Depression is one of the most significant public health problems facing our nation.
From 1992 to 2002, according to the National Institutes of Health, the prevalence of depression rose from 3.3 percent to 7 percent of the population. Rates rose for both genders, all age groups and all ethnicities. In the U.S., the lifetime prevalence of depression is 17 percent, meaning that nearly 1 in 5 people will suffer an episode of depression at some time during their life. That is nearly twice the rate as in developing countries.
There are both genetic and environmental risk factors for depression. In addition, among those who are genetically susceptible, environmental triggers, such as adverse life experiences and chronic stress, may affect gene expression leading to a greater risk of depression.
For instance, early life stress such as childhood trauma may increase sensitivity to stress. Other risk factors include isolation, poor social support, depression among one’s social group and personality factors ranging from neuroticism to low self-esteem.
The main symptoms of depression are sadness, loss of interest in enjoyable things, sleep difficulty or excessive sleep, changes in weight and/or appetite, agitation or mental slowing, fatigue, difficulty concentrating, guilt or feelings of worthlessness and suicidal thoughts. Depression is present when the majority of these symptoms are present nearly daily for two or more weeks, in the absence of another cause, such as substance use.
The majority of people with depression do not contemplate suicide. That said, suicide still ranks as the 10th leading cause of death in the U.S. Factors that increase risk for suicide include history of prior attempts, social isolation, hopelessness, a family history of suicide and a personal history of childhood adversity. Social factors, including prior military service, rural residence or belonging to a sexual minority also appear to increase risk. For all groups, access to firearms has been shown to increase the risk of suicide.
For those who suffer from depression, there is hope. Effective strategies to help control depression symptoms are available and have been shown to produce a favorable response for the majority of those suffering from this illness.
Treatment options include mental health counseling, known as psychotherapy, and medications or a combination of the two. Evidence supports that both psychotherapy and medication therapy have comparable benefits. However, psychotherapy may have longer-lasting benefits than those of medication therapy, as symptoms may recur after drug discontinuation.
It is not surprising that social support and family connectedness are associated with better outcomes. Specifically, these are protective factors that reduce the risk of suicide. Religiosity and participation in religious activities has also been associated with lower suicide risk.
If you know someone in emotional pain, the National Institute of Mental Health recommends five steps to take:
Ask about risk of self harm.Keep them safe by reducing access to lethal means.Be there to listen.Help them connect with a friend, family member, spiritual adviser or mental health adviser.Stay connected. The National Suicide Prevention Hotline is (800) 273-TALK.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.