Men’s Breakfast 23 Sept. 2006 -- AA MacKenzie

Men and Depression

Helping Men Understand depression and it’s affects on those around them

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An General Overview of Depression and it’s affects

Depression Affects People All Over the World

Sources: World Health Organization. World Health Report 1999: Making a Difference. Geneva, 1999.World Health Organization. Mental and neurological disorders. Fact sheet No. 265. December, 2001.Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996;276:293-299.Glass RM. Awareness about depression: important for all physicians. JAMA. 2003;289:3169-3170.

•Accounts for 3.7% of the Global Burden of Disease

•Affects 121 million people worldwide

•5.8 percent of all men(9.5 percent of all women)

•By 2020, depression will be the second leading cause of worldwide disability

•Christians are just as susceptible as non-Christians

Depression and Suicide Go Hand in Hand

• 90% are associated with mental illness, mostly depression

• 70% of successful suicides occur during a bout of

depression

Sources: Australia Bureau of Statistics (2004) as cited in the Courier Mail, Wednesday, 06 September 2006. Institute of Medicine. Reducing Suicide: A National Imperative. Washington DC, 2001.

More than 2400 suicides a year in Australia alone(Over 2X the number of homicides)

Figures for attempts not kept, but are believed to be 10X or 20X that many.

Impact of Depression on everyday life

• Depressed men:•are 2X as likely to die in any given year by suicide, trauma and homicide•have higher rates of cardiovascular disease, stroke, cancer, and diabetes•are more likely to be divorced•exhibit lower work productivity, earning potential•are at increased risk of job loss, likelihood of depressed children

• Depressed workers average 5.6 hours lost labor time per week (versus 1.5 hours for non-depressed)

Sources: Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003;289:3135-3144.

Depression has a Massive Economic and Social Impact

Depression Is Uniquely Gender Specific

Sources: National Institute of Mental Health. Real Men. Real Depression. March, 2003.Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. The Cleveland Clinic Health Information Center Web site. Depression in Men.

Drastic action is taken more by men

– Men: 80% of all suicides – Women: 20% of all suicides

• Depressed males and females present differently • Males: more frequently undiagnosed and untreated• In 2004: Half million men and 1 million women suffered from depression

Depression Is Uniquely Gender Specific

Sources: National Institute of Mental Health. Real Men. Real Depression. March, 2003.Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. The Cleveland Clinic Health Information Center Web site. Depression in Men.

Opportunity interval for prevention is markedly shorter in men.

Temporal Gender Gap Between Thought

and Action

• Women consider suicide 42 months before acting

• Men consider suicide 12 months before acting

Living with the Blues

Symptomology and diagnosis

Clinical Depression – a definition

• Everyone feels down, depressed or discouragement at some time in their lives– However, for some this is a regular,

serious and ongoing illness or condition– When someone’s mood is low or flat,

and they lose motivation and interest for at least two weeks we usually say they are clinically depressed

Clinical Symptoms• the “Big 9”

– low, flat mood– loss of interest– appetite changes– sleep changes– difficulty making decisions & concentrating– fatigue– feelings of worthlessness or guilt– loss of libido– thoughts of death

Males’ Symptom Complex for Depression is Distinctly Different from Females

Wide Range of Typical Symptoms • Sadness, hopelessness, worthlessness, restlessness • Variable physical symptoms like headaches, gastrointestinal

problems and physical pain • Increased substance/ alcohol abuse

Source: Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=8022027A-C9BC-4931-B93F392D2BC06876. Accessed Aug. 25, 2005.

Men May Hide These Symptoms/Show Depression in Other Ways • Antisocial behavior • Indecisiveness • Feelings of being burnt out / empty

• Increased susceptibility to stress • Sudden spells of anger • Lower impulse control

What Do the Experts Say?

Men may be more willing to report:• Fatigue, irritability• Loss of interest in work / hobbies• Sleep disturbances

Sources: National Institute of Mental Health. Real Men. Real Depression. March, 2003.Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.

“Men get irritable, women get depressed.”— Ron Kessler, Ph.D.

Professor of Health Care Policy, Harvard Medical School

Men may be reluctant to report: • Feelings of sadness, worthlessness,

excessive guilt

Screening and Diagnosis

Sources: Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003;289:3135-3144.

Depression is often miss-diagnosed

• Criteria used to diagnose depression is

too “feminised”

• Doctors fail to detect the illness in 60% to

70% of depressed men without classic

symptoms (although this is getting better)

• Start with recognizing unique symptoms

Contribute to a breeding ground for depression

Risk factors

Source: Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.

Depression’s roots are complex

- Depression is often caused by a number of factors working in combination, including:

•Family history of depression, which suggests a genetic association •Prior history of depression •Mental illness, such as bipolar disorder •Abuse of drugs and alcohol •Bereavement

Risk factors

Source: Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.

Depression is insidious

• Depression can also be caused by:• Experiences of loss, such as unemployment or relationship

breakdown • Stress• Undealt with childhood trauma • Some medications, such as corticosteroids and drugs for

hypertension • Sleeping disorders • Poor physical health, serious or prolonged illness.• Spiritual factors.

Depression and the Bible

Even some great biblical characters wrestled with depression. – At one point in his life, Moses wanted to die (Exodus 32:32)– While struggling with his suffering, Job "cursed the day of his birth"

(3:1). He said, "I will speak in the anguish of my spirit, I will complain in the bitterness of my soul" (7:11). In addition, he cried, "My spirit is broken, my days are extinguished, the grave is ready for me" (17:1).

– Elijah was incapacitated with depression soon after he had been an integral player in one of the great demonstrations of God's power (I Kings 19)

– After Jonah witnessed the astounding grace of God among the wicked Ninevites, he angrily said, "Death is better to me than life" (Jonah 4:3)

Depression and the Bible

• The prophet Jeremiah declared, "Why did I ever come forth from the womb to look on trouble and sorrow?" (Jeremiah 20:18)

• The amazing prophecy of Isaiah 53:3 states that the Suffering Servant, the Lord Jesus, was "a man of sorrows, and acquainted with grief." Sorrows and grief can refer to both physical and mental pain, which could include depression.

Depression and Christian Men

Some common myths:• Depression means weakness• Christian men don’t get depressed• Depression is a sign of a lack of faith• Depression always has a spiritual cause• Depressed people can just choose to get out

of it

Perpetuating myths of depression only exacerbates the problem

Diagnosing depression may present difficulty

• women more likely to meet DSM criteria

• characteristic symptoms for men–Sadness, hopelessness, worthlessness,

restlessness– Variable physical symptoms like headaches,

gastrointestinal problems and physical pain– Increased substance/ alcohol abuse

Diagnosing depression may present difficulties

• As men may disguise symptoms• Increased susceptibility to stress• Sudden spells of anger• Lower impulse control• antisocial behaviour• Burnout• indecisiveness

Diagnosing depression may present difficulties

Men may be more willing to report:– Fatigue, irritability– Loss of interest in work / hobbies– Sleep disturbances

Men may be reluctant to report: •Feelings of sadness, worthlessness, excessive guilt

Living with the Blues

Effects of parental depression on children

Effects on children

M. Weissman (1986)

• first demonstrated that family members of depressed people were at an increased risk of developing the disease themselves

• follow up study ten years later– increased social impairment– 3 x prevalence of depression & phobias– 5 x prevalence of panic disorder– 5 x prevalence of alcohol dependence– 83% depressed offspring also experience

anxiety or substance dependence

Source: Weissman et al (1997), Arch. Gen. Psych. 54, 932 – 942

Effects on children

A study of 853 children of 477 mums who were subject of child protection cases in Ontario

• 136 depressed, 341 not depressed

– Children of depressed mums at increased risk of:

– ADHD; conduct disorder; being on medication; accessing mental health services;

– not more likely to be abused, neglected or expelled

Source: Leschied et al (2003) The Relationship Between Maternal Depression and Child Outcomes in a Child Welfare Sample

Effects on children

Parental depression increases the risk of insecure attachments between parent and child– insecure attachment is a predictor of

poorer outcomes for children

Source: Herring & Kaslow (2002), Fam. Proc. 41(3), 494 – 518.

Effects on children

Another study demonstrated that children of depressed parents

– had not learnt to effectively regulate their own emotions

– frequently attempted to regulate their parent’s behaviour

– this led to increased emotional insecurity & mood disorders

Source: Cummings (1995), Develop. Psyc. 31(3), 425 – 427

Effects on children

Yet another study looked at communication patterns between depressed parents and their children– found communication was more

–Ambiguous–Changeable–unreliable with regards to meaning

Source: Teti et al (1995), Develop. Psyc. 31, 364 – 376

Effects of depression

on MARRIAGE

Effects on marriageStudy sampling 522 Australian families

– when the female partner depressed:» one third of male partners also

depressed» compared to only 20% of those

married to wife not experiencing depression

» when mum and dad both depressed there is additive effect for their children in terms of childhood/ adolescent depression and externalising behaviors.

Source: Brennan et al (2002), J. Cons. Clin. Psych. 70(5), 1075 – 1085.

Effects on marriage

A 1994 study was the first clear demonstration of a link between depression and increased parental conflict

• ALSO increased conflict led to increased emotional insecurity and mood/ anxiety disorders in children

Source: Davies and Cummings (1994), Psych. Bulletin 116 (3), 387 – 411.

Effects on marriage

Another researcher retrospectively asked large sample about childhood experiences

• adult children of depressed parent:–More likely to have grown up with conflict

»5x more likely to have major depressive disorder

» 5x greater likelihood of substance abuse

Source: Pilowsky et al (2006), J. Am. Acad. Chil. Adol. Psych. 45, 452.

DEPRESSION - A FAMILY

AFFAIR…

Effects of depression on other family members

DEPRESSION - A FAMILY AFFAIR…

• 141 families (50 dad depressed; 41 mum depressed; 50 neither depressed)– both father & mother depression serious

predictor of childhood depression

– however, non-depressed parent’s relationships with children was also negatively affected!

Source: Jacob and Johnson (1997), J. Fam. Psych. 11(4), 391 – 409.

RULE OF RECIPROCITY

During adolescence, parental depression raises likelihood of children experiencing depression– However, when kids reach adolescence it

becomes reciprocal!

– Parents children

Source: Ge et al (1995), Devel. Psych. 31, 406 – 419.

Other factors that affect families

• The effect of depression on family members– depression also increases likelihood of

• loss of income (even poverty)• social isolation• alcohol abuse• divorce• and so on

Source: Pilowsky et al (2006), J. Am. Acad. Chil. Adol. Psych. 45, 452.

Why family members have increased risks

– heritability– develop dysfunctional neuroregulatory

mechanisms (endochrine systems)

– exposure to negative cognitions

– insecure attachment, decreased responsiveness

– living with continual stress & conflict

Source: Goodman & Gotlib (1999). Psych Rev 106, 458 – 490.

TO SUMMARIZE…

Parent with Depression

Poor communication, insecure attachments, emotional insecurity

Childhood mood disorders, externalising behaviours

Increased conflict, decreased attachment

Spousal depression

Depression can truly be considered ‘a family affair’

Men & Depression…

What does help look like?

Help for Depressed Men

• Treatment optionsUnfortunately, men tend to think that asking for help is a sign of weakness, so family or friends may need to encourage a depressed man to see his doctor.

• Treatment for depression can include: • Medications, such as antidepressants• Support from friends and family• Competent counselling • Natural therapies • Self-help such as proper diet, regular exercise, leisure activities,

looking outward, etc.

Helping families with a member suffering depression

• Three (3) broad suggestions1. Help family members support the person

with depression

2. Support family members themselves

3. Consider working with whole family if possible

Helping family members

1. Helping family members support the depressed person• Encourage them to help the person get

treatment– not getting treatment is not a sign of

irresponsibility or not wanting help– it is part of the disease– family members need to know they can help the

depressed person get treatment, take medications, keep appointments (especially in the beginning)

Helping family members

1. Helping family members support the depressed person

• encourage families to:– be emotionally supportive

– be patient! be realistic

– separate illness from the person

– not to take it personally

– not to blame themselves unfairly

– take suicide risk/ signs seriously

– facilitate but not enable

– help with diet, exercise, leisure, interactions

Supporting the family members

2. Supporting the family members themselves• the depressed person often has very little capacity for

supporting others• as a result can be lonely and isolating for the family of

the depressed person• Be aware of their own risk of depression• Don’t reinforce feelings of guilt and shame• Supporting family through grief process• Linking with support networks

– church, support groups, pastoral care, etc.• Bibliotherapy

Supporting the family members2. Supporting the family members themselves

• Bibliotherapy1) Lisa, Bright and Dark by John Neufeld

– This novel recounts a teenager's struggle with mental illness and her problems with getting her parents to acknowledge that she needs help.

2) When Someone You Love Has a Mental Illness by Rebecca Woolis

– This book offers concrete advice to loved ones about how to deal with family members who are in crisis, how to work with insurance companies and how to find help.

3) Helping someone with a mental illness by Carter & Golant

– A very helpful book which give practical strategies and encouragement to struggling families.

Supporting the family members

2. Supporting the family members themselves• from a Christian point of view be aware that this

experience often raises real issues for the family’s faith– anger– doubt– why?– difficulty attending church

Working with whole family

3. Consider working with whole family if possible

• 313 people with depression followed up after 1, 4, 10 years

• several factors associated with low incidence of relapse (All relational in nature!!)

– increases family independence– decreased family conflict– increase in stable friendships

Source: Moos et al (1998), J. Ab. Psych. 107 (3), 450 – 460

Working with whole family

3. Consider working with whole family if possible• 93 families with at least one depressed member

– half received 2 information lectures– half 6 – 11 group sessions tailored for them– both helped– second approach improved family function

and children’s well-being

Source: Beardslee (2000)

Living with the Blues

3. Consider working with whole family if possible• 60 couples with at least one depressed partner

– CMT (a form of CBT) led to decrease in person’s depression and marital conflict, and an increase in relationship satisfaction

Source: Teichman (1997), Families on the threshold of the twenty-first century. Erlbaum.

Working with whole family

4. Consider working with whole family if possible

• 350 mums with depression– when dad was able to show at least low levels

of warmth and maintain moderate levels of structure it mediated against children developing depression

– other studies have shown mum’s support is protective for kids when dad is depressed

Source: Mezulis et al (2004), J. Fam. Psych. 18, 575

Helping Families

• Depression is nearly always treatable or at least manageable

• by supporting both individuals and their families real change is possible

• church communities can play a very constructive role

What can anyone do?• Know the symptoms• Encourage the depressed person to seek help• Be a friend and listen• Stay in touch and check how they’re going• Offer practical helps• Don’t give cliché answers or make light of it• Don’t pull away because you feel out of your depth• Affirm the person’s strengths• Take any comments about suicide seriously• Help create aware and supportive churches• Pray for the person (in their presence)