After a knowledge drought about depression, the 1980s and 1990s brought increased medical and psychological understanding. According to John Greden, MD, Rachel Upjohn Professor of Psychiatry and Clinical Neurosciences, chair in the Department of Psychiatry, and executive director of the U-M Depression Center, doctors now understand that a combination of genetic vulnerabilities and trauma produce alterations in the brain. With further stress—including alcohol, drugs, and poor sleep— depression can occur.
With depression affecting one out of every seven people, according to the U-M Depression Center, and with suicide the eighth leading cause of death among Americans in 2005, according to the Surgeon General, many faculty at the School are building on past research to work toward finding solutions.
Depression across the life span
From infants and mothers to elementary-school children and adolescents to the elderly, faculty are studying depression across the life span.
Professor Mary Ruffolo is one faculty member studying depression among adolescents. In the Mental Health Outreach Project funded by the State of Michigan Department of Community Health, she and Lecturer Dan Fischer have modified and evaluated evidence-based cognitive behavioral interventions (CBT) delivered in group formats for youth living with depression.
Preliminary findings from the first two years of the evaluation indicate that the group intervention is effective in decreasing significantly the levels of depressive symptoms reported by the youth. Delivering the intervention in school-based health clinics has decreased the level of stigma associated with youth seeking mental health treatment and increased their access to mental health services.
Studying the other end of the life span is Associate Professor Lydia Li. With a pilot grant from the U-M Geriatrics Center, she and colleagues are studying the prevalence and correlates of depression and suicidal behavior among frail elderly persons living in the community.
Preliminary findings suggest that depression is quite prevalent in this population, with 35 percent of the sample having recognized depression and 28 percent taking antidepressants. About 2.5 percent of the sample have considered or tried injuring themselves. While women are more likely to have recognized depression, men are more likely to have self-injury thoughts and attempts.
Contrary to popular belief, “depression is not a consequence of aging,” says Dr. Greden. Rather, with little or no intervention, depression worsens over time.
Depression across cultures and races
Professors Matthew Howard, Briggett Ford, and Sean Joe are taking another approach to depression: the effect of culture and race. Professor Matthew Howard recently reviewed self-reports of psychiatric symptoms among incarcerated African American and White youth. Depression was found to be higher and suicide ideation significantly higher among White juvenile offenders.
In October, Assistant Professor Briggett Ford spoke at a U-M Depression Center panel presentation, “Depression at Work.” Ford has found that culture, race, and ethnicity affect gender differences, symptoms, diagnosis, and acceptance of depression. While men tend to express their depression in anger and White women in sadness, depressed Black women tend to be irritable. Thus, Whites with depression are more likely to be diagnosed correctly, while Blacks with depression tend to be diagnosed with schizophrenia.
“What cultural norms and stigmas must people go past before they are willing to say they are sad?” asks Ford. She asserts that although it is more common for women than men to be allowed to be depressed, this has been changing. In addition, faced with the multiple demands and priorities of their daily lives, often people of color see the need for permission to be ill. Thus, if close friends and family members overlook symptoms, an African American with depression may be less willing to seek treatment.
Assistant Professor Sean Joe has recently focused on interventions for African American males in a common consequence of depression—self-destructive behaviors, including suicidal behavior. Among those with mood disorders, he has discovered a fourfold increase in risk of attempts of suicide.
In an article published in the November 1 issue of the Journal of the American Medical Association, Joe reported the first nationally representative study for attempted suicide among Blacks of African American and Caribbean ethnicity in the United States.1 He found that about 70,000 of them try to kill themselves each year and 4 percent, or about 1.4 million, attempt suicide at least once in their lives. This rate is comparable with the general population but higher than previous estimates.
Hope through self-help and treatment
Dr. Greden emphasizes that depression can be treated and reversed. Individuals have tools at hand to help control depression: exercise and regular sleep increase the production of neurotrophins for antidepressant action in the brain, while cessation of substance abuse halts negative input. Research shows that a combination of medication and psychotherapy works better for most individuals than either method alone.
Professor Thomas Powell has focused on self-help for individuals with mood disorders. In a study of hospitalized patients with unipolar and bipolar disorders, Powell and colleagues reported that the illnesses were managed by two factors.2 Education both before and after the development of the illness influenced outcome, and those who felt involved in a self-help group for people with mood disorders reportedly managed their illness more effectively.
“Self-help is not a solitary activity, it is a mutual activity,” Powell wrote. “It is not a helping of ‘others’ activity, it is a ‘helping ourselves’ activity.” He has found that self-help groups for those with unipolar depression and bipolar disorder are a complement to professional treatment. Powell is writing a book that further explores the role of self-help in mood disorders.
Treatment, however, tends to be less available to those with lower income. In a study of low-income women in an urban Michigan county, Professor Richard Tolman found that fewer than one in five respondents with a current mental health problem (including depression) and/or substance dependence problem received treatment in the past year.3 In comparison, women of comparable age and race ratio (Black or White) in a nationally representative sample were significantly more likely to receive treatment for major depression (31.8% versus 20.2%). Reasons women gave for not receiving treatment included cost, structural barriers, and perceptions of treatment.
Associate Professor Brett Seabury has created two interactive video tutorials to teach students how to apply the classroom concepts of crisis intervention and suicide assessment. He has used these tutorials for the past four years in his teaching and has also made them available on the SSW website for the benefit of other instructors and students, knowing of many colleges in the United States and one in Scotland that use them. Seabury evaluated the two programs, reporting that students using the programs were able to effectively apply crisis and suicide concepts in simulated video examples.4
These and other faculty members continue to look toward future research in depression. For example, Associate Professor Leslie Hollingsworth is principal investigator, with Professor Matthew Howard as co-investigator, on a new study funded by the U-M Rachel Upjohn Depression Center. They are collecting data in a pilot study of an uninsured, urban population in Detroit to assess perceived barriers to depression care and to test a depression screening and intervention innovation.
In another study funded by the Depression Center, Richard Tolman presently is examining whether the relationship between trauma and major depression among low-income women is direct or occurs through posttraumatic stress disorder.
As faculty work to understand depressive symptoms, factors, and treatment, they are helping to build a knowledge base that can bring hope and freedom to millions affected by this brain disease.
—Tanya C. Hart is editor of Ongoing
1 Joe, S. (2006). Prevalence of and risk factors for lifetime suicide attempts among Blacks in the United States. Journal of the American Medical Association, 296(17), 2112–2123.
2 Powell, T. J., Yeaton, W., Hill, E. M., & Silk, K. R. (2001). Predictors of psychosocial outcomes for patients with mood disorders: The effects of self-help group participation. Psychiatric Rehabilitation Journal, 25(1), 3–11.
3 Rosen, D., Tolman, R. M., & Warner, L. A. (2004). Low-income women’s use of substance abuse and mental health services. Journal of Health Care for the Poor and Underserved, 15, 206–219.
4 Seabury, B. (2005). An evaluation of on-line, interactive tutorials designed to teach practice skills. Journal of Teaching in Social Work, 25(1/2), 105–115.