Overview

 General Considerations

Depression is a term commonly used to describe everything from transient sadness to a serious psychiatric disorder that encompasses both psychological and physical symptoms. While everyone experiences feelings of sadness from time to time, a depressive disorder may be present when these feelings of sadness are prolonged and interfere with daily functioning. Depression is a real medical and psychological condition and there are many proven treatments. These treatments are often more effective if implemented in the early stages of depression. Depression is often called the "common cold" of mental health, and is a frequent issue and condition affecting all age groups, genders and ranks.

 Recognizing the Symptoms Associated with Depression

Depression is a prolonged and persistent negative mood, which usually affects an individual's work performance interpersonal relationships and quality of life. Active duty personnel who do not improve substantially with a 12 month course of treatment will usually undergo a Medical Evaluation Board.

While sadness is key sign of depression, it is sometimes not readily apparent (i.e., people can hide their moods). It is therefore important to recognize that Sailors who are depressed often show several other signs, including a significant change in behavior. A talkative person, for example, may suddenly become silent and detached from others. The following signs are often associated with depression:

• Persistent feelings of sadness
• Loss of interest in pleasurable activities
• Apathy at the workplace/decline in work performance
• Difficulty sleeping
• Change in appetite or weight
• Poor focus and concentration
• Feeling fatigued (lack of energy)
• Statements of excessive guilt
• Hopelessness
• Restlessness, irritability or easily agitated
• Thoughts of suicide
• Engaging in unsafe behaviors (reckless driving, driving while intoxicated, and decreased safety practices)

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 Additional Information about Depression

• Depressed workers may be more prone to accidents since the symptoms of depression may affect the unit member's safety.
• Not all depressed people are suicidal; however depression does increase the risk of suicidal thoughts and behaviors.
• For Sailors who are depressed, normal activities may become overwhelming.
• Persons with depression may deny there is a problem.
• Individuals with depression may withdraw from social support networks at the time when they need them the most.
• Symptoms such as lack of sleep and poor concentration may lead to additional life stressors, such as difficulty with job performance.
• Relationship loss or threatened loss is a frequent precipitant of depression.
• Alcohol, sometimes used as a coping mechanism, can make depression worse.

 The Impact of Depression on Work

Depression may have a significant impact on overall work performance. Sailors may come to work late and appear tired from lack of sleep. Poor concentration and focus may reduce productivity or accuracy. In addition, depression can lead to irritability that may foster conflict with peers and supervisors. Low morale, lack of cooperation, and unintentional injuries may also be observed on the job.

 Understanding Barriers to Seeking Help

Depression can often interfere with a service member's desire to seek help. People may feel a sense of helplessness or hopelessness and become convinced that nothing can help. Some Sailors may be afraid of medications, while other may have reservations about therapy. Other times, the stigma associated with having depression or getting assistance may prevent people from getting the help they actually need! Knowledge that depression is a real medical condition and that effective treatments are available can be vital in getting people help…and the earlier the better! Most people with depression can be successfully treated by a primary care or mental health provider.

Depression is most often treated on an outpatient basis. Many people with depression are helped by therapy alone. Others have better success with medication or a combination of medication and therapy. Someone who is reluctant to go to Mental Health may be more open to seeing their primary care provider. Most importantly, encourage them to get help now and sooner rather than later, as depression tends to worsen overtime

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 What Leaders Can Do to Help

The role of Commanding Officer, Department Heads, Division Officers, Chiefs and front line supervisors is to assist the service member, whether an officer, Chief, petty officer or junior Sailor in getting help. Leaders should encourage use of base helping agencies to resolve problems such as depression. Leaders who recognize the presence of depressive symptoms are not expected to act as counselors or therapists. Emphasize that you are looking forward to the Sailor returning to their prior level of functioning and offer encouragement that effective treatments are available. Leaders can take the following steps to help unit members with depression:

• Know the warning signs of depression--for example, changes in the unit member's performance may be a sign that emotional problems are interfering with work.
• Communicate to the Sailor with depression that asking for help is a sign of strength not weakness.
• Ask the person directly about depressed mood or loss of interest in pleasurable activities. Consider information you may receive from coworkers and/or family members who express concerns about the emotional state of the individual.
• Barriers to seeking help may need to be addressed with the Sailor. Discussions should address concerns the service member may have about the negative career impact from seeking help. Leaders may also need to remind members about the possible consequences of not seeking help, such as the condition worsening with greater impact on job performance.
• Ask directly about thoughts or feelings of suicide. Refer to the mental health provider and to medical immediately if you suspect suicidal behavior.
• Ask directly about how you can be supportive.

 Community Resources Available to Help Depressed Personnel

• Encourage personnel to seek care with their Primary Care Provider for depression.
• The Mental Health Clinic offers treatment through therapy and/or medications.
• In many communities, free support groups are available for people struggling with a variety of emotional problems including depression.
• Contact Fleet and Family Support Center (FFSC) or mental health for further information.

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  Suggested Resources

National Institute of Mental Health website:  www.nimh.nih.gov
National Alliance for the Mentally Ill www.nami.org
Virtual Naval Hospital www.vnh.org

  References

• Diagnostic and statistical manual of mental disorders; DSM-IV-TR. (2000). Washington DC: American Psychiatric Association.
• Harold, K., & Benjamin, S. (1995). Comprehensive Textbook of Psychiatry VI eds. Baltimore: Williams and Wilkins. 
• Hoge, C. W., & Lesikar S. E. (2002). Mental disorders among US military personnel in the 1990's: association with high levels of health care utilization and early military attrition. American Journal of Psychiatry, 159, 1576-1583.

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