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Keeping the black dog at bay: Remaining vigilant against depression

An exploration into depressive mental health and why the world cannot afford to ignore the dangers of disorders, such as depression, regardless of the current health crisis.

17 September, 2020

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Depression Assessment Telehealth Anxiety

The world cannot afford to ignore the dangers of mental health disorders such as depression, regardless of the current health crisis.

Given our preoccupation with COVID-19 these days, it’s easy to forget that there are other health issues, especially pertaining to mental health, which continue to afflict a significant section of the population in Australia and around the world. Indeed, they may be exacerbated by the pandemic.

Over 264 million people are affected worldwide by depression, which is a major health concern in Australia as well, according to Jaimie Bloch, a clinical psychologist and founder of Mindmovers Psychology in New South Wales.

In Australia, more than one million adults currently experience depression, and in their lifetimes, as many as one in seven people in the country will be depressed, according to some estimates. Further, looking at the overall state of mental health in the country, another report has found that 20 percent of Australians in the 16 to 85 age group suffer from a mental illness in any given year, with depressive, anxiety and substance use disorders being the most common.

Why are numbers on the rise?

There are a number of factors commonly linked to depression, according to mental health experts who note that it is usually triggered by "a combination of recent events and other longer-term or personal factors, rather than one immediate issue or event".

Contributing factors include long-term issues, such as extended unemployment or prolonged work stress, physical or mental abuse in a relationship, or continued isolation or loneliness. Stress-inducing life events, such as losing a job or death of a close friend or relative, and drug or alcohol abuse can also trigger depression. Family history can play a part as well, with up to 40 percent of the risk for developing depression possibly due to genetic factors, according to the Australian Psychological Society.

Meanwhile, the coronavirus pandemic is contributing to the problem with growing numbers of Australians suffering from depression, as widespread lockdowns and associated job losses affect mental health.

"COVID-19 has created this lack of uncertainty and people who were already suffering from mental health challenges are definitely being impacted the most, especially in lower socio-economic groups and minority groups," says Jaimie. Amid the lockdown, psychologists are "seeing even more isolation", she says, adding that contributing factors like domestic violence have also increased.

But the pandemic has also forced people to pay more attention to mental health. This is a positive development because the key to staying on the front foot against conditions like depression, Jaimie says, is to recognise the problem early by being at the forefront of assessment and analysis – a focus area for Pearson Clinical.

"Pearson Clinical provides such amazing equipment and psychological assessment tools. They really provide great objective measures without which it would be impossible to get baselines and to figure out where a patient might be."

Culture plays a major role

The number of Australians who are diagnosed with depression and anxiety disorders is on the rise and this trend may have its roots in the larger cultural environment that many Australians, and others in the West, find themselves in, says Jaimie.

Many across the developed world have cut themselves off from traditional support networks and living conditions in Australia are also seen worsening feelings of isolation and loneliness more so than in other countries and cultures.

"Unfortunately, Australia [and] a lot of Western countries have very high rates of depression and suicide. There are always many reasons, but a lot of it is due to Western culture and the way that mental health is viewed and looked at," Jaimie says. "There is a lot of stigmatisation around having mental health challenges, which means that people are less likely to reach out for support."

In countries like Australia, a large number of people live within their nuclear families, meaning that there is less familial support structure – from grandparents, cousins, aunts and uncles, for example, than there would be in cultures where multigenerational living is more common. As a result, Jaimie says, there is "less community, less focus around that altruistic connection and more focus on self", noting that research suggests that “the more self-focused you are, the more negative and critical you are and the more depressed you’ll be”.

She also notes that the data presents a surprising dichotomy – Western countries have shown to have both the highest happiness levels, and the highest depression rates.

"There definitely could be this factor of chasing this dream which could make you really happy, but at the same time extremely stressed out and burnt out," she observes.

"Especially in Australia, you have so much stress at home, this never-ending, constant rat race, this cycle that people are stuck on. Because of that you’re going to have moments of happiness and you’re going to have these really deep moments of loneliness and sadness too."

In the Harvard Study of Adult Development, one of the longest-running studies of its kind, researchers are continuing to find that in developed, Western countries "where minimum material living conditions are?often satisfied, people may struggle to become happier because they are targeting material rather than social goals".

An unequal affliction

While depression can hit anyone at any time, Jaimie says that young people – her key clinical group – are at high risk and numbers are on the rise, with one in four adolescents experiencing a mental disorder. Further, early onset of the condition can lay the foundations of depression for later in life, she says.

“There’s plenty of research that shows all mental health disorders are created and the foundations implemented before the age of 25. It’s definitely more prevalent once you hit adulthood but the underpinnings of it are in youth.”

It is a growing concern for Australia’s young people. Mission Australia’s 2019 Youth Survey found that over a third of respondents cited "mental health" as one of the top three issues affecting Australia today, and a similar percentage cited mental health as a top-three personal concern.

More than 40 percent of Year 12 students report symptoms of anxiety and depression, which is higher than the normal range for their age group, and suicide is the leading cause of death for people aged 5-17 years old, according to the Black Dog Institute. Socioeconomic factors also unquestionably play a role, according to Jaimie, with Aboriginal and Torres Straits Islander people having the highest suicide rate among the Australian population.

Prioritising mental health

In response to the scale of the problem, the field of psychology has "exploded" in the last few decades, according to Jaimie. And growing accessibility to a psychologist, awareness in the community to the importance of mental health, and research around the outcomes when people can access support, have been hugely positive steps for Australians.

She sees reason to be hopeful, but adds: "I think that for all mental health it takes time and…obviously there is more work to be done." For her and her peers, finding the right diagnostic material and assessment tools are part of the battle, but she hopes that there is a growing recognition of the need for a cohesive strategy across the board, from the national level down.

Indeed national support has been forthcoming in the age of the coronavirus. With caseloads growing even as assessments become challenging due to the need for social distancing, psychologists and other health professionals are having to innovate rapidly – including with telehealth solutions – to limit in-person appointments to minimise risk.

The government’s support has been invaluable here, Jaimie says, and programmes like Australia’s e-mental health strategy have come into their own. With funds flowing into e-mental health, getting accessibility to people has been prioritised.

"This strategy is obviously a long-term vision, developing accessibility and a high-quality e-mental healthcare system for people."

It is also crucial to involve multiple stakeholders. "People don't change by themselves or in a vacuum and we need community support, so getting everyone in line and onto the same page is crucial," Jaimie says, emphasising the need to help everyone to understand the science and data we have around to understand thoughts and emotions.

Particularly given Australia’s cultural background and the predilection for isolation and stigmatism of mental health, there needs to be much more awareness in the community about the importance of investment in mental health, especially early on.

“I think that a lot of people might not prioritise their mental health until they’re in a crisis, and crisis work is always unhelpful. We want preventative work - so people accessing services or connecting to someone before something becomes really bad."

Continue reading: Placing a lens on depression