The term depression has become pervasive within our culture, from the more common use of the word reflecting a person’s temporary state of unhappiness, to the DSM-IV TR classification used to describe a person’s medical condition involving a prolonged state of sadness, loss of interest in life, feelings of hopelessness, and decreased energy. The latter definition describes a serious and often untreated life-threatening illness, affecting millions each year, so many in fact, that depression is now believed to be a common and recurrent health problem for more than 35 million people annually. (National Comorbidity Study, NIH 2003). Subsequently, depression in the United States is now the leading cause of disability for all ages (WHO 2008).
Equally, the U.S. Department of Health and Human Services 2005-2006 Household population report revealed:
- 4% of Americans experienced depression, with 80% reporting some level of functional impairment.
- 27% of those people reported serious difficulties in work and home life.
Since 2006, DOHMH has been collecting information about depression from New York City residents in its annual Community Health survey (CHS). As of 2009, 13.1% of NYC residents report a history of depression, with 4% reporting their first diagnosis of depression.
Additionally, of the 20 leading causes of disability-adjusted life years (DALYs) in New York City, (NYC, 2011 Epi Data Brief), major depression was the second leading cause of DALYs.
Depression causes suffering, decreases quality of life, and affects serious impairment in social and occupational functioning (NIMH 2008). Although depression can be reliably identified when seen by a professional, vast numbers of people go undiagnosed and untreated. This is the problem.
So, if This problem is So Universal, Why Don’t More People Get Treated?
We know that depression affects both the mind and the body, producing changes in the biochemistry of the brain, much like other medical disorders. When left untreated, depression can result in not only unnecessary suffering, but also more serious physical complications.
Similarly, most people go to their doctor primarily with complaints of physical ailments never linking a depressive episode as their primary aliment. At the same time primary care doctors, don’t typically screen for depressive symptoms as a rule, and therefore do not identify depressive symptoms as being the underlining problem. Research shows that screening in medical facilities can increase early identification rates and lead more people to treatment (Rost 2011). If asked, people often feel more comfortable telling their primary care doctors about these symptoms, therefore, primary care doctors provide the most logical gateway for combating barriers to treatment.
Over the past several years, the NYC Department of Health and Mental Hygiene (DOHMH) has been active in depression-related activities as well as generating depression related publications for doctors, clinicians, and the general public to use.
- Our 2008, City Health Information (CHI) entitled, “Detecting and Treating Depression in Adults” provides physicians with materials for diagnosing and appropriately treating depressive patients, such as the simple PHQ-2 screen for depression.
- Our 2010 CHI, “Improving the Health of Adults With Serious Mental Illness,” targeted at physicians and mental health professionals alike, explains potential courses of action in treating physical health problems among those with serious mental illness (SMI), and encourages the coordination of metal and physical health care in patients living with SMI, including depression.
- The June 2011 Health Bulletin “Depression: Feeling Better” defines depression and explains how to identify and self-manage the disease.
- Lastly the Depression Action Kit, available on the DOHMH website includes a number of publications aimed at health care professionals and the general public about identifying and treating depression, such as depression management goal sheets and depression fact sheets.
Older adults have a disproportionate incidence of depression if they are experiencing isolation. The risk of depression in the elderly increases with other illnesses as well, when ability to function becomes limited. Estimates of major depression in older people living in the community range from less than 1 percent to about 5 percent, but rises to 13.5 percent in those who require home healthcare and to 11.5 percent in elderly hospital patients. (Hybels CF and Blazer DG)
As part of our efforts to address this growing problem, through the New York City Council funded Geriatric Initiative, DOHMH has structured screening, referral and reporting of depression for the individuals served. These are delivered in a multitude of non-traditional settings such as senior centers, doctor’s offices, naturally occurring retirement communities (NORCs), homeless shelters, soup kitchens, churches, synagogues, and social clubs and as outreach to homebound seniors.
In fiscal year 2011, the Geriatric Initiative screened 5,819 older adults for depression, and has provided treatment referrals and support as needed for countless others.
In truth there has never been a better time to embrace the idea that one’s physical health is directly affected by one’s mental well-being, and no better time to take the necessary steps toward health integration practices. With Healthcare reform upon us, and the advent of Health Homes in New York State, we now have the road map and the green light to make it finally possible.