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Depression is a debilitating condition that can render a person incapable of coping with daily life. At its very worst, it can leave one feeling utterly hopeless and carries a very high risk for suicide. People suffering from chronic disease have an even higher incidence of depression than the general population. The positive news is that, when properly diagnosed, it can be successfully treated. However, further research is needed to find the most effective approach to diagnosis as a first step to providing more timely help for those in crisis.
Coping with chronic disease is a tremendous strain that, in more than 10% of cases, will trigger an episode of debilitating depression, according to the Public Health Agency of Canada.
“Depression is a devastating condition that has a major impact on quality of life for patients and their families. We need to focus resources on providing the most effective therapies to those who are in the greatest need,” says Dr. Brett Thombs, a senior investigator at the Lady Davis Institute.
Despite its prevalence, depression can be difficult to diagnose and some people with the condition resist seeking treatment because of the stigma attached to mental health issues. As a result, some governing bodies and medical associations have endorsed the use of standardized questionnaires to screen for depression among those suffering from chronic medical conditions. On the surface, screening for depression seems like a good way to identify patients within a setting where they could receive care. However, research led by Dr. Thombs shows that such questionnaires do not work nearly as well as advertised. When they have been used to try to identify people in need of treatment for depression, many more people have gotten treatment, but the number of people with depression has not been reduced.
“Simple-to-use depression questionnaires are popular precisely because they are easy to administer to patients who come for treatment for chronic conditions like heart disease, diabetes, and arthritis, but fail to reveal undiagnosed depression. Contrary to expectations, however, they do not find many patients who benefit from initiating depression treatment. On the other hand, they generate high numbers of false positives,” said Dr. Thombs, who has reviewed the data along with a team of internationally renowned mental health professionals, epidemiologists, and graduate students that he has assembled. His team has pointed out the urgent need for an effective approach to managing depression in medical settings so that patients can be provided the help they need.
“The bottom line,” he insists, “is that tremendous resources are being expended on diagnostics that don’t work and in prescribing drugs to people who do not benefit. Furthermore, the perception that we have a solution can be a barrier to the development, testing, and implementation of new and innovative strategies.”
As impressive as have been Dr. Thombs’ findings to date, more research is required in order to refine the data and to point the way to better alternatives. To this end, he hopes to create a Depression Screening Registry that would enable researchers to analyze hundreds of databases simultaneously in order to determine the best strategy to identify people who would benefit from treatment for depression. “Our work will help to steer mental health resources to those who need it most,” he said, “which is critical because people with severe depression can be effectively treated and this is key for helping the increasingly large number of people with chronic medical conditions live more fulfilling lives.”
The Psychosocial Research Axis at the Lady Davis Institute is dedicated to examining the psychological distress associated with serious illness, and the toll it takes on patients.
Researchers within the Psychosocial Axis, headed by Dr. Phyllis Zelkowitz, bring wide-ranging expertise to the study of psychosocial elements of physical and mental illness and undertake important critical evaluations on how health research is conducted. Psychosocial inquiries evaluate interventions that help patients to cope with serious mental and physical illnesses, such as depression and borderline personality disorder, cancer and disfigurement, thereby improving their quality of life.
Research themes include: Cultural psychiatry, where the JGH Psychiatry Department is world-renowned for its work on how culture influences symptom expression, help-seeking behaviour, adherence to treatment, and response to health communications, with regard to both mental disorders and chronic illness. Particular emphasis is given to studies of vulnerable populations, such as Aboriginal groups, immigrants, and refugees in the interest of influencing health policy and reducing disparities in access; Psychosocial factors in disease, which involves the development and evaluation of screening and treatment programs for serious illnesses, such as cancer, cardiovascular disease, rheumatoid arthritis, scleroderma, and sleep disorders, and where psychological distress is associated with increased morbidity and greater utilization of health care services. Axis members are also innovators in the development and evaluation of accessible, evidence-based psychosocial interventions to reduce distress and disability and to enhance quality of life in medical patients. Women’s health issues are another important focus of research, including studies of mental health problems during pregnancy and post-partum, screening for gynecological cancers, and sociocultural factors associated with decisions about breastfeeding; and the Etiology and treatment of mental disorders, which focuses on biological and psychosocial risk factors for the development of psychiatric disorders in adults and children, such as depression, Tourette’s syndrome, and attention deficit hyperactivity disorder.
Support the work of Dr. Thombs and his fellow Psychosocial Axis researchers in the Lady Davis Institute, and contribute to improve health outcomes and quality of life for patients with serious mental and physical illnesses and their families.