Unemployment and depression

Depression and UnemploymentDavid Oddie, B.Sc., M.A., M.S.W., R.S.W.Social Worker, Social Determinants of Health Service, Access & Transitions

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Topics of Discussion

Scope – Mental Illness and Depression

Characteristics of Depression Unemployment / Employment What is the connection between

Unemployment and Depression? How could it happen? What to do? Treatment Options Resources

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Scope – Mental Illness

Mental illness is about our moods, thoughts, perceptions and behavior.

Mental illnesses can have few or many symptoms.

Symptoms can have varying degrees of intensity, from negligible to extreme.

1 in 5 people in Ontario / Canada will experience some form of mental illness.

Only about 30% of these people seek assistance.

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Reasons for Not Seeking Assistance

Not recognizing there is a problem Not knowing what help is available Barriers to Service ( transportation, access,

language)

Feeling ashamed or embarrassed that they need assistance

Trying to handle the symptoms on their own

Lack of support Stigma and stereotyping

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Mental Illnesses

4 general categories including Mood Disorders, Schizophrenic Disorders, Anxiety Disorders and Personality Disorders.

Depression is a Mood Disorder.Also included in Mood Disorder are •Bipolar Disorders (often referred to as Manic – Depressive Disorder)•Dysthymic Disorder (has been referred to as Melancholy)

First written about in “The Anatomy of Melancholy” published in 1621 by Robert Burton.

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Depressive Symptoms

Prolonged feelings of sadness and despair Anhedonia – serious loss of interest in activities

(can include hobbies / leisure, work tasks, social events) – sometimes defined as “disengagement from goal-related behaviors” (Durbin, 2014)

Changes in eating and sleeping patterns Hopelessness and helplessness Fatigue, lack of energy Slowed thinking, difficulty making decisions Agitation or slowed physical movements Recurrent thoughts of death / suicide

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Diagnosis

Diagnosed (as are all Mental Illnesses) by interview and observation using the DSM (Diagnostic and Statistical Manual of Mental Disorders) now in it’s 5th Edition (June, 2013).

A person who experiences 5 or more (out of 9) symptoms, for 2 weeks or more can be diagnosed as having a “Major Depressive Episode”.

Symptoms cause “clinically significant distress or impairment in social, occupational or other important areas of functioning.”

Symptoms not attributable to physiological effects of a substance or another medical condition.

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Difference between being sad and apsychiatric diagnosis of DepressionHaving occasional sad or depressive feelings is a normal part of all lives given normal life events including losses (personal, monetary), ages and stages and environmental events.

The difference comes down to # of symptoms, severity of symptoms, length of time experiencing these symptoms and impact on the person’s life / normal functioning.

E.g. Bereavement (uncomplicated) or “normal” griefFrom DSM 3 (1980) – the feelings are less than 2 months and that, during this period, there are no more serious symptoms developed (such as suicidality).

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Types of Depression

There are a variety of Depressive Disorders including:•Major Depression with mild, moderate or severe levels.•Biological based Depression such as Seasonal Affective Disorder or Post-partum Depression.•Depression with Psychotic Features.•Depression associated with personality disorders and psychological vulnerability.•Dysthymia – associated with lower number of depressive symptoms but consistently present over 2 years (for adults) or 1 year (children).

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Causes of Depression

A variety of factors and / or circumstances can contribute to a person developing a major depressive event.•Genetic or family history•Childhood adversity (poverty, neglect, abuse)•Psychological or emotional vulnerability•Biological factors such as issues of brain chemistry, endocrine issues or immune system problems•Major stress

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Prevalence

Depression is a worldwide phenomena with reported rates higher in U.S., Canada and Europe than reported rates in East Asian countries.

Affects 10-25% of women and 10-15% of men. Other studies have shown a 2X higher chance of women developing depressive symptoms and disorders.

By 2020, depression will rank second (behind heart disease) as a cause of disability in the world.

General estimate of 25% of those with depression will make at least one, non-fatal suicide attempt in their lives. Highest risk of suicide is for older adults (5X more likely over age 60). Also high in young adults.

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Unemployment

The Unemployment Rate is probably the most frequent statistic used when reporting news about our economy or any job-related news. We should understand what it really means.

The definition is related to the supply of labor as a factor of production (of any kind). This means that it does not relate to anything that is unpaid (including unpaid housework or volunteer work).

It does relate to the activity of job search and the availability to take a job within a given period of time (a reference week).

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Unemployment

Unemployment Rate = # of unemployed people

# of people in the labour force

X 100% Ontario employment increased by 81,100 jobs (both

full & part) from January 2012 to January 2013 resulting in a decline in the unemployment rate to 7.7%. Sounds good!

However, in January of 2013, Ontario lost 31,200 full time jobs (goods-producing and service-producing sectors). Sounds bad!

Since there was a sharp decline in the number of people looking for work which removed 22,200 unemployed people from the calculation. This results in the unemployment rate remaining at 7.7%. December, 2014 the rate was 7.0%.

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Employment

Toronto’s workforce represents 20% of Ontario’s total. We, like the rest of Ontario, are linked to American economic shifts.

Manufacturing jobs, such as those involved in the car industry, are a prime example of this relationship. Declines in this sector have been the most significant in Toronto area.

In Toronto, 8.04% work in finance and insurance compared to 4.61% for Canada.

230,000 people are employed in financial services (Toronto) representing 64% of Ontario’s and 31% of Canada’s sector employment.

Other positive employment sectors (Toronto) are Public Administration, Health Care / Social Assistance and Professional / Technical / Scientific Services.

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Importance of Work

Sense of purpose Feeling useful Values Independent Salary & Benefits Structure Being with People Productive Control Stay out of Hospital Chance to Dream

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Interaction between Depression and Unemployment Overall rate of depression in those working

full time is approximately 7%. In Canada, depression costs $51 billion

annually with a third of that due to lost productivity.

Overall rate of depression registered by those unemployed is close to 13%.

Loss of employment ranks similar to serious injury, loss of a loved one or going through a divorce in terms of the level of stress.

Unemployment doesn’t “cause” mental health disorders but it can amplify or trigger pre-existing issues.

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How could it happen?

Most common responses to becoming unemployed are shock, anger, frustration and denial. It may include physical symptoms.

Loss of self worth, drop in self-esteem, questioning abilities, questioning friends.

Over time, family problems including loss of position (e.g. breadwinner), loss of pride / contribution.

Possible increase in use of alcohol, drugs, smoking plus drop in energy.

Without a network, social isolation can be your worst enemy.

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How could it happen - continued

As time goes on the depression may work itself in a negative cycle – less activity gives rise to rumination / negative thoughts, energy goes down, rejection during job search increases in impact.

Imagine – if you have a poor or fragile self image, you are engaging in an activity that requires you to market yourself and invite strangers to accept or reject you.

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Options & Actions

Find out whether you are eligible for Employment Insurance, welfare or other subsidies. Keep some income flow and benefits going.

Consider joining self-help / job seeking groups that are available in the community.

Consider investment in new / updated skills whether related to your work or just job searching.

Reach out to your family / friends for support of all kinds (e.g. food, money, childcare).

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More Options & Actions

If you have structure / routines, keep some of them going (e.g. house cleaning, exercise, taking the children to appointments, eating, regular meeting with group / friends) Remember, depression is time limited.

Tell everyone you know that you are looking for work. Tell them exactly what kind(s) of work you are looking for. This may include a large network that exists or creating a new one (e.g. tell the guy at the corner store).

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Still More Options & Actions

Organize yourself as much as possible.

Have an organized spot in your home / apt. to do your job search.

If isolation or issues at home interfere, go to your nearest Employment Resource Centre (free, many resources, free groups, computers, etc.)

Use a job log to keep track of efforts / results / places you should follow up with.

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Treatment Options

If you are having problems functioning, talk to your doctor / medical professional.

Medication – anti-depressants, anti-anxiety.

Psychotherapy – e.g. Cognitive Behavioral Therapy.

Psychoeducation. Self-help groups in the community. Electroconvulsive therapy. Treatments are used individually or in

combination.

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Remember

You do not need to be alone in this time.

Depression (unless it is a severe, biological, long standing issue) is time limited. Keep important routines going as much as possible.

Be organized and structure your days as much as possible.

Do not be afraid to approach medical help if you are having problems functioning.

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Help

Crisis and Emergency: Your local emergency department or 911

Telehealth Ontario: Speak to a nurse at 1-866-797-0000

Phone support at CAMH: 416-595-6111 or 1-800-463-6273

CAMH Switchboard: 416-535-8501, Option 2

Mental Health Helpline: 1-866-531-2600 Drug & Alcohol Helpline: 1-800-565-8603 Ontario Problem Gambling Helpline: 1-

888-230-3505

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THANK YOUTHANK YOU

Sources•Depression 101 (C. Emily Durbin, Springer Publishing Co., 2014)•DSM 5, Diagnostic and Statistical Manual of Mental Health Disorders (American Psychiatric Association, American Psychiatric Publishing, 2013)•Local Labor Market Update 2013 (Toronto Workforce Innovation Group Top Report)•www.investtoronto.ca•www.statcan.gc.ca – Guide to Labor Force Survey•www.camh.ca – Depression•http://www.camh.ca/en/education - Mental Health and Addictions 101