Depression Stigma Sometimes Deadly

Last month a young Baltimore woman, merely 19 years old, was found dangling lifeless from a tree in a quiet wooded area. She had suffered from depression and had hanged herself.

Sadly, she was not receiving psychiatric treatment. Friends and family were devastated.

As tragic as this story is, the circumstances behind it are far too common. A 2003 report found that only about one half of people with depression in the United States received medical treatment for the illness.

While this represents an increase of about one-third over the treatment rates from the early 1980s, there clearly remains enormous room for improvement.

A major obstacle to closing the treatment gap is the stigma that exists in the minds of many people, despite much more openness about these disorders than existed previously.

The word "stigma" derives from Latin for a tattoo indicating slave or criminal status. Now it refers to a mark of infamy, disgrace or reproach. Throughout history depression has been misconstrued as resulting from demonic possession, moral failings, distorted sexual feelings and bad parenting.

Diseases Are No One's Fault

Major depression, or clinical depression, is a disease of the brain, much like asthma is a disease of the lungs. And, as with asthma, it is no one's fault that the disease occurs -- not the fault of the person suffering, and not the fault of parents or others.

Diseases happen for a complex set of reasons that primarily involve biology. In the case of depression it is the biology of the brain. The treatment typically involves antidepressant medications as well as psychotherapy, which is "talk" therapy.

One reason that many people do not get the treatment that they need is that they fail to understand that they have an illness. A second reason is that while they may know they have an illness, they are afraid to acknowledge it because of the stigma they perceive is attached to it.

Enter the stigma busters. Dr. Karen Swartz is co-director of the Johns Hopkins Mood Disorders Program. Eight years ago, in response to the death by suicide of three high school students in Baltimore, she started the Adolescent Depression Awareness Program (ADAP). Along with a team of psychiatrists and psychiatric nurses, Swartz began impressing upon high school students, their parents, and their teachers, the message that depression is a common and treatable medical illness.

Health Education Wizards

Among the clever ways Swartz educates teens is to invoke an image from the wildly popular Harry Potter book series. She uses J. K. Rowling's description of the Dementors, black-hooded creatures who create a cold, empty feeling, and leech happiness from their victims, eventually sucking the soul out of them. Rowling has said that she drew on her own experience of depression in creating these terrifying beings.

The ADAP program also draws on ordinary humans, teens who have faced mood disorders, to help students see that these illnesses can happen to people like themselves, and that they can be overcome. A series of such teens were filmed for a 26-minute DVD called "Day for Night: Recognizing Teenage Depression".

In a paper e-published last week in the journal Health Education and Behavior, the ADAP team reported that among 3,538 students surveyed on their knowledge about depression before and after exposure to the ADAP curriculum, the number scoring 80 percent or higher on the assessment tool more than tripled from pretest to post-test.

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