Men and depression

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  • [title and photo appear] Depression is a common and potentially deadly illness that affects people all over the world. [first bullet appears] In fact, major depression accounts for 3.7 percent of the entire Global Burden of Disease.1 [second bullet appears] It is estimated to affect 121 million citizens worldwide [first sub-bullet appears] including 5.8 percent of all men and [second sub-bullet appears] 9.5 percent of all women.2 It’s predicted that [third bullet appears] by 2020, depression will be the second leading cause of worldwide disability.
  • [title appears] Sadly, depression and suicide go hand in hand. [blue box with top text and US graphic appear] There are more than 30,000 suicides a year in the United States alone, [parentheses text appears] which is nearly twice the number of homicides. [first bullet appears] Ninety percent of suicides are associated with mental illness, mostly depression, and [second bullet appears] 70 percent of all successful suicides occur during a bout of depression.
  • [title appears] Thus, depression has a massive economic and social impact on the workplace. [first bullet appears] Depressed men are twice as likely to die in any given year than non-depressed men. This is not only due to [first sub-bullet appears] suicide, trauma and homicide, [second sub-bullet appears] but also due to higher rates of cardiovascular disease, stroke, cancer, HIV/AIDS and diabetes. [second bullet and first sub-bullet appear] Depressed men are more likely to be divorced, [second sub-bullet appears] to have lower work productivity, lower earning potential, [third sub-bullet appears] increased risk of job loss, and a greater likelihood that their children will be depressed.7 The dollar impact of all of this is not inconsequential. [third bullet appears] Workers with depression average 5.6 hours of lost labor time per week, [text in parentheses appears] compared with 1.5 hours for the non-depressed. [blue box and first bullet appear] This comes out to an estimated $44 billion a year in lost labor time from workers with depression [second blue bullet appears] versus $13 billion worth of lost labor time from the non-depressed.
  • [title and graphic appears] Depression is uniquely gender specific.6 It’s poorly understood why, physiologically, this is the case, but [first bullet appears] the reality is that males and females often present differently with depression, and [second bullet appears] males are more frequently undiagnosed and untreated.8 [third bullet appears] In the United States in 2004, approximately 6 million men and 12 million women suffered from depression. [first sub-bullet appears] Yet men represented 80 percent of all suicides, and [second sub-bullet appears] women, 20 percent.7,8 What’s especially striking is [blue text appears] the temporal gender gap between thought and action in suicides. [first bullet appears] While women, on average, consider suicide for 42 months before acting, [second bullet appears] men spend only 12 months considering it. [blue box and text appear]This means the opportunity interval for prevention of suicides in males is markedly shorter, which, in part, may account for their higher suicide success rates.
  • [title and graphic appears] Depression is uniquely gender specific.6 It’s poorly understood why, physiologically, this is the case, but [first bullet appears] the reality is that males and females often present differently with depression, and [second bullet appears] males are more frequently undiagnosed and untreated.8 [third bullet appears] In the United States in 2004, approximately 6 million men and 12 million women suffered from depression. [first sub-bullet appears] Yet men represented 80 percent of all suicides, and [second sub-bullet appears] women, 20 percent.7,8 What’s especially striking is [blue text appears] the temporal gender gap between thought and action in suicides. [first bullet appears] While women, on average, consider suicide for 42 months before acting, [second bullet appears] men spend only 12 months considering it. [blue box and text appear]This means the opportunity interval for prevention of suicides in males is markedly shorter, which, in part, may account for their higher suicide success rates.
  • [title appears] Experts are increasingly aware that males’ symptom complex for depression is distinctly different than in females. [first line of blue text appears] Most are aware of the wide range of symptoms associated with depression, [first bullet appears] including sadness, hopelessness, worthlessness, restlessness, [second bullet appears] and variable physical symptoms like headaches, gastrointestinal problems and pain, [third bullet appears] and increased substance abuse. [second line of blue text appears]But in reality, men hide many of these symptoms. Whether by nature, habit or tradition, “men don’t cry,” or at least they don’t like to admit to crying. Swedish researchers describe a “male depressive syndrome” that includes [first bullet appears] “increased susceptibility to stress, [second bullet appears] sudden spells of anger, [third bullet appears] lower impulse control, [fourth bullet appears] anti-social behavior, [fifth bullet appears] indecisiveness, and [sixth bullet appears] feelings of being burnt out and empty”.
  • [title and photo appear] U.S. experts concur, saying [first blue text line appears] “men may be more willing to report [first bullet appears] fatigue, irritability, and [second bullet appears] loss of interest in work or hobbies, and [third bullet appears] sleep disturbances than [second blue text line and bullet appear] feelings of sadness, worthlessness, or excessive guilt.”7 [blue box and quote appear] Dr. Ron Kessler, professor of health care policy at Harvard, succinctly describes it this way: “men get irritable, women get depressed.
  • [title appears] Thus, depression has a massive economic and social impact on the workplace. [first bullet appears] Depressed men are twice as likely to die in any given year than non-depressed men. This is not only due to [first sub-bullet appears] suicide, trauma and homicide, [second sub-bullet appears] but also due to higher rates of cardiovascular disease, stroke, cancer, HIV/AIDS and diabetes. [second bullet and first sub-bullet appear] Depressed men are more likely to be divorced, [second sub-bullet appears] to have lower work productivity, lower earning potential, [third sub-bullet appears] increased risk of job loss, and a greater likelihood that their children will be depressed.7 The dollar impact of all of this is not inconsequential. [third bullet appears] Workers with depression average 5.6 hours of lost labor time per week, [text in parentheses appears] compared with 1.5 hours for the non-depressed. [blue box and first bullet appear] This comes out to an estimated $44 billion a year in lost labor time from workers with depression [second blue bullet appears] versus $13 billion worth of lost labor time from the non-depressed.
  • [title appears] Thus, depression has a massive economic and social impact on the workplace. [first bullet appears] Depressed men are twice as likely to die in any given year than non-depressed men. This is not only due to [first sub-bullet appears] suicide, trauma and homicide, [second sub-bullet appears] but also due to higher rates of cardiovascular disease, stroke, cancer, HIV/AIDS and diabetes. [second bullet and first sub-bullet appear] Depressed men are more likely to be divorced, [second sub-bullet appears] to have lower work productivity, lower earning potential, [third sub-bullet appears] increased risk of job loss, and a greater likelihood that their children will be depressed.7 The dollar impact of all of this is not inconsequential. [third bullet appears] Workers with depression average 5.6 hours of lost labor time per week, [text in parentheses appears] compared with 1.5 hours for the non-depressed. [blue box and first bullet appear] This comes out to an estimated $44 billion a year in lost labor time from workers with depression [second blue bullet appears] versus $13 billion worth of lost labor time from the non-depressed.
  • [title appears] Thus, depression has a massive economic and social impact on the workplace. [first bullet appears] Depressed men are twice as likely to die in any given year than non-depressed men. This is not only due to [first sub-bullet appears] suicide, trauma and homicide, [second sub-bullet appears] but also due to higher rates of cardiovascular disease, stroke, cancer, HIV/AIDS and diabetes. [second bullet and first sub-bullet appear] Depressed men are more likely to be divorced, [second sub-bullet appears] to have lower work productivity, lower earning potential, [third sub-bullet appears] increased risk of job loss, and a greater likelihood that their children will be depressed.7 The dollar impact of all of this is not inconsequential. [third bullet appears] Workers with depression average 5.6 hours of lost labor time per week, [text in parentheses appears] compared with 1.5 hours for the non-depressed. [blue box and first bullet appear] This comes out to an estimated $44 billion a year in lost labor time from workers with depression [second blue bullet appears] versus $13 billion worth of lost labor time from the non-depressed.
  • Men and depression

    1. 1. Helping Men Understand depression and it’s affects on those around them Men’s Breakfast 23 Sept. 2006 -- AA MacKenzie DO WN BUT N T O UT , O Men and Depression
    2. 2. An General Overview of Depression and it’s affects
    3. 3. Depression Affects People All Over the World •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 nonChristians 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.
    4. 4. Depression and Suicide Go Hand in Hand 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. • 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.
    5. 5. 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) Depression has a Massive Economic and Social Impact 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.
    6. 6. Depression Is Uniquely Gender Specific Depressed males and females present differently • Males: more frequently undiagnosed and untreated • In 2004: Half million men and 1 million women suffered from depression • – Men: 80% of all suicides – Women: 20% of all suicides Drastic action is taken more by men 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.
    7. 7. Depression Is Uniquely Gender Specific Temporal Gender Gap Between Thought and Action • Women consider suicide 42 months before acting • Men consider suicide 12 months before acting Opportunity interval for prevention is markedly shorter in men. 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.
    8. 8. Living with the Blues Symptomology and diagnosis
    9. 9. 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
    10. 10. 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
    11. 11. 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 Men May Hide These Symptoms/Show Depression in Other Ways • Increased susceptibility • Antisocial behavior to stress • Indecisiveness • Sudden spells of anger • Feelings of being burnt out / empty • Lower impulse control Source: Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=8022027A-C9BC-4931B93F392D2BC06876. Accessed Aug. 25, 2005.
    12. 12. What Do the Experts Say? 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 “Men get irritable, women get depressed.” Ron Kessler, Ph.D. Professor of Health Care Policy, Harvard Medical School — 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.
    13. 13. Screening and Diagnosis • Criteria used to diagnose depression is Contribute to a breeding ground for depression 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 Depression is often miss-diagnosed 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.
    14. 14. Risk factors - 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 Depression’s roots are complex Source: Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.
    15. 15. Risk factors • 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 is insidious Source: Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.
    16. 16. 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)
    17. 17. 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.
    18. 18. 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
    19. 19. 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
    20. 20. 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
    21. 21. 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
    22. 22. Living with the Blues Effects of parental depression on children
    23. 23. 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
    24. 24. 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
    25. 25. 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.
    26. 26. 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
    27. 27. 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
    28. 28. Effects of depression on MARRIAGE
    29. 29. Effects on marriage Study 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.
    30. 30. 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.
    31. 31. 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.
    32. 32. DEPRESSION - A FAMILY AFFAIR… Effects of depression on other family members
    33. 33. 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.
    34. 34. 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.
    35. 35. 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.
    36. 36. 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.
    37. 37. TO SUMMARIZE… Depression can truly be considered ‘a family affair’ Parent with Depression Poor communication, insecure attachments, emotional insecurity Increased conflict, decreased attachment Childhood mood disorders, externalising behaviours Spousal depression
    38. 38. Men & Depression… What does help look like?
    39. 39. Help for Depressed Men • Treatment options Unfortunately, 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.
    40. 40. Helping families with a member suffering depression • Three (3) broad suggestions 1. Help family members support the person with depression 2. Support family members themselves 3. Consider working with whole family if possible
    41. 41. 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) –
    42. 42. 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
    43. 43. 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
    44. 44. Supporting the family members 2. Supporting the family members themselves • Bibliotherapy 1) 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.
    45. 45. 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
    46. 46. 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
    47. 47. 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)
    48. 48. 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.
    49. 49. 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
    50. 50. 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
    51. 51. 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)

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