The death of beloved comedian Robin Williams is a stark reminder of how depression can ravage anyone, regardless of one's status or prominence in society. Caused by a complex interplay between genes and environment, depression continues to be a major mental health concern as prevalence rates remain among the highest relative to other psychiatric conditions. The lifetime estimate for major depressive is 16.6 percent (Kessler et al, 2005). Studies have reported lifetime estimates as high as 20 percent for women and 12 percent for men (Kessler, 1994). And not only are those rates increasing, but 80 percent of those afflicted will experience multiple episodes of the disorder (Kessler, et al, 2003).
Of particular note, the risk for suicide, one of the most tragic consequences of depression, is highest among older, white men who are depressed (CDC data). The risk for those who struggle with depression and substance abuse is even greater.
While research has yet to fully explain why suicide rates are higher among middle-age or older white males, one possibility is that men may be less likely than women to seek to seek help until it is too late because they are traditionally discouraged from expressing emotions. The fact that men choose more lethal methods when they decide to end their lives may also be another reason why suicide rates are higher among men. I would also propose that white men, who hold the position of highest privilege in society, tend to have less experience facing negative or stigmatizing experiences as compared to other groups, including women and minorities, who may have spent a lifetime learning to cope with such experiences. The contrast effect of falling from power as they age, retire, or develop medical conditions combined with the lack of necessary tools to cope with negative experiences may pose a greater challenge for white men as a result.
Can any of the factors that make older white men, or anyone who is vulnerable, be remedied? Research, including my own, shows that negative thinking styles put people at risk for developing depression. For example, people who tend to believe that life is overwhelming and filled with insurmountable obstacles, think that they are inadequate or flawed, or believe that negative consequences will follow if something negative happens to them are likely to become depressed.
As one effective form of alleviating the symptoms of depression, cognitive behavior therapies are geared towards changing these negative styles and helping people overcome their urge to withdraw or escape from life stresses.
In addition to cognitive behavior therapies, anti-depressant medications and interpersonal therapy have also shown to be effective for treating depression. Yet many people remain untreated because they lack awareness of the condition and how it is treated or because they are afraid of being stigmatized. As a result, people often choose ineffective ways of helping themselves and often face a long downward spiral, including developing feelings of hopelessness and a belief that suicide may be the only solution to get relief from their suffering.
Of course, even those who receive effective treatments may not be completely out of the woods. Relapse is common once treatment is discontinued and people often suffer from multiple episodes of depression. Patients often need a combination of cognitive behavior therapy and anti-depressant treatment once depression becomes chronic, and even so may not fully respond, or may relapse even if their symptoms lift for a while. In fact, some theories suggest that, like a scar, depression may not completely heal for some people once it begins. This means that identifying those who are vulnerable and intervening before depression begins may hold promise for making the greatest public health impact. A recent study I conducted using a new cognitive and behavioral strategy combined with others to inoculate people from being depressed showed that the likelihood of developing depression might be reduced, even in those who develop medically induced depression
The increasing prevalence of depression, the high rates of relapse, and the extent of individual and societal costs associated with depression -- an estimated $83 billion per year on the U.S. economy (Greenberg et al., 2003) -- underscore the importance of identifying risk factors and implementing prevention programs. But we cannot wait to intervene until those who are susceptible reach adulthood. Children and adolescents who are vulnerable usually suffer in silence. Unlike those who act out or have other disruptive conditions, children who are vulnerable to depression may be quiet, obedient, and aim to please and as a result rarely come to the attention of parents, educators, and pediatricians until full-blown symptoms emerge. For this reason, I would advocate incorporating evidence-based CBT strategies into the general social-emotional curriculum in schools to help those who are vulnerable before it is too late.
The heartbreaking death of one of our brightest stars brings home to us that using creative ways to psychologically inoculate vulnerable children and adolescents may hold the greatest potential for reducing the ever-increasing burden of depression. Not to do so would be irresponsible.
Greenberg, P.E., Kessler, R.C., Birnbaum, H.G., Leong, S.A., Lowe, S.W., Berglund, P.A., (2003).
Kessler RC1, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU,Kendler KS. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994 Jan;51(1):8-19.
Kessler, R.C., Berglund, P., Demler, O., Jin, R.,Merikangus, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.
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Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
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