Chronic Depression: Disease Or Charcter Flaw?

A major survey on depression symptoms from the National Mental Health Association (NMHA), released in july 2006, revealed a dramatic degree of progress in public understanding. Yet even amid this promising trend, the survey sheds light on the difficulties faced by millions of people striving to manage this sometimes chronic, life-long illness.

The NMHA survey shows a major shift in public opinion in the last decade about the cause of depression. A majority (55 percent) of those polled who have never been diagnosed with depression symptoms understand depression is a disease, and not “a state of mind that a person can snap out of.” In 1991, only 38 percent recognized depression as an illness.

The survey also sketches a troubling portrait of the socio-economic lives of some people with depression symptoms. Survey respondents with depression symptoms reported higher levels of unemployment and divorce than respondents who don’t have the disorder.

“We set out to get a snapshot of the state of depression and its treatment,” said Michael M. Faenza, president and CEO of the NMHA. “The good news is that there is greater public understanding of depression and that people living with depression are finding substantial relief by following their treatment plans. The challenging part is understanding the degree to which public perceptions impact those in treatment,” said Faenza.

In this year’s survey, nearly one in three Americans say they believe depression symptoms is a state of mind. “Fifty-five percent understand the truth about depression. That is good, but it is not enough,” said Faenza. “You’d never hear 31 percent of the population deny that diabetes and heart disease are real. Erroneous beliefs about depression fuel stigma, bad public policies and poor personal choices by those living with the illness and may impede their recovery.

”The survey also describes a strong correlation between clinical depression symptoms and diminished social and economic circumstances for families. Survey respondents with depression report greater rates of divorce and unemployment than the general public. What’s more, respondents who have experienced multiple depressive episodes are even more likely to be divorced or unemployed. They also are more likely to have lower income and educational levels. The NMHA survey, conducted by Public Opinion Strategies LLC, comprised interviews with 500 adults currently being treated for depression, 300 primary care physicians, psychiatrists and psychologists and 800 members of the general public.

Gap Between Knowledge and Behavior

Survey respondents who are living with depression symptoms overwhelmingly feel that treatment, including medication, psychotherapy or both, works. (Their average self-rated symptom severity dropped from 8.5 before treatment to 3.6 within six to 12 months after starting treatment, using a severity scale of one to 10, with 10 being the most severe.)

Yet people are finding that staying with treatment is hard work. While they seem to understand the value of long-term treatment (in fact, most respondents believe that adhering to treatment is not difficult) nearly one-third (29 percent) of people on antidepressants report skipping doses during the week and nearly one-fourth (24 percent) have difficulty attending regular psychotherapy sessions. However, physicians and psychiatrists surveyed believe adherence is much lower than people in treatment profess. Almost 40 percent of doctors believe those they treat have difficulty staying with their medication regimens (a number consistent with most studies), and half (52 percent) say those they treat have difficulty staying with their psychotherapy regimens.

The survey suggests many reasons why some people don’t stick with treatment. In addition to struggling with the nature and demands of the depression symptoms, they may find the requirements of long-term vigilance overwhelming. A majority of doctors (70 percent) say those they treat for depression symptoms might find adherence easier if they could take medication less often. But medication is not the only issue. Though people with depression symptoms believe diet and exercise to be beneficial to long-term wellness, they nevertheless report not adhering with these regimens either.