Unmasking the symptoms of depression

Older people are the least likely age group to use mental health services or to discuss their emotional wellbeing with others. Julie Bajic shares some tips for recognising the signs and symptoms of mental illness.

Emotional contagion, the tendency for two individuals to emotionally converge, was first described by a US researcher Elaine Hatfield. According to Hatfield, emotional contagion is achieved through an automatic mimicry and synchronisation of one’s expressions, vocalisations, postures and movements with those of another person.  If we interact with a happy person, we are likely to feel happy. On the other hand, if we interact with a sad person, we are likely to feel sadness. This theory underpins my PhD research investigating the influence of emotional contagion on home care workers.

Over recent years there has been a growing awareness on the importance of our wellbeing through media campaigns, R U OK? Day, and mental health ambassadors. The Australian Psychological Society promotes the importance of psychologists, and National Psychology Week, aims to increase public awareness of how psychology can help people and communities lead healthier, happier and more meaningful lives. Treatment for mental health is available through doctors who can make referrals to psychologists and other mental health providers through Medicare schemes. Early intervention is critical and has better clinical outcomes.

Around 45 per cent of Australians aged 16 to 85 will experience mental illness at some point in their life, while one in five Australian adults will experience a mental illness in any given year. Depression is the most prevalent psychiatric disorder and once detected, is treatable. Depression is particularly common in those with declining health and increasing need for support.

The Australian Bureau of Statistics highlights that the highest rates of suicide in Australia are in men aged 85 and over, closely followed by women aged 80-85. Furthermore, older people are the least likely age group to use mental health services or to discuss their emotional wellbeing with their families, doctors or service providers. Mental illness may be difficult to detect in older people who live in the community, as the signs and symptoms are often masked by other health conditions, limited interactions and support networks.

Home care providers who assist elderly clients with activities of daily living and community access are exposed to clients with varying levels of support needs. Aged care workers have clients with varying levels of mental health needs. These clients may not have undergone formal mental health screening by their service provider, been diagnosed and referred to treatment. The clients themselves often do not recognise they have a mental health condition. Aged care workers similarly may not realise that their clients have mental health symptoms requiring treatment and may attribute their emotional distress to the process of ageing.

What is depression?

Individuals who experience depression may have any of the following symptoms:

• feel indecisive, overwhelmed, lacking confidence and feeling irritable
• physically experience excessive tiredness, disturbed sleep, feel sick and run down and turn to alcohol and other drugs
• changes in behaviour which may include social withdrawal, poor concentration and turn to alcohol and other drugs
• thinking style may become negative, feeling hopeless and worthless and having suicidal thoughts.

 Is depression a normal part of getting older?

No. Depression is essentially the same disorder across a lifespan, however symptoms may present differently. Older people may:

• be less likely to describe sadness
• report pain and/or multiple physical symptoms
• have problems with memory
• have substantial weight loss
• be slowing down in movement
• use different language (for example talk about their nerves)

 What are the risk factors for developing depression in old age?

The process of ageing in itself is not a risk factor for an individual to develop depression. Older people who require a high level of support to continue living in their own homes are twice as likely to experience depression compared to older people who need less support. Risk factors increase with any of the following symptoms which can have an accumulative effect:

• death of a loved one
• being socially isolated
• living in residential care
• having chronic illness
• being a carer (of a spouse, a sibling or a child)
• being from a culturally and linguistically diverse background
• having dementia.

Implications for workplaces 

Depression can have a large impact on aged care employers who need to be aware of the potential impact of mental illness in their workers as well as in their clients. Client depression can affect workers and may impact their job satisfaction. Aged care workers need to be trained in how to respond to clients with emotional needs as well as understand where they can get support for their own emotional needs.

The following recommendations are based on my research and include both client and employee mental health considerations.

For clients:

• Provide screening of client wellbeing needs and conduct regular reviews
• Refer clients with high scores or disclosure of mental health conditions to specialists
• Provide staff training in client mental health awareness

For employees:

• Provide awareness of organisational mental health support and resources, including Employee Assistance Programs (EAPs)
• Provide awareness of external agencies and resources such as beyondblue (1300 224 636) and Lifeline (13 11 14)
• Provide face-to-face contact for remote workers in the delivery of supervision, mentoring and peer support
• Offer employees support during and following critical incidents.

In response to mental health education needs in the sector, beyondblue developed a Professional Education to Aged Care (PEAC) three-hour program for direct care workers and registered nurses. The program aims to raise awareness and improve the detection and management of anxiety and depression in residential and community aged care settings.

Julie Bajic is principal psychologist and founder of Wise Care, and a PhD candidate at Macquarie University. Wise Care is a registered provider of beyondblue’s Professional Education to Aged Care program.

This article appears in the current edition of Community Care Review magazine (November edition). 

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