Sunday, January 14, 2001

Project seeks to improve diagnosis of depression

Checklist to help raise awareness

By Tim Bonfield
The Cincinnati Enquirer

        Do you feel like such a failure that you've let your family down? Do you feel uninterested in doing things you normally enjoy? Do you think you would be better off dead?

        These and similar questions will become an increasingly common part of people's visits to their primary care physicians if the leaders of a communitywide depression-awareness project have their way. In fact, one large neighborhood clinic network already has stepped up its efforts to check patients for signs of depression.

    For people with depression or other mental heath concerns, these agencies provide service referrals, consumer advocacy services or research services:
    • Mental Health Access Point: Helps connect children and adults to mental health services in Hamilton County. 558-8888.
    • Mental Health Associations of Cincinnati and Northern Kentucky: Agencies that provide information, support groups, screenings and volunteers. In Cincinnati: 721-2910. In Northern Kentucky: (859) 431-1077.
    • National Alliance of the Mentally Ill: A family and patient consumer advocacy group. Hamilton County: 948-3094; Northern Kentucky: (859) 441-7377; Warren and Clinton counties, 933-5201.
    • Recovery Initiative: A consumer-run agency offering support groups, a resource center and advocacy services. 221-8660.
    • University of Cincinnati Biological Psychiatry Program: Conducts clinical trials of medications to treat mental disorders. 558-6652.
    • Women's Crisis Center: Provides support for women and children who are victims of rape, incest and physical abuse. 491-3335.
    • Psychiatric Emergency Services: Provides 24-hour crisis counseling. 584-8577.
    • Crisis and Suicide Hotline: Provides 24-hour crisis counseling and referral. 281-CARE.
Learn more about depression or, if you think you might be depressed, take this test.
        The Cincinnati Health Network, which includes seven clinics that see about 25,000 patients a year, has started using a standard, nine-question checklist to measure whether a person has depression and whether treatments are making any difference. The effort is part of a wider project to adopt clinical treatment standards for chronic health conditions.

        “We know that when depression is effectively diagnosed and treated, a lot of other health problems are relieved as well. People get better all the way around,” said Dr. T.J. Redington, medical director for the Cincinnati Health Network and director of community health for the Health Alliance of Greater Cincinnati.

        Unlike the talk people hear about winter blues, depression is a mental health problem with potentially serious consequences.

        Depression is a chemical imbalance in the brain that can hurt personal relationships, damage careers, aggravate other health problems and in extreme cases lead to suicide.

        Cheviot resident Cecelia Shooner, 51, has been living with bouts of depression since she was 19. She praised the increased effort to encourage doctors to look for depression because it took years for her problems to be diagnosed.

        “At the time, I thought everybody saw the world the way I did. Nobody ever said to me, "This is depression,' ” Ms. Shooner said.

        Depression is more common than many people think, affecting an estimated 19 million Americans a year, according to the National Mental Health Association. And while experts say depression can be effectively treated with medication and counseling, fewer than half of those who are depressed ever seek or receive treatment.

        There are clear differences between clinical depression and a few days of feeling blue, Ms. Shooner said.

        “I would notice when I was losing ground. Simple physical tasks become greatly burdensome. I would get fatigued and want to stay in my house all the time and not socialize at all,” she said. “Untreated, it could go on for a year or longer.”

        “You lose all your motivation to do the things you love the most. You lose your spirituality. You get a deep sense of isolation and lack of motivation. And if it continues long enough it turns into despair. You start to see absolutely no hope of change and that's when you become a suicide risk.”

        “The idea of taking my own life certainly entered my mind more than once,” Ms. Shooner said.

        Over the years, Ms. Shooner needed hospital care several times for severe depression. But she has avoided hospital stays for three years now. New-generation medications, counseling, and developing a written plan to use when depression hits have made the difference.

        In addition to teaching photography, Ms. Shooner also teaches people how make their own “wellness recovery action plans,” she said.

        Since 1999, the Health Improvement Collaborative of Greater Cincinnati has been running a depression-awareness project — a program expected to continue for several more years.

        Last year, the depression project began offering classes for doctors to update them on how to spot and treat depression in patients who come to see them for other medical problems. It also has begun working with Tristate employers to raise awareness among workers because more than 70 percent of people with depression are employed, yet their productivity is affected by depression.

        “Depression is a huge mental-health issue. It is pervasive throughout the community,” said Dr. Allen Daniels, chairman of the depression project and chief executive of Alliance Behavioral Care.

        “All primary care doctors should be more routinely screening patients for depression. But many don't,” Dr. Daniels said.

        For example, people who survive heart attacks but become depressed are far more likely to die within a year than those who are not depressed. Some heart-attack survivors get screened for signs of depression, but many don't, Dr. Daniels said.

Myth of holiday suicides

        Increased community awareness about depression is important because many people have misconceptions about depression and suicide, said Dr. Herbert Hendin, medical director of the American Foundation for Suicide Prevention.

        For example, many people, including many in the media, think the holiday season produces the highest numbers of suicides. But December actually has the lowest number of reported suicides of any month.

        About 30,000 people a year nationwide kill themselves, including 78 suicides reported in 1999 in Hamilton County. The highest months for suicide actually are June, July and April, according to the foundation.

        “There is such a thing as holiday blues. People become aware of lost family members or their lack of family relationships. But it appears that this kind of thing does not lead to suicide,” Dr. Hendin said. “The factors that lead to suicide are more complex.”

        About 95 percent of people who commit suicide had a history of mental illness that was either diagnosed or was well known among family and friends. About two-thirds of those people had suffered from depression. Others had bipolar disorder, schizophrenia and other problems.

        “We think better treatment of depression will lead to a reduction in suicide rates,” Dr. Hendon said.

Screening gets easier

        Screening for depression has become increasingly simple. There are several standard questionnaires on the market. Several self-tests are offered on the Internet.

        The one used by the Cincinnati Health Network was modified from a popular form called the Prime-MD Patient Health Questionnaire, along with information from DSM-IV, a widely used manual of psychiatric illnesses.

        Regardless of test results, anyone who feels suicidal should call 911 or a community hot line.


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