Awareness defeats stigma of mental disorder

Oct. 11 marked two important events: National Coming Out Day and National Depression Screening Day. This overlap was a mere coincidence of timing and probably struck most people as completely unrelated. Yet participants in the two events do share one major similarity: a dedication to overcoming public stigma.

In passing through the symbolic lavender doors erected on Beinecke Plaza for National Coming Out Day, members of Yale’s LGBTQ community publicly declared ownership of their sexual identity and lent courage to those who remain closeted due to perceived social, cultural, or religious stigma and persecution. Similarly, as high-profile figures increasingly choose to come out of the “mental illness closet” and disclose their personal experiences with postpartum depression (Brooke Shields), bipolar disorder (Jane Pauley), and psychotherapy (Alex Rodriguez of the New York Yankees), some of the stigma surrounding mental disorders is beginning to fade.

Yet despite such advances, misconceptions about mental health remain prevalent among the general public. This was evident at the Yale Primary Care Center and Hill Health Center on Oct. 11, where groups of Yale medical students, led by Dr. Hilary Blumberg and her team from the Yale Mood Disorders Research Program, took time off from classes to disseminate information about mental illness and to administer free depression screenings to passersby.

While many people were eager to hear what we had to say, some seemed amused, uncomfortable, or even offended at the mere mention of the word “depression.” Nonetheless, our brief community intervention did seem to be of some benefit. In addition to providing education about mental illness, our group also identified a number of people who demonstrated symptoms of depression, several of whom required immediate attention by their physicians.

Our experiences on Thursday accord well with published statistics. According to the National Institute of Mental Health, depressive disorders affect about 10 percent of the U.S. population age 18 and older in any given year. Meanwhile, 54 percent of people believe depression is a “personal weakness,” and 41 percent of depressed women are too embarrassed to seek help, according to the National Mental Health Association. The stigma and shame associated with mental illness have a very real health impact; one widely quoted statistic states that 15 percent of depressed people will commit suicide, though some experts suggest that the figure is even higher.

Nor is suicide the only medically significant result of mood disorders. Depression is associated with higher rates of medical care utilization, poor adherence to medical regimens, and increased morbidity and mortality from other illnesses. Several studies have recently demonstrated depression’s contributory role in fatal coronary artery disease. And according to the World Bank’s landmark Global Burden of Disease study, depression is currently the fourth-leading cause of disease burden as measured in disability-adjusted life years (DALYs), but will move up to second (after heart disease) by 2020.

According to a 2004 Rand Corporation report, mood disorders pose a significant economic burden as well. Depression results in more absenteeism than almost any other physical disorder and costs employers more than $51 billion per year in absenteeism and lost productivity.

These troubling statistics are also reflected at U.S. universities. According to the American Psychiatric Association, nearly half of all college students report feeling so depressed at some point that they have trouble functioning. If left untreated, depression can lead to suicide; indeed, according to a recent survey by the American College Health Association, 9.4 percent of students reported seriously considering attempting suicide at least once during a 12-month period.

Suicide is the second leading cause of death among college students. None of this even begins to touch upon the many other psychiatric issues common among college students, including eating disorders and substance abuse.

Despite all the grim statistics, there are also glimmers of hope on the horizon. Last month the U.S. Senate passed the Mental Health Parity Act of 2007, a bill that will end discriminatory insurance coverage of treatment for mental illnesses, providing coverage equal to those of physical illnesses and injuries.

This action is the culmination of a decade of bipartisan work by Senators Edward Kennedy, Pete Domenici, Mike Enzi and the late Paul Wellstone. Hopefully such national endorsements of the importance of mental health care will help reshape the public consciousness surrounding mental illness. Additionally, new research conducted at Yale and elsewhere has yielded increasingly solid evidence that diseases such as depression and bipolar disorder have a biological basis and can respond to medical treatment.

The considerable stigma afflicting mental disorders may never completely disappear. But events like National Depression Screening Day represent a positive step toward minimizing the shame and misconceptions that prevent those who are suffering from seeking the help they need.

Justin Chen graduated from Yale College in 2003. He is co-president of the Yale Medical Student Psychiatric Association. He is currently a student at the Yale School of Medicine.

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