The suicide of Robin Williams sent shock waves across the country. The common thread in almost all the media coverage was around why he did it—and how it could have been prevented. It was widely known that he had struggled in the past with alcohol and drugs, and more recently with depression. Yet, those closest to him felt that he was managing his depression well, and getting the help he needed.
The 2012 National Survey on Drug Use and Health, which is sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services, reported a 6.9% prevalence rate of major depression in adults over a 12-month period. In this survey, a major depressive episode (MDE) was defined as "A period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure, and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image."
The specific DSM-5 symptoms for MDE include:
- Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).
- Decreased interest or pleasure in most activities, most of each day
- Significant weight change (5%) or change in appetite
- Change in sleep: Insomnia or hypersomnia
- Change in activity: Psychomotor agitation or retardation
- Fatigue or loss of energy
- Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt
- Concentration: Diminished ability to think or concentrate, or more indecisiveness
- Suicidality: Thoughts of death or suicide, or has suicide plan
Are Your Employees Receiving the Help They Need?
Demographically, women are far more likely to report suffering a major depressive disorder than men, at 8.4% vs. 5.2%, respectively. By age, the 18 to 25 cohort had an 8.9% prevalence rate, followed by 7.6% for those who were 26 to 49, and 5.5% for those 50 and older.
Overall, 68% reported seeing or speaking with a health professional or other professional about depression in the past year. Of those who received help, most were seen by general practitioners or family doctors (58.5%), followed by psychiatrists or psychotherapists (34.4%), then by counselors (24.6%) or psychologists (24.3%).
One could argue that some help is better than no help—and, of course, the first concern is for the 32% who received no treatment for their depression at all. However, the high rate of treatment by general or family practitioners is cause for some concern. A recent study published in the Journal of the American Medical Association (JAMA) raised questions about whether primary care providers were able to provide optimal or the most effective care, with about a third of patients going undiagnosed in a primary setting. Other studies have pointed lower rates of treatment to remission for those with MDE. Issues impacting lower success rates include prescribing the correct anti-depressants, providing adequate follow up and monitoring, over-reliance solely on medication for treatment, and inadequate knowledge or resources for more complex cases or those patients who are non-responsive to treatment.
How We Can Help
As your EAP, we can be the first step in helping your employees get the help they need. We're confidential, easy to access and free—there's no need for employees to wait to talk to a qualified counselor, as we're available 24/7, and we can talk about the range of options available if the employee or a family member shows signs of depression. More than that, we can help connect them to the resources they need to receive effective care.
When an employee or family member calls us, our consultants ask callers about mental health and substance use concerns. We look for indications of possible anxiety, depression, or substance use disorders.
Whether or not the client appears to be "clinically depressed" or not, our EAP consultants are interested in getting them to whatever resources may help their mood or functioning. This is done in partnership with the client and might include taking a screening test to further look at mood issues; referral to self-help literature, groups or organizations; referral to counseling and/or medical professionals; or making a plan of intervention with follow-up by the consultant to re-assess the situation.
The consultant is able to discuss various treatment options for depression including biological methods (e.g., medication, ECT), self-help methods, Cognitive-Behavioral Treatment, couple's or family therapy, individual counseling, etc. Sometimes a client will need to address a concurrent alcohol or drug problem and may be referred for a formal drug/alcohol use assessment, treatment program or self-help group.
Help Is Just A Phone Call Away
Raising awareness about depression is critical—but, equally important, employees must be encouraged to seek the help they need. That's why your VITAL WorkLife EAP is so important—there are no barriers, no stigma and no cost to take those first steps. If clinical assistance is indicated, we work with youy to find appropriate assistance that is in-network wherever and whenever possible. Contact us and we'll be there, ready to help.