Depression – one of the biggest costs associated with Mental Health Issues – Have the Number Been Underestimated?

The following sets out the facts about depression form definition to resolution.

Why is this particular mental health issue one that is most talked about?

Of the $100 Billion estimated to be costing industry and society in general in the US each year, of this $44 Billion has been attributed to this one issue. (Other issues which will not be discussed in this article or on this website are mental health issues which are based on psychosis and for which heavy medication is used and for those persons who are afflicted, they appear to be well-catered for within the medical, psychological and psychiatrist professions.)

The research indicates that for a mental health issue disorder to be recognised it gas to have been classified as such in the DSM-5 register of diagnosable diseases. (Diagnostic & Statistical Mental Health ?)

For depression to be recognised, it has to have been classified as a clinical condition that has been diagnosed by a mental health professional and that the disease must significantly interfere with a person’ cognitive, emotional and social abilities.

The research also indicates that mental health results from responses to different stressors and experiences over time, yet the advocates for improving mental health issues seem reluctant to state outright that ALL of these types of diseases are stress-based. ( we will discuss that later).

IN the DSM-5 even though mental health issues arise in response to different stressors and experiences over time, when looking at the definitions of stress in this register they talk about ‘acute stress disorder’. In order to have a diagnosable stress disorder the underlying theme seems to be that the person needs to have had PTSD, and that there needs to be some kind of dissociative symptoms such as: numbing detachment, decrease in emotional responsiveness, reduction in awareness, derealisation, depersonalisation and dissociate amnesia.

Now. No one I know necessarily has these underlying conditions in order to know that they are stressed. You have to wonder about how and why depression and the like arise and why it is such a big issue nowadays?

I Australia 87% of workers are depressed either mild, medium or severe. (APS Study 2015 – a cumulative figure) in effect this Australian research concentrates on whether workers are in fact depressed, to some degree, rather than concentrating on whether those people who self-selected: the severe category – approx. 26% – had been “diagnosed” as depressed. According to some accepted index.

What this says to me is that the US figures on the number of workers who are depressed either: mild, medium or severe, have been hugely underestimated. The US research indicates that only 16 Million people are actually depressed.

The OECD Study on countries prescribing medication for depression, the US was not in fact in the study. The country topping that list was Iceland and Australia came second on the list. Yet when the figures for US were extrapolated onto this data the US would have come out on top as the country prescribing the most medication for depression.

Antidepressant use is not an accurate window into rates of depression.

In the US only 1/3rd of people with severe depression take and antidepressant. However, in Korea, with the lowest antidepressant rate in the OECD study has the highest suicide rate in the world. One reason given is that Koreans feel that mental health issues are seen as personal weaknesses.

Antidepressant use is on the rise because it is also being prescribed for: anxiety, mild depression, social phobias and much more. (Skye Could & L Friedman 2016)

Depression is on the rise and the campaigns for Australia are about increasing awareness of the issue and having more understanding around this and therefore being able to have dialogue easily so that those affected would not feel stigmatised.

In the US the issues revolved around:

  • Raising awareness about depression in the workplace and its effect on productivity
  • Promoting early recognition of symptoms, and
  • Reducing the stigma surrounding mental health conditions

If depression is on the rise and there is a concerted effort to alert the workforce about this and to show them that management is showing workers that they do care about their workers’ mental health why would workers be reluctant to put up their hands and say: ‘Hey, I have an issue and I need help?’

The real reason lies somewhere between not trusting management to do the right thing and be compassionate and supportive to not wanting to be ostracised and stigmatised. So, therefore people are not putting up their hands and not saying they are depressed and not wanting to have their depression clinically diagnosed because once that happens they will be forever trapped within the mental health system, having to take prescribed medication for years and which may well lead to difficulties getting other work.

Let’s look at the accepted definition of a major depressive disorder.

The criterion include:

  • The need for 5 or more of the following symptoms that have been present during the same 2-week period and represent a change from previous functioning and at least 1 of the symptoms in a. a depressed mood and b. or loss of pleasure
    • Insomnia
    • Fatigue or loss of energy everyday
    • Feelings of worthlessness
    • Diminished ability to think or concentrate, indecision
    • Recurrent thoughts of death or suicide
  • The symptoms cause clinically significant distress or impairment I social, occupational or other important areas of functioning
  • The episode is not attributable to other physical effects of a substance abuse and other medical conditions
  • The occurrence of the major depressive episode is not better explained by schizoaffective disorders or other psychoses
  • There has never been a manic episode.

In the US only 1/3rd of people with severe depression take an antidepressant. This could be interpreted to mean that people do see this as a personal weakness and do not want to get caught up in the stigma attached with being diagnosed by a clinician (a psychologist or a psychiatrist) and the resulting stigma attached because of being recorded in the system of mental health disorders register.

So, here we have a world-wide mental health issue with people who have known severe depression symptoms not wanting to be “clinically” diagnosed, yet what about the vast majority of the workforce who have not or do not want to be diagnosed, or those who do not want to go to a mental health clinician. What are they doing? How are they coping? Wat are employers doing about this? Where is this endemic issue arise? Why is it here and why is it on the increase?

All of the research state something like the following yet they seem to gloss over it for some unknown reason. They state: how you respond to stress is the basis of the effects illness disease and specifically mental health issues which range somewhere between depression right through to anxiety, what is being done to help employees not slip further into the grip of the effects of stress.

If leaders of corporations knew that there was a system that could reduce stress and mental health issues:

  • Decrease depression by 60%
  • Decrease fatigue by 50%
  • Decrease anxiety by 46 %

And a whole lot more…

Would they be open to learning about this, especially since it does not involve:
Antidepressants, medication of nay kind, psychologist or psychiatrists or any other clinician and does not require to be clinically diagnosed.

The costs of depression as part of the overall mental health cots, both direct and indirect approx. $44Billion of approx. $100 Billion overall costs.

The goal of the programs in the US are about implementing a system of awareness and understanding so that the employer can identify workers with those disorders and then point them in the right direction of effective care. And. Specifically, effective care means firstly being diagnosed by a recognised mental health clinician, and generally being put onto medication, having psychotherapy or using electroconvulsive therapy if all else fails. Who in their right mind would volunteer and say they have severe depression!

What this does ultimately is to take the “cure” out of the hands of the individual and into the permanent register of the mental health system. Would you ever be able to escape? Remember ‘One Flew Over The Cuckoo’s Nest.”

Let’s look at some of the usual symptoms of depression:
It has been stated that depression is not just about having a a bad day. True an don-going depression generally negatively affects how a person feels, thinks and acts, decreasing their ability to function well at home and at work.

Common symptoms include:

  • Feeling sad
  • Loss of interest or pleasure in activities
  • Difficulty in concentrating and making decisions
  • Change sin appetite
  • Trouble sleeping
  • Fatigue
  • Restless activity
  • Feelings of worthlessness or guilt
  • Thoughts of suicide or self-harm

Research indicates that depressions affects 16M Americans, yet on an expanded view of the top countries prescribing medication the US would top that list. I believe that this figure is severely understated!

We know that depression affects the workplace and has a significant impact of: presenteeism. Lack of engagement, absenteeism, performance, focus and decision-making, time management, completing tasks, and social interactions and communication in general.

The question that needs to be asked is: if the above impacts on workplaces are known and that it is costing employers billions each year, why aren’t they doing something about this for their entire workforce, not just trying to single out those with severe depressive symptoms and sending them off to a clinician for assessment?

What about those who do not fit into the “severe” category, yet who are affected and who are performing sub-optimally? What programs are employers implementing on their behalf before they plunge into severe or diagnosable depression.

In Western Countries the solution appears to be , and in order to cover themselves legally, morally and socially, these countries pleas for a mentally healthy workplace include:

  • Increasing awareness and education
  • And helping workers understand what these issues are and then
  • encouraging employees to seek help

In the US The Centre for Workplace Mental Health has an approach with these initiatives:

  • raise awareness about depression and its effects on productivity
  • promote early recognition of symptoms and
  • reduce stigma surrounding mental health conditions

The objective of this campaign of increased awareness and understanding is to help “normalise” depression thus increasing the likelihood that employees will seek care when needed.

In the US to cover employers, they recommend including depression screening in their health risk appraisals and employee assessment programs. They also encourage employers to inform their health plans that they want primary care clinicians to conduct routine depression screening and to offer collaborative care.

They state that when depression is effectively addressed in the workplace it promises to:

  • lower the total medical costs
  • Increase production
  • Decrease absenteeism and
  • Reduce disability costs.

Results indicate 40-60% reduction in absenteeism and presenteeism with treatment of depression.
That this is a sustainable investment results indicate that for every $1 dollar spent in treatment for depression an anxiety, this leads to a ROI of $4 in better health and work performance.

How and why does depression arise?

Current research suggests that depression is caused by a combination of:

  • Genetic
  • Biological
  • Environmental and
  • Psychological factors

Depression can exacerbate: diabetes, cancer, heart disease and Parkinson’s disease.

And. Sometimes these medications lead to an increase in depression.

Risk factors include:

  • Personal or family history
  • Major life changes
  • Stress
  • Certain physical illnesses, and
  • Medications

Treatments and therapies

Depression is usually treated with medications, psychotherapy or a combination of both, or electroconvulsive (ECT) brain stimulation.

Research indicates that anti-depressants lead to an increase in the way your brain uses certain chemicals that control mood or stress. However, tit can take between 2- 4 weeks for this medication to work. The opinion is that if or when you are coming off this medication that you need to do so slowly so that you do not experience withdrawal symptoms. One unfortunate effect of this type of medication, particularly on teenagers or those under 25 is that it can increase thoughts of suicide.

The types of psychotherapy include: counselling, CBT – cognitive behavioural therapy, IPT – Interpersonal Therapy or problem-solving.

Then, if these do not work the go-to method is ECT or rTMS – repetitive transcranial magnetic stimulation or VNS – vagus nerve stimulation.

Beyond treatment tips:

  • Try to be active and exercise
  • Set realistic goals
  • Spend time with people you know and trust
  • Stop isolation
  • Don’t expect mood improvement to increase rapidly
  • Postpone important decisions such as marriage or divorce or changing jobs
  • Continue to educate yourself about depression.

What causes depression?

  • Chemical imbalance
  • Faulty mood regulation
  • Genetic realisation
  • Stressful life events
  • Medications
  • Medical problems

In all cases chemical are involved.

The research approach is to identify genes that make individuals more vulnerably to decreasing moods and influence how an individual responds to drug therapy. This necessarily leads to the objective to make a better drug!

Our brains impact on depression and certain areas help regulate mood, make nerve connections, grow nerves and help them function better. This is the aim of the drugs.

Stress plays a role in depression and may be a key factor
Stress can suppress the production of new neurons.
Anti-depressants do spur growth and branching of nerve cells – neurogenesis.

An arear that plays a significant role in depression is the amygdala which is in the limbic system the subconscious area which operate automatic the functions and is associated with emotions. It is activated when a person recalls emotionally charged memories such as a frightening situation. Activity in the amygdala is higher when a person is sad or clinically depressed. This increased activity continues even after recovery from depression.

On-going exposure to stress hormones impairs the growth of nerve cells and the HTA area.
The ultimate goal in treating the biology of depression is to improve the brains ability to regulate mood.
A combination of electrical and chemical charges allows communication within and between nerves.
Several genes influence stress response.

Temperament shapes behaviour
And is determined by

  • Your genetic inheritance and
  • By the experiences you’ve had during the course of your life
  • Cognitive psychotherapy points out that your view of the world and your unacknowledged assumptions about how the world works also influence how you feel.

Therapy and medications can shift thoughts and attitudes that have developed over time.

Stress plays an important role in depression.
Stress has its own physiological consequences
It triggers a dearth of chemical reactions and response in the body
Every real or perceived threat to your body triggers a cascade of stress hormones that produces physiological changes.

Stress response starts with a signal form the hypothalamus. HPA axis governs a multitude of hormonal activities and may play a role in depression
Change son hormonal systems may well affect neurotransmitters.
Research shows trauma during childhood can negatively affect hormone systems thru life.

Early loss traumas

Certain events have a lasting physical as well as emotional consequence.
Early losses in emotional trauma may leave individuals more vulnerable to depression later in life.
e.g. death of a parent
withdrawal of love or affection

They say you need to gain conscious understanding of the source of the loss or it may return.

Early trauma causes subtle changes in brain function that account for symptoms of depression and anxiety.
The key brain regions involved in the stress response may be altered at the chemical or cellular level.

SAD – exercise or sunlight

Certain medical problems are linked to lasting mood disturbance. Medical illness or medication may be the root of up to 10-15% of all depressions.
Thyroid medication is an example.
Heart disease is also linked to depression.
Lack of vit B12
Endocrine disorders
Drugs – steroids or blood pressure medication

Medications that may cause depression:

  • Anti – microbial
  • Biotic
  • Fungal
  • Viral

Heart and Blood pressure
Hormone tablets
Tranquilisers, insomnia aids and sedatives
And other e.g. narcotic pain medication such as codeine

US Survey talked about those who had been diagnosed with depression in the last year and revolves around: public understanding of the impact employer recognition and stigma.