Picture Story Five: Depressed

View the picture story.

To print picture as a handout, use the pdf version of the file.

Health literacy issues:

• Mental health awareness
• Different cultural views on mental health issues
• Available community services for mental health care in the United States

The basic story:

In January, a woman is having an active, happy life. She is busy with work, friends, family, school, exercise and parties. In February she starts to feel sad. In March she feels worse. She cries a lot. In April she is still sad, and she doesn't want to eat. In May she feels very tired and stays in bed all day while other people are busy outside. In June she decides to ask for help.

Background information:

Depression is a very common illness worldwide, affecting an estimated 9.9 million adults in the U.S. alone annually. It is believed to be in part caused by environmental factors and in part caused by biological factors. Nearly twice as many women as men experience major depression. Depression can occur at any age to people from all ethnic, racial and socioeconomic groups. Depression is highly treatable with counseling, antidepressant medication, or a combination of the two. Many people from other countries don't know about treatment, in part because of a low presence of mental health care in many parts of the world. The World Health Organization reports that:

• Over 30% of countries do not have a mental health program.
• More than 25% of countries do not have access to basic psychiatric medication.
• 70% of the world's population has access to less than one psychiatrist per 100,000 people. (WHO, 2001)

Many people come to the United States to escape situations of war and torture, which may have left them traumatized and depressed. Others may experience socioeconomic hardship or other challenges of cultural adjustment which make them more vulnerable to depression. Often immigrants don't seek care because they are unaware of mental health care options, feel stigma around the issue of mental health, or feel they can't afford care.

Many communities in the United States provide sliding scale mental health services. These services may be found via county or municipal health departments or community service boards. Increasingly, services are being offered in languages other than English from government and other non-profit mental health care providers.

Major depression (sometimes called clinical or chronic depression) is believed to have a biological basis that can respond to triggers in life. Neurotransmitters in the brain are out of balance. The term major depression is used when a person has some of the following symptoms for more than 2 weeks and the symptoms don't get better. Possible symptoms:

• You are very sad. Maybe you cry all the time.
• Sleeping is a problem. Maybe you sleep too much, or maybe you sleep too little.
• Eating is difficult. Maybe you don't feel like eating, or maybe you eat all the time.
• Thinking, remembering and concentrating are difficult.
• Your physical energy is low, or you feel like you can't sit still.
• You don't like doing things that you always liked before.
• You have physical problems like headaches or stomachaches, but they don't get better from normal treatments.
• You think about dying or killing yourself.

Some other important things to know about depression:

• An episode of major depression can be triggered by a traumatic life event, or it can happen without a triggering event.
• If you have major depression, it does not mean you are "crazy." It may be important to clarify this in class.
• If other people in your family have major depression, there is a stronger chance that you can get it.
• Some people get depression from taking some kinds of medicine.
• Some people get it if they have certain physical illnesses.
• Sometimes women can get depression after they have a baby.

QUESTIONS

• Do many people talk about depression in your native countries?
• Is it OK to talk about?
• What do depressed people do for help in your native country?
• Do many people talk about it in the United States? (You can point out that some people don't like to talk about it and others think it's ok. It is ok to talk about with social workers and doctors because they can help you get the treatment you need to get better. Medicine and counseling are very common for treating depression in the United States.)
• What do depressed people do for help in the United States?
• Where can you get help for depression in this community? (Before class, check local listings of mental health service providers. Possible sources of mental health help, or referrals for help, in your community: community service board, public health clinics, the local department of health and human services, doctors' offices.)