a person and their family who are having a difficult time in their life and may be suffering from depression.  Read the story carefully to identify risks and protective factors for depression in the various characters in the story. 

Jack just celebrated his 56th birthday at his favorite restaurant with his family and his close friends from work.  Although he was a little worried that his father might make a scene in public, because of his drinking problem, everyone behaved and had a good time at the restaurant.  Jack feels really good about being 56.  He still has nearly all his jet-black hair and goes fishing almost every week with his clients in his sales job.  The only health problem he has is high blood pressure, which is controlled pretty well, as long as he remembers to take his medication.

Three days after his 56th birthday party, Jack is absolutely devastated to learn that he is being laid off from the sales job that he has loved and held for 27 years.  Jack loves being a salesman, enjoys working with people, and has been meeting his sales quotas for years.  There appears to be no reason for Jack to lose his job, except that his boss feels he can pay less salary and benefits to a younger person and still get the job done.  Jack and his wife Connie, age 46, are handling many challenges this year, such as completing a $20,000 remodeling project in their home.  They are helping Jack’s 76-year-old mother and 48-year-old brother, who both suffer from chronic mental illness, adjust to a new living facility.  After about six months in the new facility, Jack’s mother died suddenly from a heart attack.  Connie had quit her good paying job as a legal assistant when their second child was born to be the primary caregiver for their children, Carl and Mick.  Carl is 14 and has mild Down’s syndrome and Mick is 15 and was just diagnosed with type 1 diabetes.  The children are otherwise healthy and are full of life and energy, but they both require close attention.

Jack is really overwhelmed by the loss of his job and changes in family status.  He loves his old job so much that he just can’t imagine ever finding one that he likes as much.  Jack misses his close friends from work who never call him anymore and are too busy to socialize with him.  He frets over the debt from the remodeling on their home and the fact that they have to take money out of their $100,000 retirement savings that he worked hard to build over the years.  He is sure that his family of four is going to end up destitute, hungry and homeless.  He doesn’t want Connie to go back to work, but finally reluctantly agreed that she should find a job, even though it will probably pay less than he thinks he can earn in sales.  Through a friend at church, Connie finds a job she loves and makes new friends at work. 

So Jack is now the primary caregiver for their children and is running the household.  He is surprised to find out how much time and hassle are involved with being a “house-husband” and he is anxious to find a new high-paying job as soon as possible.  Jack confides in his father-in-law, Robert, about his troubles.  Robert takes Jack fishing a few times.  While relaxing and fishing, Robert suggests that Jack try to focus on the positive aspects of his situation, such as enjoying the freedom and time he now has for his children, because it won’t be long before Mick will be “leaving the nest.” Also, Mick is very smart and can probably get at least a partial scholarship for college.  Robert assures Jack that he has set aside a little money to help Mick go to college and for Carl to get some extra care he may need in the future.  Another positive is the chance for Connie to get back into the workforce, which is something she has missed.  Also, Jack and Connie have invested their savings well and own rental property that Jack could upgrade, and this would help them through this difficult financial time.  Robert also firmly and frankly tells Jack to immediately talk with his doctor about possible depression and that Jack should not feel ashamed about his problems and that help for depression is available.  Connie’s new insurance policy will pay for any needed medications, as well as some costs for therapy if needed.

Q: Who are the main characters in this story? 
A: Jack, husband and father; Connie, wife and mother; the two teenage children, Carl and Mick; and Robert, Connie’s father and Jack’s father-in-law. 

Q: Name at least one risk factor for depression that each person in this story might have.  A:  For example, what are some of the biological risks, social risks, or psychological risks Jack might have?”

Q: After reading this story, which people in this story do you think are at high risk for depression? 
A: Jack who just lost his job is probably at the highest risk.  Mental illness and alcohol abuse run in his family (so he may have a hereditary and genetic predisposition); he has numerous stressful life events and daily hassles with losing his job, looking for a new job, running the household, and caring for the children and checking in on his disabled brother; he lost the social support of his friends from work; he is suffering from the recent death of his mother; he has cognitive distortions about becoming destitute (even though he has some retirement savings and his wife Connie is working); and he suffers from hypertension. 

Jack’s wife Connie may also be at risk, mainly because of the many new stressful life events and daily hassles she is facing with being employed outside the home.  Even the children may be at risk, because of the many changes in their daily routines. 

Q: Can you think of anything that wasn’t included in this particular scenario that would also put someone at risk for depression? 
A: Consider someone whose spouse has become very ill or develops Alzheimer’s disease.  This scenario is very common and the ill person requires a large amount of extra attention.  The care-giving person and the ill person may each be at risk of developing depression.

Q: What are some protective factors against depression these characters in the story might have.  What kinds of things do you think might help people from becoming depressed?
A: Connie has made new friends at work, which is a protective social support factor. Robert shows wisdom and “socio-emotional selectivity” by helping Jack focus on the positives of the situation. Robert is trying to convince Jack to seek professional help for depression. 

Sources:
Department of Foods and Nutrition, The University of Georgia, Athens, GA 30602. Division of Aging Services, Georgia Department of Human Resources, Atlanta, GA 30303. December 2007.

Mental Health America.net