Sex differences may also be playing a role in whether or not people are willing to open up about their depression. While women seem more prone to depression overall, that may be due to men being far more likely than women to keep their symptoms hidden. Because of different sex roles, boys are encouraged control their emotions and to be strong and independent while girls are encouraged to show their emotions. As a result, admitting to feeling depressed can make many men feel unmanly, as they are no longer able to control their emotions. This can lead men dealing with depression to cope with its symptoms in other ways, including acting out aggressively or resorting to drugs and alcohol to numb the negative feelings. In extreme cases, depressed men may be more vulnerable to committing suicide.
Whether people are dealing with depression themselves or know someone else who is, it is vital to educate ourselves about depression, including its causes, effective treatments, and constructive ways of offering emotional support. Just showing depressed people that we are willing to do this on their behalf can often mean much to them and show them that we are ready and willing to help them recover.
Though the stigma surrounding depression is often very real, especially depending on where people happen to live, it is still important to be as open as possible about what they are experiencing. Not only does concealing symptoms mean delaying any possibility of getting help, but the stress of hiding depression often makes the problem much worse. And being willing to open up about what people are dealing with also allows family and friends to provide them with the kind of support they will need as well.
12. Is there a depression epidemic?
In recent years, depression has been increasingly recognized as a major public health issue worldwide. Not only are medical doctors around the world prescribing antidepressants in record numbers but more people than ever are opening up about being depressed. For this reason, the World Health Organization has launched a campaign aimed at improving mental health services around the world.
According to the latest Health of America report released by the Blue Cross Blue Shield Association, major depression diagnoses in the United States have soared between the years 2013 and 2016 alone. While there have been 33 percent more cases of major depression across all age groups, the highest rates have been found to be among adolescents (63 percent) and millennials (47 percent).
The actual diagnosis rates varied widely from state to state but forty- nine out of fifty states are reporting increases in depression (Hawaii being the only exception) with higher rates being found in the Northeast, Northwest, and the Midwest. Not surprisingly, women are being diagnosed with major depression at twice the rate as men though this will likely change too in future.
People diagnosed with major depression are also far less healthy in general than nondepressed individuals with 85 percent of all people with depression also having one or more serious health problems as well. This includes medical conditions such as heart disease; stroke; Parkinson’s disease; and, in older people, a greater likelihood of developing dementia. This also leads to depressed people being more likely to rely on health care services with overall health care costs being more than double that of people without depression.
The increase in cases of adolescents with depression is especially startling because the rate of depression was very low in 2013 when these statistics were first collected (1.3 percent overall). Based on these results and other recent findings, the American Academy of Pediatrics has released new guidelines to screen all children and teenagers for depression to help catch these cases as early as possible. We will explore possible reasons for this rise in depression among young people later in the book.
Despite this apparent rise, however, some experts are disputing whether or not there is a real epidemic at work. In a controversial 2007 book, titled The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, authors Allan V. Horwitz and Jerome C. Wakefield argue that the apparent rise in new cases of depression in recent years may just be an illusion. While they acknowledge that depression is certainly real, Horwitz and Wakefield suggest that the actual number of people experiencing depression is no greater than it has ever been.
As for why new cases are being diagnosed, the authors suggest that more people are seeking treatment because of the increased publicity surrounding depression in the popular media. Not only are we seeing many more news stories about depression, including stories about celebrities dealing with mood problems but we are also seeing more movies and television programs featuring characters with depression—something that was much rarer even twenty years ago.
At the same time, the psychiatric profession has introduced new ways of defining depression that makes even ordinary cases of sadness seem to be something that needs medical treatment. As well, medical doctors are prescribing antidepressant medication much more frequently than they ever did before, and even the popular media helps this trend with stories about the positive benefits of medications such as Prozac (and it likely helps that pharmaceutical companies are now advertising antidepressants in popular magazines and websites. Along with encouraging people who might otherwise let their depression go untreated to seek help, many patients may be asking their doctors for medication to help them deal with problems they used to resolve on their own.
Whatever the reasons for this new depression epidemic that seems to be occurring, or whether this increase will continue in future, it is more important than ever that people who develop symptoms of depression reach out to get the help they need. There is less excuse than ever to suffer in silence.
Causes and Risk Factors
13. Why do individuals become depressed?
As we have already seen in the Introduction, depression seems virtually universal and has even been seen in many nonhuman species. In fact, just about any pet owner or animal breeder can tell stories about the deep emotions that animals seem to experience, including depression and grief following the death of a loved one. Along with the learned helplessness often seen in animals kept in cages, especially when isolated or deprived of normal social stimulation, researchers studying animals in the wild have recorded numerous instances of grief and despondency in many animals, suggesting that these are truly universal traits. Certainly, photographs showing elephant calves grieving for mothers who have been killed by poachers demonstrate how real this emotion can be.
Researchers have identified numerous different causes for depression, ranging from genetic and biochemical factors to psychological causes, including the influence of stress, trauma, life changes, and even the amount of sunlight we happen to be getting. We will be exploring all these different factors later in the book.
But can we understand more about why we become depressed by looking at possible clues from our evolutionary history? Some researchers have suggested that we can. For example, one proposed explanation is the “behavioral shutdown” hypothesis. This suggests that depression can actually be a healthy coping mechanism under some circumstances, as it helps us adapt to extreme situations by reducing activity as much as possible.
In other words, being depressed leads us to take time out of our lives to recover and regain the inner resources needed to cope in future. Being in a depressed state can also force us to ruminate about our lives and give us the time needed to make effective changes. Our ability to survive depression also depends on the support we receive from family and friends, something often seen with animals living in social colonies in the wild as well.
There is also the “psychic pain” hypothesis which suggests that the kind of emotional distress seen in depression is very similar to how physical pain affects the body. For example, the physical pain we experience after being burned forces us to withdraw from the fire to prevent being injured further. In much the same way, the psychic pain that can lead to depression can also act as a warning that certain activities may harm us if we are not careful.
According to brain imaging research supporting the psychic pain hypo
thesis, depressed people show greater activation of those brain regions that have also been linked to pain perception. Many of the symptoms found in depression, including disrupted sleeping and eating patterns, loss of pleasure, and impaired motor functioning, are also found in chronic pain patients. While severe depression can be viewed as a more extreme form of responding to psychic pain, mild depression can be an effective strategy under the right circumstances.
Though trying to explain different forms of mental illness in terms of evolution is still controversial, the possible role of depression as a way of adapting to stress can help us understand why it appears so universal. It may also help explain why depression can often take different forms, depending on the kind of life circumstances people may face, the inner resources they have available to them, and the help they can receive from the family members and friends who care for them.
14. Is depression linked to trauma?
It’s hardly surprising that people who survive a traumatic experience are often going to develop posttraumatic symptoms afterward. As we have seen in Question 8, many people affected by natural or man-made disasters may lose confidence in their ability to cope effectively. Whether this traumatic event is something that happens only once (such as a natural disaster) or repeatedly (such as with victims of domestic abuse), the despair that can occur due to this belief in their own helplessness can be extremely hard to overcome. And as new traumatic events occur, this sense of helplessness becomes progressively worse.
But this kind of learned helplessness doesn’t just affect people who are directly exposed to traumatic events. Family members or friends of trauma victims can also experience these symptoms when they hear about these first-hand experiences and try to provide emotional support. This is known as secondary traumatic stress, and it can take a toll as well.
Research studies have long shown that children of Holocaust victims often develop trauma symptoms as well from hearing the stories of their parents or from grandparents describing what had happened to them. Even health professionals who deal with trauma patients can develop secondary trauma due to repeatedly listening to their patients’ experiences. Though this secondary trauma may not seem as serious as what trauma victims experience directly, it can still have an impact that shapes how people view their own lives and how they deal with stress. And, as you can imagine, this is one of the reasons that the suicide rate in health care professionals can be so much higher than average.
But there is also the depression that can occur in people who experience long-term trauma. People living in war zones, who are in long-term abusive relationships, or are dealing with chronic sexual or physical abuse often develop what has been termed complex posttraumatic disorder (C-PTSD). First proposed by Judith Herman in her 1992 book, Trauma and Recovery, she suggested that people dealing with long-term stress often showed symptoms very different from people experiencing single-event traumas.
As a result, they can often become passive and withdrawn (due to learned helplessness), or develop highly unstable personalities. Along with all the classic symptoms of depression, they can also show other symptoms such as self-cutting; substance abuse; violent behavior; and, in many cases, suicide attempts.
This kind of chronic trauma can take many different forms though. Religious, sexual, or ethnic minorities in many Western countries are often victimized by violent hate crimes intended to intimidate them. Whether or not individual members experience these crimes directly, the fact that the violence was directed at the community to which they belong is enough to make them feel victimized. This is often referred to as identity trauma since it involves attacks on a person’s sense of identity as much as it is a physical threat. There is also collective trauma, which can strike an entire nation after a wide-scale event such as 9/11 or the recent Boston Marathon bombings. Though the panic subsides fairly quickly, the ever-present sense of Will it happen again? never really goes away.
As you can see, trauma can occur in many different ways and often affects not only victims of trauma but the people close to them as well. This is why counseling can be so important for health care professionals and even family members trying to take care of loved ones in need.
15. Why is depression so common in young people?
For reasons that are still unclear, young people seem to be particularly vulnerable to depression. According to statistics released by the National Institute of Mental Health (NIMH) in 2015, 12.5 percent of adolescents aged from twelve to seventeen have had at least one major depressive episode. Even more alarmingly, these figures seem to be part of a rising trend, with the percentage of young people dealing with depression showing a sharp rise over the past ten years.
Research has also shown that adolescents who develop symptoms of depression at an early age (age thirteen or younger) are more likely to experience chronic depression as they grow older. In one study looking at adolescent depression, 35 percent of boys and girls who had significant depressive symptoms at age thirteen showed similar problems at age seventeen. Girls showed greater levels of depression overall, and boys suffering from depression showed little improvement with time.
While there have been different explanations giving for the rising problem of depression in young people, one recent research study is suggesting that the rise of new technology, including smartphones and the Internet, may be playing a role. The study, which examined trends in emotional well-being in adolescents from 1991 to 2016, shows a significant drop in personal happiness beginning in 2012. Breaking these results down further, researchers found that adolescents who spent much of their time with electronic media (smartphones, electronic games, and the Internet) were generally less happy, were less satisfied with their lives, and had lower self-esteem than their less connected counterparts.
Among the possible reasons for the depression-technology link are the general drop in face-to-face social interactions among adolescents seen in recent years, the loss in sleep time often related to excessive screen use, and potential addiction issues due to becoming too dependent on social media. There are also the mental health issues that can arise from cyberbullying or other forms of electronic harassment, which can also influence self-esteem and psychological well-being.
As vulnerable as young people in general appear to be, girls are twice as likely to be diagnosed with a mood disorder as boys. Along with differences in brain development, girls also go through the physical changes linked to puberty around two years earlier than boys. This makes them especially vulnerable to the effect of social influences, including cyberbullying and peer pressure relating to personal appearance. It’s probably not surprising that girls are far more likely to spend time on social media sites than boys.
This leads to increased exposure to negative media influences, including images of “ideal” females who often make them feel inadequate as a result. They are also prone to “body shaming” if they fail to meet these often unrealistic beauty standards, which can also lead to rejection from other young people their same age.
So, what are the long-term consequences of adolescent depression? Studies seeking to answer this question have shown that adolescents suffering from depression were substantially more likely to develop depression as adults (aged twenty-one or over). They were also more vulnerable to developing anxiety problems when older though available evidence is mixed on whether adolescent depression in linked to increased risk of suicide as adults.
As you can see, adolescents suffering from depression need to begin treatment as soon as possible to avoid the serious problems that can develop otherwise. Studies examining different treatment approaches have been shown to be effective in relieving symptoms of depression. Along with medication to control depressive symptoms, supportive counseling can also be used to teach coping skills and help adolescent patients understand what is happening to them. While cognitive behavioral therapy remains the gold standard in treating adolescent depression due to the numerous studies that have attested to its effectiveness
, we have also seen a rise in newer treatment methods that can also help.
Along with new treatment approaches such as dialectical behavior therapy and short-term psychodynamic therapy, therapists have also had success with a range of other treatment approaches such as art and music therapy. Family counseling is also available, which allows adolescent patients to attend counseling with a parent or other family members to help improve communication and cope better with stress. Young people considering supportive counseling usually have the option of either individual therapy or joining a treatment group in which group members support each other and encourage social skills that can make depression easier to control. We will be discussing treatment programming in more detail in a later section.
Aside from more traditional treatment approaches, school-based psychosocial programs have become more common in recent years to provide mental health care for children and adolescents who might otherwise “slip between the cracks.” While most of these programs focus on issues such as substance abuse and suicide, they also provide information on depression and coping to help students recognize the symptoms they might be experiencing.
One example of a program with proven effectiveness in curbing suicide and depression was developed by the Cincinnati Children’s Hospital Medical Center for use in high schools throughout the Cincinnati area. The program, titled Surviving the Teens, provides information on teen stressors, coping strategies, and warning signs of depression and suicide. Research on the more than sixty thousand high school students who have already gone through the program has shown a significant drop in suicide attempts as well as reduced social anxiety and depressive symptoms.
While programs such as Surviving the Teens are still in the experimental stage, treatment resources for young people dealing with depression can be found in most places. There are also online resources for young people who might be reluctant to talk about their problems in person. Check the Appendix section for more information about programs in your area.
Depression Page 5