DEPRESSION: ‘URBAN’ MALADY GROWING IN RURAL AREAS

ORIGINALLY WRITTEN JANET HAMOUS
At work, at home, and at play-times they are a-changin’. Compare your life to that of your parents and don’t be surprised if the differences outnumber the similarities.

Technological advances have given us new tools to make our lives more efficient, safe and convenient, and have virtually changed the way we work and live.

Two-wage-earner families have given us the means to afford the latest innovations.

But the casualty of our modern world with all its many enhancements may be our mental health, particularly that of our kids.

Statistics kept by Prairie View, the community mental health center for Marion County, show that some of the mental health issues we often attribute to “big city life” are now being seen in growing numbers right here at home.

“Twenty years ago, the No. 1 diagnosis in Marion County for community mental health center initial problems was adjustment disorders,” said Richard Archer, vice president of operations for children and adolescent services at Prairie View.

“Adjustment disorders are like, ‘I lost my job,’ or ‘I’m going through a difficult time in my marriage, or ‘My girlfriend broke up with me.'”

Archer said these disorders are typically significant events that people recover from, possibly without the need for medication or longer-term therapies.

“That used to be the primary entry to mental health,” he said. “Now it’s serious depression.”

Depression among children

Prairie View’s Marion County office saw 836 people in 2004, 347 of them new patients. Of those, 140 sought help for depression.

Children represent the fastest-growing population group accessing services.

Of the 347 new patients, 136 were children between the ages of 1 and 18.

“It’s a big chunk,” Archer said. “About 40 percent of the new admissions to the community mental health center are kids.”

Archer said Prairie View saw 81 children under age 13. Of those, 36 were diagnosed with depression. Of the 13-to-18-year-olds, depression was also the No. 1 diagnosis.

“I met with the clinician who works with children, and the average of her caseload is seven,” he said. “She sees kids with depression and significant emotional problems that are labeled as bipolar, post-traumatic stress, multiple struggles with learning disabilities, oppositional defiance and attention deficit.

“It’s just amazing.”

Archer said child and adolescent services are a growing segment of the Prairie View program.

“There’s been a real change over the past 10 years.” he said. “Even 15 years ago, culturally we didn’t see or believe kids would even get depressed.”

Changes in home life

Archer attributes the increase in mental health issues to changes in the culture of kids growing up in this society.

“We’ve gone from my generation where there was a dad in the workplace and a mom in the home, to a model that has completely changed to both parents working,” he said. “So we have a different model of how kids see what the home is like.

“Now there’s a tradition of kids being in preschools and home schools where parents drop the children off for the whole day, for the whole week and for much of their young lives.”

Archer said research studying the impact of cultural changes on children’s development has found both good and questionable things around issues of attachment.

“That’s neither a good or a bad thing, but it’s certainly a change in the culture of how we raise kids,” he said. “And one of the impacts has been on families. There’s a whole lot more stress.”

Stress in the family

A more stressful family life is another factor contributing to an increase in mental health services for kids, Archer said.

“There’s a need to work a lot of hours to support families, and that stress gets seen in increases of emotional problems, depressions, violence and alcohol abuse in adults,” he said. “The innocent victim of that is often the kid. That has had a tremendous impact on the numbers that we see.”

How adults manage stress impacts the atmosphere at home, Archer said.

“Some families can’t manage real well, or there’s a member of the family that has a mental illness or a substance abuse problem or a violence problem or has a combination of any of those,” he said.

“Kids just don’t do well with that. They don’t feel loved, they don’t feel like they’re adequate and then they have a great deal of difficulty trying to know who they are and how to relate well.”

Responding with aggression

Those feelings often play out in aggression, Archer said.

“When children are raised in chaotic living situations, they are so wanting structure and for somebody to be in control that they will take it upon themselves to be in control,” he said.

“Kids that are in families where there is no apparent sense of control or power will seek it out in inappropriate ways, in aggressive ways-violent ways and verbally aggressive ways. It’s just a solution to a problem they see in their own lives.”

Schools are often the first to identify a problem, and improvements in screening and identification have resulted in mental health referrals at younger ages, Archer said.

“We’re better equipped now to make more accurate diagnoses because of advances in brain imaging technology,” he said. “We have also done a better job understanding childhood mental illnesses and realizing that young kids come in with pretty significant issues.

“When I was a kid, you could be raised in a family that was just a wreck with problems, and the prevailing wisdom was ‘kids will be OK; they’ll get by because they are young and they don’t know any better.’

“We know now that isn’t true. We realize the impact of these situations on kids is part of a body of memory that influences our perception of ourselves. That has made a significant change in how we approach children.”

Archer said this phenomenon is being seen throughout the state.

“I think we’re all seeing significant influxes of kids with serious emotional problems,” he said. “Schools have been a real reflection of changing attitudes and behaviors of the past 15 years.”

More adult depression

Depression is also the most common mental health diagnosis for adults in Marion County, mirroring a national trend, Archer said.

Changing work roles have had a major impact on the numbers of people, particularly men, reporting depression.

Archer pointed to work done by the Center for the Study of Society and Work on the role that work has played in men’s lives over the last 30 to 40 years and how women in the work force have helped shape that change.

“At one time men as workers had more control over the product they were producing.” Archer said. “As we’ve become more technological and computerized, we’re farther and farther away from the actual product. There’s less and less control that people feel, and that translates to greater stress and increases a sense that men don’t feel adequate in the work force.

“From my father’s generation to my generation, what it means to be a breadwinner has changed drastically.”

Rural poverty and stress

Archer said poverty levels in rural areas are another factor contributing to depression.

“We certainly know that poverty influences one’s ability to cope,” he said. “And coping and feeling adequate have a great bearing on a family’s functioning and a kid’s functioning.”

Changes in life on the family farm have also contributed to levels of depression in rural areas, Archer said. (See article, Page 9).

“Farmers are very independent,” he said. “One of the things you tend to see in those horribly difficult situations is an individual who didn’t seek the help they needed and struggled quietly on their own to manage something that has been devastating for them.”

Less stigma about assistance

Archer said he believes inroads are being made in reducing the stigma associated with seeking mental health care. Part of that success is due to celebrities talking openly about their experiences with depression and treatment.

“Shows like ‘Oprah’ have really raised people’s awareness of issues,” he said. “We are getting more and more understood as not anything magical and mysterious but as a clearly more evidence-based way of managing diagnoses like depression, anxiety and trauma. They are treatable kinds of issues that people bring in.”

Archer said most people could benefit from therapy sometime in their lives, particularly when they are navigating through major life changes.

“It’s helpful for all of us to be able to sit back with someone who is well versed with that developmental struggle who can help you look and understand and shed some light on the paths that can lead out of the turmoil,” he said.

Talking to a neutral person who can help you adjust and cope with change may be the best option, Archer said.

“It’s the forest-and-the-tree sort of thing,” he said. “We live our lives, we get involved in our day-to-day activities and it’s difficult to separate out to see the big picture.

“People really need to give themselves an opportunity to look at who they are and where they’re at in their lives and take some mental assessments of, ‘How am I dealing with this life I’m in? How do I tend to cope when upset?’

“If it’s by yelling at the kids, yelling at my spouse, isolating, being angry or removed, or biting peoples’ heads off at work, is that where I want to be?”

Finding help

Archer said family members are often ill prepared to help a person who is struggling with answers to such questions.

“Often we need to back away and say ‘OK, neutral person, what’s the way out of this? What are some things I need to rethink?’ We really know the way, it’s just we get so tightened around the problem we can’t find solutions,” he said.

Archer said it is best to get help early when you begin to notice a problem, before the symptoms become solidified.

“We all have our own style of managing stress, and we tend to resort to the same style,” he said. “If we get moody, we get more moody when we have a lot of stress. If we drink, we’ll drink more during those times. If we tend to be grumpy, we might get grumpier or angrier.”

Archer said success in therapy is largely dependent on the relationship built between the therapist and the client.

“That’s 70 percent of what effects change,” he said. “So if I’m working with you and you’re comfortable, feel connected, feel listened to and have faith and trust in me, the other techniques I have will be a lot more applicable.”

Care is accessible

Archer said anyone may access the county’s community mental health center, and he encourages people who feel they need help to make that initial phone call to set up an appointment.

The county supports the program, and Archer said financial assistance is available, both for people who do not have insurance as well as those who have insurance with high co-pays.

“We look at people who don’t have money and how we’re going to help them to people who have insurance that need some help,” he said. “We look at one’s ability to pay, so it’s a sliding fee basis.”

If someone is concerned about cost, “they should make that phone call and talk to a therapist and a financial counselor will help work out a way,” he said.

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