Dealing with Depression

An ounce of prevention

What if we could prevent depression altogether? Many older people cope remarkably well with illness, bereavement and other stressors. Research confirms that an individual's psychological resources play a significant role in mental health. For example, seniors with a sense of mastery and control are less likely to be depressed, even if they have a physical disability. The important factors are a positive perception of their situation and the belief that they can still control daily routines. Seniors who feel more in control take a more active role when facing illness or disability, thereby lessening adverse effects on well-being. This has implications for the kinds of supports seniors might want – whether they live in the community or in institutions.¹¹

Preventing depression or reducing its impact also means caring for all aspects of physical and mental health (see Tips).

And good mental health for all

Seniors who take responsibility for their psychological well-being and enjoy good mental health are clearly in the majority. Researchers even detect a decline in the prevalence of depression among Canadian seniors over the past three decades.¹² Yet our society needs to do a better job of reaching out to those who, as they slide into depression, lose their means to cope with the disease.

Canada's National Population Health Survey showed that mental health tends to improve with age at least until the middle years and, on one measure (sense of coherence, which is a measure of psychological well-being), well into the senior years. But there are also socio-economic factors at work in mental health. We know that regardless of age, people with higher social and economic resources have only half the odds of being affected by depression or anxiety arising from distressing life events.

Timely access to affordable, appropriate treatment for depression is therefore an issue for society. We must also establish for all ages and all socio-economic levels strategies to promote resilience and other psychological coping mechanisms that can contribute to reducing or even preventing mental health problems.¹³ The mental health sector is recognized as one of the weak links in Canada's health system. Yet without incurring extraordinary costs in time and money, attention and resources could be dedicated to:

• training to ensure that health professionals have specific skills to recognize and treat depression in seniors
• developing and strengthening community resources designed specifically to help seniors with mental health problems (or at risk of developing them)
• promoting the benefits of the whole range of therapies for treating seniors with depression, including cognitive therapy and other supportive therapies
• designing culturally appropriate approaches to treatment for Aboriginal seniors and seniors who belong to particular ethnic groups.¹⁴

Finally, we need to support the work of senior caregivers at risk for depression. Some caregivers have said they prefer telephone and newsletter support, citing barriers to participating in support groups: the need to find a replacement caregiver, time constraints, lack of transportation. Respite services and online support groups might also overcome these barriers.¹⁵

Good mental health doesn't happen by accident: it happens when individuals take responsibility for their health, when health professionals and the general public are aware of mental health risks and remedies for seniors, and when society provides appropriate support for those who are most vulnerable to mental health problems. Caring for mental health is an integral part of caring for health, because good mental health is essential to seniors' ability to continue living autonomously in the community and to achieve full, satisfying lives.