"Recession Depression" a Growing Mental Health Concern on Memphis Medical News

"Recession Depression" a Growing Mental Health Concern

By: SHARON H. FITZGERALD

Economic Woes Take a Toll

You've heard the joke: It's a recession if you lose your job; it's a depression if I lose mine. Whatever you want to call the nation's economic downturn, it's downright depressing, say mental health professionals, and a recent survey confirms that the economy is taking its toll on Americans' mental health.

"A lot of it's really common sense. In a recession, when people are concerned about their economic future and their jobs, people become anxious and depressed," said Michael Fitzpatrick, executive director of the National Alliance on Mental Health (NAMI). "We recognize that, in many cases, when people experience job loss, the result is high anxiety or depression. We also recognize that depression is one of the most common mental illnesses."

Alerted to a trend in so-called "recession depression," NAMI partnered with Mental Health America (formerly known as the National Mental Health Association) to survey adults nationwide. The survey findings clearly indicate a link between the economy and depressive symptoms or worse. In fact, individuals who are unemployed were found to be four times as likely as those with jobs to report symptoms consistent with severe mental illness. Key survey findings included:

Thirteen percent of unemployed individuals reported that they have thought of harming themselves, while that number is about 3 percent for people with full-time work.
The unemployed were twice as likely to abuse alcohol or drugs in the last six months.
Almost half the unemployed reported "significant difficulty" in obtaining healthcare, and certainly lack of treatment just compounds the problem.
Of those who hadn't spoken to a health professional about their mental-health concerns, 42 percent cited cost or lack of insurance coverage as the main reason why.

Of the 1,002 adults surveyed from Sept. 17 through 20, nearly 20 percent reported that they had experienced a forced change – firing, layoff, pay cut or reduced hours – in their employment status during the last year. These individuals were five times more likely to report feeling hopeless most of the time.

The telephone survey polled 500 men and 502 women at least 18 years old and living in private households in the continental United States. The margin of error was ±3.1 percentage points.

David L. Shern, PhD, Mental Health America president and chief executive officer, said the poll illuminated "the consequences of economic uncertainty and economic displacement and that they cause real problems that are a real concern from a public-health perspective." That 13 percent of the unemployed think of harming themselves is a "very startling" statistic, he added.

What frustrates mental-health professionals is that depression is very treatable, if only the patient will seek help. In fact, treatment with antidepressants and talk therapy is effective more than 80 percent of the time. While Shern acknowledged that the "double whammy" of job loss and thus loss of health-insurance coverage decreases the likelihood that some depressed individuals will turn to a professional for treatment, programs do exist with payments on a sliding scale. The time burden usually isn't enough to warrant concern, he added, even for individuals who have job.

Whether employed or not, the uncertainty of today's business climate puts people in "a state of activation, as though they are in danger," Shern said. Think post-traumatic stress disorder (PTSD). Besides depression, such "toxic stress" may prompt other mental disorders and neural changes. Just like in PTSD, the stress may cause hormonal shifts, particularly a rise in levels of cortisol, "which starts to place you at risk for all kinds of negative outcomes," Shern said. He added that cortisol has an immunosuppressant effect, thus increasing risk of infection.

Fitzpatrick noted that "situational depression," a result of reaction to the environment, is a different animal than serious long-term depression, and the treatments vary widely. Treatments for situational depression are highly effective, he said.

"Most people treated for depression are treated by general practitioners, their family physician," Fitzpatrick said. Thus, front-line doctors are the first line of defense to keep depression at bay, particularly now. Questions early in a patient visit regarding sleeplessness, restlessness, anxiety and trouble concentrating may tip doctors off that patients are falling victim to their stress, he said.

A position statement issued in October by the American College of Preventive Medicine recognizes the role of primary-care physicians in combating the undertreatment of depression. In short, the statement said all adults should be screened for depression, and primary-care physicians should be doing the screening. Most depressed patients who see a primary-care doctor go undiagnosed, the statement said.

Mental Health America strongly encourages physicians to ask patients to fill out a PHQ9, a nine-symptom checklist to help primary-care physicians diagnose depression. "While the patients are in the waiting room waiting to see the doctor, that's a great opportunity for them to fill out a PHQ9, literally nine questions that are very straightforward. In fact, we recommend that the physician be reimbursed for performing a lab test for giving someone this screening questionnaire," Shern said.

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David L. Shern, mental health, Mental Health America, mental illness, Michael Fitzpatrick, National Alliance on Mental Illness, Recession depression

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Economic Woes Take a Toll

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