Chronic Depression: Disease or Charcter Flaw?
By Charles Donovan
A major survey on depression symptoms from the National Mental Health Association (NMHA), released in july 2001,
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
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
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
“The survey clearly shows that the fewer episodes of depression people reported, the more likely they were to
have stayed with treatment, whatever that treatment may be,” said Faenza. “Facing up to this illness and taking
personal responsibility for its treatment are vital. Yet some may not acknowledge and seek treatment for depression
because of negative public attitudes and misperceptions.”
In fact, even as people with depression symptoms struggle with the illness itself, they also seem to be
searching to determine their best course of treatment, how long they should stay in treatment, what they might
expect from treatment and whether they will ultimately recover. As a result, more people are employing a
combination of techniques to get and stay well.
Public perceptions about depression symptoms often diverge significantly from the perceptions of people in
treatment and may discourage them from seeking effective therapeutic approaches. For example, the survey results
showed that the general public ranks regular exercise, a healthy diet and psychotherapy higher than medication for
effectiveness in warding off future episodes of depression symptoms. In contrast, doctors and people in long-term
treatment rate staying on medication as the most effective way to prevent a relapse, even as they seek the right
mix of psychotherapy and lifestyle choices.
Perceptions also diverge when it comes to understanding what treatment can deliver. Thirty-five percent of the
general public believe that a person can be cured completely of depression symptoms, a belief held by only 12
percent of people in long-term treatment for the illness. It is likely that many in this group are struggling to
achieve realistic expectations for treatment because the majority of subjects in the survey sample are in long-term
treatment for multiple episodes of depression symptoms.
About half of those who experience depression symptoms will never have another episode; half will. The findings
suggest that people treated for clinical depression symptoms understand the frequently episodic nature of this
common illness. More than three-quarters (76 percent) believe that they will need some type of treatment for the
rest of their lives, and most understand that their treatment will control, but not necessarily cure, their
depression symptoms. However, even as more people come to terms with the long-term demands of depression symptoms,
too many still find it difficult to make a treatment plan work for them. “The upshot is that people living with
depression conduct highly individualized searches for the right mix of therapies—medical, psychological or
lifestyle. The last thing they need is for stigma or public misperceptions to diminish their efforts,” said
Source : National Mental Health Association, July 11, 2001
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