Depression: Overcoming Barriers to Diagnosis and Care

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April 6, 2017

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You probably know someone with depression. Nearly one in five Americans will have an episode of major depression at some point in their life, and more than 300 million people worldwide suffer from the illness, according to the World Health Organization (WHO).

Nonetheless, the stigma around depression persists, and it is one of the central reasons that less than half of those affected receive treatment from a health professional. To help reduce the stigma associated with depression and lead to more people seeking help, the focus of the WHO’s World Health Day on April 7 is Depression: Let’s talk.

Baptist Health Primary Care physician Paul Di Capua, M.D.,  medical director of Primary Care Innovation at Baptist Health Medical Group, says healthcare systems often fail to address mental, behavioral and social health. He is determined to change this as well as the stigma associated with the illness.

An Illness That Improves With Treatment

Treating patients holistically has been the focus of Dr. Di Capua’s clinical training and research. Working with Baptist Health social workers, he is creating an integrated health model that recognizes and treats mental and behavioral health problems with evidence-based, personalized care. “If someone has hypertension or diabetes, we treat it with medications. However, individuals with depression often suffer alone without receiving the necessary – and effective – therapies to get well,” Dr. Di Capua explained. “The mind can get sick just like the heart or kidney, and it, too, requires treatment when it is sick.”

In line with recommendations by the U.S. Preventive Services Task Force, Dr. Di Capua’s program ensures that all patients in Baptist Health Primary Care are systematically screened for depression. Patients diagnosed with depression are proactively followed throughout their illness by social workers Carla Paulino, MSW, and Jessica Pagan, RCSWI, MSW.

“Depression is characterized by an inability to carry out daily activities, so patients often do not come to their follow-up appointments unless prompted,” Dr. Di Capua explained. “That’s the natural course of the illness. Our program is designed to help patients with depression by flipping the typical health system paradigm – we reach out to them rather than wait for them to come to us.”

Depression Affects People in Different Ways

Characteristics of depression are continual sadness and a loss of interest in activities that a person normally enjoys. According to the WHO, people with depression also may experience such symptoms as decreased energy, change in appetite, anxiety, concentration problems, indecisiveness, feelings of guilt or hopelessness and thoughts of self-harm or suicide.

Depression results from a complex interaction of social, psychological and biological factors. People who have experienced adverse life events, such as bereavement, unemployment and psychological trauma, are more likely to develop depression. “Depression narrows the horizon of people’s lives and makes it harder for them to see the full spectrum of possibilities,” Ms. Paulino said. “Treatment can help people figure out a path to address underlying problems.”

People with chronic illnesses also are at higher risk for depression. Dr. Di Capua cited the interrelationship between mental health and physical health as the reason. For example, researchers have long understood that heart disease and depression have a two-way connection, with depression increasing the likelihood of heart disease and vice versa. “The mind and body work together, and wellness requires taking care of both,” Dr. Di Capua said.

Proper Diagnosis, Treatment Leads to Wellness

Depression can be effectively addressed with a range of evidence-based treatments, including psychotherapy and medication. Other complementary treatment options include exercise, yoga, meditation, music therapy and outdoor nature-related activities.

Proper treatment begins with a proper diagnosis, and by integrating mental healthcare into primary care. By doing so, the general healthcare system will advance prevention and treatment efforts, says Dr. Di Capua. To ensure other physicians are actively looking for signs of depression and mental illness in their patients, he is training a new generation of primary care doctors in the Florida International University Family Medicine Residency Program at West Kendall Baptist Hospital.

“The treatment plan for depression depends on its severity and effect on quality of life,” Ms. Pagan said. “Depression will not get better without taking steps to address it.”