By Claude Mills, Staff Reporter
THOUSANDS OF men battling depression may be slipping through the cracks in the community mental health system in Jamaica because they refuse to seek and sustain treatment for mental illness.
"Mostly, the men come in to be treated for aggression, or for other diagnoses such as schizophrenia or manic depression. These men go through episodes when they get depressed, but once they seek treatment and improve a little, we never see them again," Dr. Roger Gibson of the Department of Community Mental Health and Psychiatry of the University of West Indies, said.
Men see depression as a sign of weakness, and even a female illness so they deny that it is happening to them, Dr. Gibson
continued.
At a Pan American Health Organisation (PAHO) meeting last year Dr. Peter Figueroa, chief medical officer, said that mental health issues account for only two per cent of the total public health centre visits, a figure which he said was 'grossly under-represented'.
Dr. Earl Wright, Director of Mental Health in the Ministry of Health, concurs with this diagnosis.
"Men express depression in different ways than women do, so we have to assume we are under-diagnosing the incidence in men. We intend to externalise our problems a lot, and engage in self-destructive behaviour: drug, alcohol addiction, gang involvement, driving cars at high speeds, and other high-risk behaviours," Dr. Wright said.
Interestingly, depression appears twice as often in women than in men, but men seem to have more trouble handling the condition.
A recent lifestyle survey 2001 conducted by the Ministry of Health in collaboration with the Tropical Medicine Research Institute (TMRI) of UHWI found that 52 per cent of women and 41 per cent of men had symptoms of major depression in the last month.
It also found that 28 per cent of men, and 36 per cent of women reported little interest or pleasure in things they usually liked over the last four weeks.
"The results of the lifestyle survey indicate a need for these individuals to be further screened for depression. After screening, we could find at least 10 per cent of the general population suffers from depression in keeping with a worldwide phenomenon," Dr. Wright said.
The study also found that 18 to 20 per cent of those with medical problems, especially with cardio-vascular and diabetes have higher incidence because of cortisol and other chemicals involved in the treating their
illnesses," he added.
Courting death
The stigma attached to depression in inner-city communities is often high, even though these areas are often stewing cauldrons of poverty, stress and conflict.
Psychologist Dr. Leahcim Semaj pointed to a trend of 'passive suicide' where young men from poverty-stricken, war-torn communities court death openly by virtue of the risks they take.
"There are many young men in inner-city communities whose assumption is that they won't amount to anything, and they don't expect to live long either. These young men live their lives on the edge ... drug abuse, gangs, dangerous living...that is a form of suicide," Dr. Semaj said.
"There is a saying that goes: 'if you won't be better off tomorrow than you were today then what do you need tomorrow for? When people, especially men, get to that point, watch out," he added.
In Jamaica, 240 men committed suicide between the years 1998 to the year 2001, fifty-nine of whom were diagnosed with depression. Only 38 women committed suicide during this time period, 10 of whom were diagnosed with depression.
In Jamaica, the incidence of suicide is on the lower spectrum of worldwide trends, with a rate of 3 in every 100,000. In most developed countries, the rate is 11 per 100,000.
"We tend to kill other people rather than ourselves," Dr. Wright said.
Studies in the United States show that black people are experiencing higher rates of depression and suicide at a time when they are entering the middle class in ever-increasing numbers. And the suicide rate among young black men in that country has doubled since 1980.
"Suicide is not a part of our culture. We can tolerate a lot more. Other cultures, like the Scandinavian, Japanese and Eastern peoples, are more prone to commit suicide. But suicide is no respecter of persons, and we are no more immune than anyone else," Dr. Semaj said.
Experts say that denial continues to be the greatest obstacle to seeking treatment for depression.
"The cost of treatment is not prohibitive as in the past where there were months and sometimes years of hour-long weekly sessions. There are shorter and more effective means of psychotherapy. But still, men are not seeking help," Dr. Gibson said.
Experts suggest that the refusal to recognise depression as a treatable mental illness could be because a lot of Jamaicans tend to equate mental illness with the raving, half-naked schizophrenics roaming the dirty streets of the big city.
"It's tough for men. Look how many organisations are set up to help women, but there is hardly any support group for men. The average man would rather trust a stranger than tell his 'bredrin' that
something mentally wrong wid him,"
Dr. Semaj said.
"We need islandwide screening, greater awareness of the problem, and more mental health officers because Jamaicans don't normally get up and seek psychologists or psychiatrists for help," he said.
A plan to address the problem is already in the works.
Earlier this year, the UWI Department of Psychiatry in collaboration with the Ministry of Health conducted a study to determine the validity of depression scales and screening instruments in private and psychiatric practice in Jamaica.
"They were trying to find if some of the instruments and scales used to measure and determine depression are culturally relevant to Jamaica," Dr. Gibson said.
The results of the study showed that the Zung Depression Scale was a reliable indicator as it found that 22 per cent of the persons attending a chronic care clinic (for illnesses such as diabetes and hypertension) in the Corporate Area may be suffering from depression.
"We are now considering doing a general islandwide screening for depression using the tests in the collaboration with UHWI and other groups next year. Worldwide trends indicate that depression is on the increase, and will be the second most diagnosed condition in the world by the year 2020. Depression also carried the highest disability in terms of production," Dr. Wright added.
WARNING SIGNS OF DEPRESSION
Have you been feeling depressed, or hopeless or a loss of pleasure in the last six weeks?
Have you ever been bothered by little interest or pleasure in things you normally did in the last month?
- Irritability
- Changes in appetite
- Changes in sleep habits
- Headaches, stomach aches, pain all over
- Chronic fatigue not wanting to get up in the morning
- Sadness that continues for up to a month spontaneous crying
- Social withdrawal a loss of interest in activities and things once
considered enjoyable.
- Feelings of guilt and worthlessness.
