Shining a Light on Depression
Is it time for us to pull out all stops and shift our primary approach to depression from treatment to prevention? Prevention is better than cure—stop it before it occurs. Keep something from happening rather than fixing it after it has occurred. Yet with depression there is a relentless focus on assessment and treatment—we keep looking for a pill.1 Although treatment is of course important, there is increasing evidence that antidepressants are associated with negative side effects for older adults, medication and psychotherapy treatments often fail, and relapse is frequent.2 But an emerging body of research is shining a light by heralding prevention as the optimal approach. There is a solution right in front of us that serves as a preventative and as a treatment to depression.
Depression in Senior Living and Preempting Illness
Depression is common across the senior living spectrum,3-5 and it is distressing that a large proportion of older adults do not receive adequate treatment for it, particularly those living in residential care.6. But prevention is gaining attention in mental health policy. For example, the National Institute of Mental Health states in its Strategic Objective 2.3 the goal “to develop and test novel interventions that are targeted at pre-symptomatic or prodromal stages of illness, [and] are designed to preempt syndrome development . . .”7
The Australian-Wide Social Cure
Australia has already pulled out the stops. Research suggests that peer or mutual support groups offer opportunities for an increased sense of belonging, developing a valued social identity and a sense of purpose.8 Research documents the effectiveness of this type of support in alleviating depression and associated loneliness, and enhancing a sense of belonging.9-14 For example, a mixed methods study of mutual help groups in an Australia-wide community mental health organization reported significant improvements in self-reported well-being, including purpose in life and a reduction in medication and hospitalizations.8 Peer support has essential characteristics that include participation by those with similar personal experiences, the establishment of collaborative, mutual and equal partnerships, self-identity as individuals who have dealt with a similar illnesses or conditions, and relationships grounded in self-determination, respect and shared responsibility.15
Pulling Out All Stops – Standardizing Mutual Support
Mutual or peer support groups provided on an ongoing basis need to be a standardized approach to depression. Not just for limited periods of time but week after week. Let us pull out all stops on this. Mutual support groups are prevention and a cure, all at the same time. Depression is predicted to be the greatest contributor to illness by 2030.16 and this social approach is a light shining on the darkness that is depression, giving us hope for the future.
Submitted by Kristine Theurer, MA (Gerontology), MTA
References
1Leggett, A., & Zarit, S. H. (2014). Prevention of mentla disorders in older adults: Recent innovations and future directions. Aspects of Mental Health and Aging, 38(3), 45-52.
2Almeida, O. P. (2014). Prevention of depression in older age. Maturitas, 79(2), 136-141. doi: doi.org/10.1016/j.maturitas.2014.03.005
3Neufeld, E., Freeman, S., Joling, K., & Hirdes, J. P. (2014). “When the golden years are blue”: Changes in depressive symptoms over time among new admitted to long term care facilities. Clinical Gerontologist, In press. doi: 10.1080/07317115.2014.885919
4McLaren, S., Turner, J., Gomez, R., McLachlan, A. J., & Biggs, P. M. (2013). Housing type and depressive symptoms among older adults: A test of sense of belonging as a mediating and moderating variable. Aging & Mental Health, 18(8), 1023-1029. doi: 10.1080/13607863.2013.805402
5Adams, K. B., Sanders, S., & Auth, E. A. (2004). Loneliness and depression in independent living retirement communities: Risk and resilience factors. Aging & Mental Health, 8(6), 475-485. doi: 10.1080/13607860410001725054
6Canadian Institute for Health Information. (2010). Depression among seniors in residential care. Ottawa, Ontario, Canada: Author.
7http://www.nimh.nih.gov/index.shtml
8Finn, L. D., Bishop, B., & Sparrow, N. H. (2007). Mutual help groups: An important gateway to wellbeing and mental health. Australian Health Review, 31(2), 246-255.
9Cruwys, T., Haslam, S. A., Dingle, G. A., Jetten, J., Hornsey, M. J., Chong, E. M. D., & Oei, T. P. S. (2014). Feeling connected again: Interventions that increase social identification reduce depression symptoms in community and clinical settings. Journal of Affective Disorders. doi: 10.1016/j.jad.2014.02.019
10Finn, L. D., Bishop, B. J., & Sparrow, N. (2009). Capturing dynamic processes of change in GROW mutual help groups for mental health. America Journal of Community Psychology, 44(3-4), 302-315. doi: 10.1007/s10464-009-9265-5
11Logsdon, R. G., Pike, K. C., McCurry, S. M., Hunter, P., Maher, J., Snyder, L., & Teri, L. (2010). Early-stage memory loss support groups: Outcomes from a randomized controlled clinical trial. The Journals of Gerontology: Psychological Sciences, 65B(6), 691-697.
12Roberts, J. S., & Silverio, E. (2009). Evaluation of an education and support program for early-stage Alzheimer disease. Journal of Applied Gerontology, 28(4), 419-435.
13Theurer, K., Wister, A., Sixsmith, A., Chaudhury, H., & Lovegreen, L. (2012). The development and evaluation of mutual support groups in long-term care homes. Journal of Applied Gerontology, 33(4), 387-415. doi: 10.1177/0733464812446866
14van Beljouw, I.M., van Exel, E., de Jong Gierveld, J., Comijs, H. C., Heerings, M., Stek, M. L., & van Marwijk, H.W. (2014). “Being all alone makes me sad”: Loneliness in older adults with depressive symptoms. International Psychiatrics. doi: 10.1017/S1041610214000581
15Ahmed, A. O., Doane, N. J., Mabe, P. A., Buckley, P. F., Birgenheir, D., & Goodrum, N. M. (2012). Peers and peer-led interventions for people with schizophrenia. The Psychiatric Clinics of North America, 35(3), 669-715. doi: 10.1016/j.psc.2012.06.009
16Hindi, F., Dew, M. A., Albert, S. M., Lotrich, F. E., & III, C. F. R. (2011). Preventing depression in later life: State of the art and science circa 2011. Look this up!, 34, 67-78. doi: 10.1016/j.psc.2010.11.008