The first thorough survey of depression in the Republic has found that the condition is 50 per cent more prevalent here than was previously thought. Aware, a support organisation for people with depression, conducted a survey of 2,000 people in the workplace and discovered that 7.5 per cent of workers are clinically depressed. That is one in 14 people. A companion survey of 1,000 patients visiting 30 general practices found that 6.7 per cent of respondents were clinically depressed.
Until now, the accepted figure for the prevalence of depression in the Republic has been five per cent - one in 20 people. However, in making this estimate, psychiatrists have relied on data from other Western countries. The new figures are not surprising, considering that there has been a 400 per cent increase in the suicide rate in men under the age of 35 in the Republic since 1990.
In the Aware survey, people completed questionnaires based on the Zung Depression Self-rating Scale. Psychiatrists regard the Zung as a robust measurement, more likely to underestimate than overestimate the incidence of depression.
"It is not easy to score positive for depression on this test, so much so that GPs said to us, `you are missing an awful lot of depression'," says Dr Patrick McKeon, a consultant psychiatrist who directed the survey. So the 7.5 per cent of workers, and 6.7 per cent of GP patients who were depressed, are severely so, making these figures conservative estimates. When people scored positively on the survey, GPs then interviewed them to see whether the survey results were correct. In 99 per cent of cases, the people did indeed have a depressive disorder.
More women than men in the survey were depressed. In the workplace, where equal numbers of men and women completed the surveys, females with depression outnumbered males with depression by two to one. The sex difference was even more dramatic in GPs' surgeries, where for every one man with depression, there were eight women suffering from the disorder. Dr McKeon's interpretation is that men are not visiting their GPs with depression because they feel awkward, ashamed and embarrassed speaking about their feelings. "This is particularly important in terms of suicide in young males, when we know that in young men who die from suicide, in the year previous to their deaths they are four times less likely to have contacted a health care professional than young women in the same age group who commit suicide," says Dr McKeon.
Another significant finding was that, of those interviewed in the workplace, one-third said they had experienced depression in the past. Yet only one-third of these - 11 per cent - had sought professional help at the time. Depression itself can stop the sufferer from getting help because people who are depressed are down on themselves and feel ashamed. The vast majority of depressed people who do seek help - 63 per cent - go to their GPs. But depression is rather difficult to diagnose among a myriad of other physical complaints. It is generally accepted that GPs pick up 50 per cent of cases of depression - which means that the other 50 per cent are missed.
The surge in suicides among young men is of particular concern in this context. A survey of third-level students by Aware found they were unlikely to go to medical services with their emotional problems. Add to this the fact that young men tend to bury their troubles behind alcohol, a potent depressant, and a picture develops of depressed young men trying to cope through inappropriate behaviours.
"In the past year or two, reports are emerging from other centres that there is a significant amount of depression in young men who end their own lives. It is often hidden, because young men are not living with the family and are not emotionally attached to anyone," says Dr McKeon.
To help parents, GPs and friends of depressed people alike, Aware is launching the "Festival" tool for uncovering depression. While it is easy to understand, offering people a checklist of symptoms for depression, it is based on hardcore, internationally agreed diagnostic criteria. "Parents should remember that young people do get depressed. Don't be alarmed about it, but do keep in contact with the young person emotionally and have a sense of how they are. If you have any doubts, try to talk to them about it in a gentle and unobtrusive way. Never dismiss anyone's depression by saying, `sure I know he's depressed, but the only reason is . . . he didn't get on in his job, he's not getting on with his girlfriend'," Dr McKeon warns.
It is not the event, but the depressed person's interpretation of the event that is crucial. Instead of trying to diagnose the condition themselves, parents should refer their children to family doctors.
Aware helpline: 01-6766166 Information: 01-6617211
Aware's annual Daisy Days run from Thursday to Saturday this week. Watch out for the "Festival" tool, a list of symptoms of depression which will appear on the packaging of certain brands of tea, sugar, bread and milk for the next month