Date: April 1st, 2004
Spring may be a time of renewal, but it is also the peak suicide season, when the incidence of death rises with the warmer temperatures. Older adults with depression are especially at risk this time of year, yet few will receive medical attention.
Psychologists have speculated that depressed, suicidal individuals survive the winter clinging to the hope that spring will rejuvenate their lives. When spring arrives, however, their expectations are dashed as life continues as before and the depression persists. Year round, late-life suicides occur every one hour and thirty-nine minutes, a death rate that is 50 percent higher than any other age group.
Suicide can be prevented when severe depression is diagnosed and treated. But there lies the problem: late-life depression is widely under recognized and under treated in the U.S. Less than 10 percent of the 6 million older adults affected by depression will ever receive treatment.
Ageism Perpetuates a Myth
At the heart of the problem is the pervasive myth that depression is a normal part of aging, according to Lea Ann Browning McNee, senior vice president of public affairs and community development at the National Mental Health Association.
"Most people think that depression comes naturally with aging-that older adults are depressed because 'they're just old,'" she said. "But no one has to live with depression."
Unfortunately, most seniors buy into this myth, too. According to the National Mental Health Association, 68 percent of Americans over age 65 know little or nothing about depression, and less than 40 percent believe that depression is a "health" problem. Those suffering late-life depressive symptoms are more likely to cope on their own than to visit a health professional for treatment.
The stigma of mental illness prohibits many older adults from speaking out about their suffering. It is now known that depression is a physical condition related to the change and imbalance of brain chemicals that help regulate mood. In earlier generations, afflicted individuals felt responsible for their condition.
"If older adults think that depression is normal, then to admit that they are really depressed somehow means that they are weak," Browning McNee said. "Depression is in no way a weakness of character or a personality flaw." Depression sufferers may also worry that a diagnosis will imply that they can no longer manage their finances or their home.
Depression Goes Undetected
When patients do visit their doctors, a lack of communication may contribute to low depression diagnosis rates. Family physicians have little time to tease out depression symptoms when patients complain of physical, rather than mental, ailments. Studies have shown that primary care physicians recognize less than one half of patients with depression.
"We don't train the primary caregivers in our society adequately, or in some cases at all, to recognize depressed and suicidal older adults," said John L. McIntosh, professor and department chair of psychology at Indiana University South Bend. Physicians, nurses, caregivers, social services caseworkers, and others who visit seniors need to know what to look for and how to take action.
Depression is the most common mental illness among adults over age 65, affecting 15 percent of community residents and more than 25 percent of adults living in nursing homes. Untreated, depression can contribute to problems with activities of daily living, leading to increased dependence, greater disabilities, and an increased risk of death, particularly suicide.
Feelings of extreme hopelessness and helplessness are common among depressed individuals, who may withdraw from their regular daily activities and from loved ones. Depression can also cause a lack of energy, difficulty sleeping, changing attitudes about life, and recurrent thoughts of death and suicide.
"Depressed people often believe that there are no more options for their problems," said McIntosh. "They may experience tremendous psychological pain-a mental hurting that has a major effect on their perspective on life and how they view their future."
While everyone experiences low days, depression is typically defined by a depressed mood most of the day, nearly every day, for a period of two weeks or longer and a loss of interest in activities that the person usually enjoys.
A Link to Stress and Disease
The onset of depression can be triggered by a major life change, such as the loss of a spouse or other family member, retirement, a move to a new community or nursing home, or a change in health status. The depressive symptoms are more severe and persistent than the grief or sadness associated with losses in late life, and interfere with a person's ability to function.
Medical illnesses common in late life, such as stroke, heart disease, Parkinson's disease, and certain kinds of cancers, as well as chronic illnesses and the associated pain, can also produce depression. The incidence of debilitating illness increases with age, and depression often results from impairments, causing physical symptoms to intensify. This process may happen gradually, so depression is difficult to detect, according to Dr. Rollin Gallagher, director of pain management at the VA Medical Center in Philadelphia.
"What is interesting is that when adults have mild aches and pains, most cope with the pain and don't visit a doctor," he said. "But with the onset of depression, older adults may complain about the pain more and feel that they can't tolerate it as well."
Medical professionals and caregivers should be aware of the relationship between impairment and depression. "The more pains an individual has, such as back pain, headaches, and leg pain, the more likely they are to have depression," Dr. Gallagher said. Once the depression is treated, the patient returns to a higher functional level.
Depression treatment varies, but may include medications and/or psychotherapy. A primary care physician may provide treatment, or may refer patients to a mental health care provider. Clinical depression is treated successfully in over 80 percent of all cases.
Symptoms of Depression
(Source: National Mental Health Association)
You may be depressed if you experience five or more of the following symptoms for more than two weeks.
- Persistent sad, anxious, or "empty" mood
- Sleeping too little, early morning awakening, or sleeping too much
- Reduced appetite and/or weight loss, or increased appetite and weight gain
- Loss of interest in activities once enjoyed
- Restlessness, irritability
- Persistent physical symptoms that don't respond to treatment (such as headaches, chronic pain or digestive disorders)
- Difficulty concentrating, remembering, or making decisions
- Fatigue or loss of energy
- Feeling guilty, hopeless or worthless
- Thoughts of suicide or death
What You Can Do
- Learn to recognize the warning signs of depression and suicide.
- Consider that depression may be a factor even when an individual complains only of physical pain and illness.
- If you suspect that a loved one is depressed, ask, and address the issue head-on. Just as you may worry about a loved one's vision, mobility, or other health problems, mental health is equally important for well-being.
- Encourage your loved one to share their concerns with a health care professional, faith leader, or other resource person.
- If you are concerned that a loved one is severely depressed, seek help for them immediately. In a depressed state, they may not have the energy or the initiative to seek help for themselves.