Do you know someone struggling with depression? Or perhaps you feel the weight of it in your own life. It’s a quiet crisis that is impacting the lives of many Texans, especially in light of new stressors due to the COVID-19 pandemic. Find out what you need to know about depression in this episode of Blue Promise. This conversation was recorded on March 3, 2020, led by guest host Shara McClure, Divisional Senior Vice President of Health Care Delivery at Blue Cross and Blue Shield of Texas (BCBSTX). It features Julie Dimoulakis, chief operating officer at Catapult Health.
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Blue Promise is a podcast and online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly.
Do you know someone struggling with depression? Or perhaps you feel the weight of it in your own life. It's a quiet crisis that is impacting the lives of many Texans. Find out what you need to know about depression in this episode of Blue PromiseSM. Thanks for joining us. I'm Shara McClure, Divisional Senior Vice President of Health Care Delivery at Blue Cross and Blue Shield of Texas. I'm hosting on behalf of our president, Dr. Dan McCoy. Julie Dimoulakis is here with us. She's Chief Operating Officer at Catapult, where they've been screening people for depression. Their findings might surprise you. Julie, thank you for joining us here today on Blue Promise and being our guest. So first off, let's level set on depression itself. Can you define depression for us?
JULIE DIMOULAKIS: Sure. It's a very common medical condition. It negatively affects how you think, how you feel and how you act. And looking at depression symptoms, are feelings of hopelessness, feeling depressed and also having little interest or pleasure in things that you once enjoyed. So, symptoms that last two weeks or more are typically considered depression.
SHARA: So, two weeks or more considered depression, and you've defined it very well for us. Are there any misconceptions about depression that you can describe?
JULIE: Sure. Well first off, that it is indeed a medical condition, so it's not something that you can or should have to wait out or kind of tough it out. I mean, it requires treatment from a medical provider, and it can be episodic. So just because you don't have it right now doesn't mean that you might not get it. So, it's really important to be aware of the symptoms and also the risk factors for depression.
SHARA: So, you described this as a medical condition and sometimes we think of mental health and physical health as being separate. But this is something where, how can mental health affect physical health?
JULIE: Sure. So, it's not uncommon for depressed individuals to stop taking their medications. Not just their medication for depression, but let's say they're diabetic and they stop taking those medications. That obviously can have a big impact. Also, when you're depressed, you feel exhausted. So, you know, exercise might not sound great. You may not be making the best eating choices. You might eat too little or eat too much. And also sleep can be an issue. You might find that you can't get enough sleep, or you have a hard time falling asleep or staying asleep. And as mentioned in the previous episode, it can really have an impact when you're going through infertility.
SHARA: So how widespread is depression? What's the extent of this issue?
JULIE: Sure, it's very common. So, within a year, about 19 million Americans experience depression. It's more common in women than in men. And women can be – throughout their lifetime, about 10 to 25 percent of women will become clinically depressed, compared with about 5 to 12 percent for men.
SHARA: So, this is, I mean this is really widespread, something that affects women a little more commonly than men. Are there risk factors that individuals have that make them a little more susceptible to being depressed?
JULIE: Sure. Certainly, your genetics. So, if you have a family history of depression, you're certainly at greater risk. Going through any major life changes – so a loss, a divorce, a lot of stress – can impact depression. Your personality. So, certain personalities, those that might have low self-esteem or get, you know, get overwhelmed easily. Those individuals can be more susceptible to depression. Also, some environmental factors. So, if you're exposed to violence, neglect, abuse, you might be at higher risk for depression as well. And then looking at chronic diseases so individuals with chronic disease or chronic pain are actually at higher risk for depression. And we actually, we saw a patient at Catapult a few weeks ago. It was a first-time patient that we took through with our nurse practitioner, and she did a depression screening. What she found is this individual scored very high for depression. She was experiencing chronic pain due to a back surgery. So, her physician recommended additional surgery, and she had decided she wasn't going to go through with the surgery and the next time the pain worsened, she was going to end her life. So, I mean it's certainly something to really be aware of, again, and be aware of the symptoms and how to get treatment.
SHARA: So, I mean, you mentioned that this person was kind of – you had an intervention, and they were saved. For those of us who might be looking, you might wonder whether we're struggling with depression or we have friends or loved ones. Are there warning signs that we need to be really in tune to?
JULIE: Sure. So, you know symptoms of one to two days here and there. You know that's pretty normal to be up and down. But symptoms that last two weeks or more – that's considered depression. So, unlike a lot of health conditions, there's no blood test, there's no physical measurements that can diagnose depression. And it's really is done with a simple screening. So, there's a nine questions set. It's called the PHQ9, where you can assess someone's risk for diabetes. And it includes things like, “How often in the past two weeks have you felt down or depressed? Have you had little interest or no enjoyment in doing things?” But also, there's some other factors that we asked for – looking at your quality of sleep, your appetite and even your ability to concentrate. I think that's an interesting symptom that people might not realize that. You know, you find it that it's hard to concentrate on reading a book or watching television. That could be a symptom of depression. So, looking at all the different answers, we can determine not only is someone depressed but also if they're considering self-harm or suicide.
SHARA: So, your organization has historically done physical health screenings. You just mention that you introduced depression screenings as part of your wellness checkups and so that creates a laboratory. You recently did 150,000 of these depression screenings that led to a study.
SHARA: Tell us about some of the findings of this study.
JULIE: Sure. So, we found some segments of the population that were at much higher risk. Millennial's were at much higher risk of depression than their older co-workers. And when it comes to self-harm and suicide, they were six times more likely to test positive. So, it's certainly a big issue and something to be aware of. And looking at your older coworkers – those over the age of 70 and still working, had the lowest incidence of less than one percent. It was really interesting, as you look at the age breakdown. We talked about women being more susceptible than men. They were 20 percent more likely. Those that were overweight and underweight were more at risk. And then we looked at some lifestyle factors like smoking, physical inactivity, overuse of alcohol. Those individuals had twice, were twice as likely to be depressed. And then we also found a correlation between chronic disease and depression – with those at the highest risk for COPD, depression, coronary artery disease and diabetes.
SHARA: So, this was a workplace screening. And at Blue Cross, we have a lot of employers who are clients, and this was done at the workplace. And we've talked about the impact to individuals. What's the impact of depression on employers?
JULIE: So, employers want a healthy, engaged, productive workforce. And when you look at a depressed individual, they're typically not healthy, engaged in production and productive. You know, presenteeism (where employees are showing up to work but not operating at their full potential) is a big issue. Depressed employees can almost appear lethargic, moving more slowly, speaking more slowly and, again, not as productive. So, it certainly affects performance and you see a higher number of sick days for depressed employees. And also, we had talked earlier about employees or individuals with depression. They stopped taking their medications. So obviously they're going to be at higher risk, and they could end up costing more for health care.
SHARA: So, when this affects employees, it affects businesses. Is there anything that employers can do to help their employees who are struggling with mental health challenges get better?
JULIE: Yes, for sure. So, it's really important to encourage employees to go and see their PCP for all of their regular preventive work. So, if they don't have a PCP, encourage them to find one, so that PCP can not only do the lab work and you know do your blood pressure and other age and gender appropriate screenings, but they can also screen for depression. So, a lot of people don't realize that your PCP is very well-suited to help diagnose and help you come up with a treatment plan for depression. So, it's great to have that resource. And you know come up with the treatment plan with your very own PCP.
SHARA: So, it's one thing to be diagnosed with depression. It's another to have access to resources to treat depression. But some people still choose not to seek treatment. What are some of the common reasons that prevent people from taking that step to access treatment for their depression?
JULIE: You know, some of it is just a lack of awareness of the symptoms. So, some of the symptoms we talked about people probably don't know. Or they might be denying the fact of how they're feeling or think that it's normal or something that they should have to live with. Also, knowing where to go for treatment can be overwhelming, if you're depressed. We talked about, you know, being tired, being lethargic, you're not necessarily going to go out and try to find out what do I do next. So again, making sure that individuals know where to go for care is really, really important. And again, that PCP can help out.
SHARA So those of us, do you have any advice for those of us who can help others that are struggling with depression get the help that they need?
JULIE: Sure. So most importantly if it's something urgent and you find someone that you know you're concerned about them committing suicide, it would be important to get them connected with the National Suicide Hotline immediately. It's certainly serious and we want to get them help and it's a really, really great resource. Otherwise encourage them to see their PCP, talk to their provider about how they're feeling, and they can do that depression screening and help them come up with that treatment plan. So, you know again, depression is a medical condition that requires treatment – and it's very common.
SHARA: Well, thank you for educating us today and shedding some light on this very important issue. That's a wrap for this episode of Blue Promise. Don't forget to subscribe from wherever you listen or watch. You can also leave a review which will help people like yourself find this content. Thanks for tuning in.
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