Depression can have wide-ranging impacts on those suffering from it and their families. It affects over 121 million people worldwide and is a leading cause of disability. Men often present with different symptoms than women, such as irritability rather than sadness, and are frequently undiagnosed. Having a parent with depression can negatively influence children's development and increase their risk of mental health issues. It also commonly damages relationships and increases conflict between family members. Seeking treatment through medication and counseling can help address depression, as can social support from loved ones.

1. Helping Men Understand
depression and it’s affects
on those around them
Men’s Breakfast 23 Sept. 2006 -- AA MacKenzie
DO WN BUT N T O UT
,
O
Men and Depression

2. An General Overview of
Depression and it’s affects

3. Depression Affects People
All Over the World
•Accounts for 3.7% of the Global Burden
of Disease
•Affects 121 million people worldwide
•5.8 percent of all men
(9.5 percent of all women)
•By 2020, depression will be the second
leading cause of worldwide disability
•Christians are just as susceptible as nonChristians
Sources: World Health Organization. World Health Report 1999: Making a Difference. Geneva, 1999.
World Health Organization. Mental and neurological disorders. Fact sheet No. 265. December, 2001.
Weissman MM, Bland RC, Canino GJ, Faravelli C, Greenwald S, et al. Cross-national epidemiology of major depression and bipolar disorder. JAMA. 1996;276:293-299.
Glass RM. Awareness about depression: important for all physicians. JAMA. 2003;289:3169-3170.

4. Depression and Suicide
Go Hand in Hand
More than 2400 suicides a year
in Australia alone
(Over 2X the number of homicides)
Figures for attempts not kept, but are
believed to be 10X or 20X that many.
• 90% are associated with mental illness, mostly depression
• 70% of successful suicides occur during a bout of
depression
Sources: Australia Bureau of Statistics (2004) as cited in the Courier Mail, Wednesday, 06 September 2006.
Institute of Medicine. Reducing Suicide: A National Imperative. Washington DC, 2001.

5. Impact of Depression on everyday life
• Depressed men:
•are 2X as likely to die in any given year by suicide, trauma and
homicide
•have higher rates of cardiovascular disease, stroke, cancer,
and diabetes
•are more likely to be divorced
•exhibit lower work productivity, earning potential
•are at increased risk of job loss, likelihood of depressed children
• Depressed workers average 5.6 hours lost labor time per week
(versus 1.5 hours for non-depressed)
Depression has a Massive Economic and Social Impact
Sources: Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms.
Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003;289:3135-3144.

6. Depression Is Uniquely Gender Specific
Depressed males and females present differently
• Males: more frequently undiagnosed and
untreated
• In 2004: Half million men and 1 million women
suffered from depression
•
– Men: 80% of all suicides
– Women: 20% of all suicides
Drastic action is taken more by men
Sources: National Institute of Mental Health. Real Men. Real Depression. March, 2003.
Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms.
The Cleveland Clinic Health Information Center Web site. Depression in Men.

7. Depression Is Uniquely Gender Specific
Temporal Gender Gap Between Thought
and Action
• Women consider suicide 42 months before acting
• Men consider suicide 12 months before acting
Opportunity interval for prevention is markedly shorter in men.
Sources: National Institute of Mental Health. Real Men. Real Depression. March, 2003.
Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms.
The Cleveland Clinic Health Information Center Web site. Depression in Men.

8. Living with the Blues
Symptomology and diagnosis

9. Clinical Depression – a definition
• Everyone feels down, depressed or
discouragement at some time in
their lives
– However, for some this is a regular,
serious and ongoing illness or condition
– When someone’s mood is low or flat,
and they lose motivation and interest for
at least two weeks we usually say they
are clinically depressed

10. Clinical Symptoms
• the “Big 9”
–
–
–
–
–
–
–
–
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low, flat mood
loss of interest
appetite changes
sleep changes
difficulty making decisions & concentrating
fatigue
feelings of worthlessness or guilt
loss of libido
thoughts of death

11. Males’ Symptom Complex for Depression
is Distinctly Different from Females
Wide Range of Typical Symptoms
• Sadness, hopelessness, worthlessness, restlessness
• Variable physical symptoms like headaches, gastrointestinal
problems and physical pain
• Increased substance/ alcohol abuse
Men May Hide These Symptoms/Show Depression in Other Ways
• Increased susceptibility
• Antisocial behavior
to stress
• Indecisiveness
• Sudden spells of anger
• Feelings of being burnt out / empty
• Lower impulse control
Source: Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=8022027A-C9BC-4931B93F392D2BC06876. Accessed Aug. 25, 2005.

12. What Do the Experts Say?
Men may be more willing to report:
• Fatigue, irritability
• Loss of interest in work / hobbies
• Sleep disturbances
Men may be reluctant to report:
• Feelings of sadness, worthlessness,
excessive guilt
“Men get irritable, women get depressed.”
Ron Kessler, Ph.D.
Professor of Health Care Policy, Harvard Medical School
—
Sources: National Institute of Mental Health. Real Men. Real Depression. March, 2003.
Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.

13. Screening and Diagnosis
• Criteria used to diagnose depression is
Contribute to
a breeding
ground for
depression
too “feminised”
• Doctors fail to detect the illness in 60% to
70% of depressed men without classic
symptoms (although this is getting better)
• Start with recognizing unique symptoms
Depression is often miss-diagnosed
Sources: Mayo Clinic Web site. Male Depression: Don’t Ignore the Symptoms.
Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003;289:3135-3144.

14. Risk factors
- Depression is often caused by a number of factors
working in combination, including:
•Family history of depression, which suggests a genetic
association
•Prior history of depression
•Mental illness, such as bipolar disorder
•Abuse of drugs and alcohol
•Bereavement
Depression’s roots are complex
Source: Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.

15. Risk factors
• Depression can also be caused by:
• Experiences of loss, such as unemployment or relationship
breakdown
• Stress
• Undealt with childhood trauma
• Some medications, such as corticosteroids and drugs for
hypertension
• Sleeping disorders
• Poor physical health, serious or prolonged illness.
• Spiritual factors.
Depression is insidious
Source: Wartik N. Depression Comes Out of Hiding. The New York Times. June 25, 2000.

16. Depression and the Bible
Even some great biblical characters wrestled with
depression.
– At one point in his life, Moses wanted to die (Exodus 32:32)
– While struggling with his suffering, Job "cursed the day of his birth"
(3:1). He said, "I will speak in the anguish of my spirit, I will
complain in the bitterness of my soul" (7:11). In addition, he cried,
"My spirit is broken, my days are extinguished, the grave is ready
for me" (17:1).
– Elijah was incapacitated with depression soon after he had been an
integral player in one of the great demonstrations of God's power (I
Kings 19)
– After Jonah witnessed the astounding grace of God among the
wicked Ninevites, he angrily said, "Death is better to me than life"
(Jonah 4:3)

17. Depression and the Bible
• The prophet Jeremiah declared, "Why did I ever
come forth from the womb to look on trouble and
sorrow?" (Jeremiah 20:18)
• The amazing prophecy of Isaiah 53:3 states that
the Suffering Servant, the Lord Jesus, was "a man
of sorrows, and acquainted with grief." Sorrows
and grief can refer to both physical and mental
pain, which could include depression.

18. Depression and Christian Men
Some common myths:
• Depression means weakness
•
•
•
•
Christian men don’t get depressed
Depression is a sign of a lack of faith
Depression always has a spiritual cause
Depressed people can just choose to get out
of it
Perpetuating myths of depression only exacerbates the
problem

19. Diagnosing depression may present
difficulty
• women more likely to meet DSM criteria
• characteristic symptoms for men
– Sadness, hopelessness, worthlessness,
restlessness
– Variable physical symptoms like headaches,
gastrointestinal problems and physical pain
– Increased substance/ alcohol abuse

20. Diagnosing depression may
present difficulties
• As men may disguise symptoms
• Increased susceptibility to stress
• Sudden spells of anger
• Lower impulse control
• antisocial behaviour
• Burnout
• indecisiveness

21. Diagnosing depression may
present difficulties
Men may be more willing to report:
– Fatigue, irritability
– Loss of interest in work / hobbies
– Sleep disturbances
Men may be reluctant to report:
•Feelings of sadness, worthlessness, excessive guilt

22. Living with the Blues
Effects of parental depression
on children

23. Effects on children
M. Weissman (1986)
• first demonstrated that family members of
depressed people were at an increased risk of
developing the disease themselves
• follow up study ten years later
–
–
–
–
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increased social impairment
3 x prevalence of depression & phobias
5 x prevalence of panic disorder
5 x prevalence of alcohol dependence
83% depressed offspring also experience
anxiety or substance dependence
Source: Weissman et al (1997), Arch. Gen. Psych. 54, 932 – 942

24. Effects on children
A study of 853 children of 477 mums who were subject
of child protection cases in Ontario
• 136 depressed, 341 not depressed
– Children of depressed mums at
increased risk of:
ADHD; conduct disorder; being on
medication; accessing mental health
services;
– not more likely to be abused, neglected
or expelled
–
Source: Leschied et al (2003) The Relationship Between Maternal Depression and Child Outcomes in a Child Welfare Sample

25. Effects on children
Parental depression increases the
risk of insecure attachments
between parent and child
– insecure attachment is a predictor of
poorer outcomes for children
Source: Herring & Kaslow (2002), Fam. Proc. 41(3), 494 – 518.

26. Effects on children
Another study demonstrated that
children of depressed parents
had not learnt to effectively regulate their own
emotions
– frequently attempted to regulate their parent’s
behaviour
–
– this led to increased emotional
insecurity & mood disorders
Source: Cummings (1995), Develop. Psyc. 31(3), 425 – 427

27. Effects on children
Yet another study looked at
communication patterns between
depressed parents and their children
– found communication was more
– Ambiguous
– Changeable
– unreliable with regards to meaning
Source: Teti et al (1995), Develop. Psyc. 31, 364 – 376

28. Effects of depression
on MARRIAGE

29. Effects on marriage
Study sampling 522 Australian families
–
when the female partner
depressed:
» one third of male partners also
depressed
» compared to only 20% of those
married to wife not experiencing
depression
» when mum and dad both depressed
there is additive effect for their
children in terms of childhood/ adolescent depression and
externalising behaviors.
Source: Brennan et al (2002), J. Cons. Clin. Psych. 70(5), 1075 – 1085.

30. Effects on marriage
A 1994 study was the first clear
demonstration of a link between
depression and increased parental
conflict
• ALSO increased conflict led to increased
emotional insecurity and mood/ anxiety disorders
in children
Source: Davies and Cummings (1994), Psych. Bulletin 116 (3), 387 – 411.

31. Effects on marriage
Another researcher retrospectively asked large
sample about childhood experiences
•
adult children of depressed parent:
– More likely to have grown up with conflict
» 5x more likely to have major depressive
disorder
» 5x greater likelihood of substance abuse
Source: Pilowsky et al (2006), J. Am. Acad. Chil. Adol. Psych. 45, 452.

32. DEPRESSION - A
FAMILY AFFAIR…
Effects of depression on
other family members

33. DEPRESSION - A FAMILY AFFAIR…
• 141 families (50 dad depressed; 41 mum
depressed; 50 neither depressed)
– both father & mother depression serious
predictor of childhood depression
– however, non-depressed parent’s
relationships with children was also
negatively affected!
Source: Jacob and Johnson (1997), J. Fam. Psych. 11(4), 391 – 409.

34. RULE OF RECIPROCITY
During adolescence, parental depression
raises likelihood of children experiencing
depression
– However, when kids reach adolescence it
becomes reciprocal!
– Parents
children
Source: Ge et al (1995), Devel. Psych. 31, 406 – 419.

35. Other factors that affect families
• The effect of depression on family members
– depression also increases likelihood of
•
•
•
•
•
loss of income (even poverty)
social isolation
alcohol abuse
divorce
and so on
Source: Pilowsky et al (2006), J. Am. Acad. Chil. Adol. Psych. 45, 452.

36. Why family members have
increased risks
– heritability
– develop dysfunctional neuroregulatory
mechanisms (endochrine systems)
– exposure to negative cognitions
– insecure attachment, decreased
responsiveness
– living with continual stress & conflict
Source: Goodman & Gotlib (1999). Psych Rev 106, 458 – 490.

37. TO SUMMARIZE…
Depression can truly be considered ‘a family affair’
Parent with
Depression
Poor communication,
insecure attachments,
emotional insecurity
Increased
conflict,
decreased
attachment
Childhood mood
disorders, externalising
behaviours
Spousal
depression

38. Men &
Depression…
What does help look
like?

39. Help for Depressed Men
• Treatment options
Unfortunately, men tend to think that asking for help is
a sign of weakness, so family or friends may need to
encourage a depressed man to see his doctor.
• Treatment for depression can include:
•
•
•
•
•
Medications, such as antidepressants
Support from friends and family
Competent counselling
Natural therapies
Self-help such as proper diet, regular exercise, leisure activities,
looking outward, etc.

40. Helping families with a member
suffering depression
• Three (3) broad suggestions
1. Help family members support the person
with depression
2. Support family members themselves
3. Consider working with whole family if
possible

41. Helping family members
1. Helping family members support the
depressed person
• Encourage them to help the person get
treatment
not getting treatment is not a sign of
irresponsibility or not wanting help
– it is part of the disease
– family members need to know they can help the
depressed person get treatment, take
medications, keep appointments (especially in
the beginning)
–

42. Helping family members
1. Helping family members support the
depressed person
• encourage families to:
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be emotionally supportive
be patient! be realistic
separate illness from the person
not to take it personally
not to blame themselves unfairly
take suicide risk/ signs seriously
facilitate but not enable
help with diet, exercise, leisure, interactions

43. Supporting the family members
2. Supporting the family members themselves
• the depressed person often has very little capacity for
supporting others
• as a result can be lonely and isolating for the family of
the depressed person
• Be aware of their own risk of depression
• Don’t reinforce feelings of guilt and shame
• Supporting family through grief process
• Linking with support networks
– church, support groups, pastoral care, etc.
• Bibliotherapy

44. Supporting the family members
2. Supporting the family members themselves
• Bibliotherapy
1) Lisa, Bright and Dark by John Neufeld
– This novel recounts a teenager's struggle with mental illness and
her problems with getting her parents to acknowledge that she
needs help.
2) When Someone You Love Has a Mental Illness by Rebecca
Woolis
– This book offers concrete advice to loved ones about how to deal
with family members who are in crisis, how to work with insurance
companies and how to find help.
3) Helping someone with a mental illness by Carter & Golant
– A very helpful book which give practical strategies and
encouragement to struggling families.

45. Supporting the family members
2. Supporting the family members themselves
• from a Christian point of view be aware that this
experience often raises real issues for the family’s faith
– anger
– doubt
– why?
– difficulty attending church

46. Working with whole family
3. Consider working with whole family if possible
• 313 people with depression followed up after 1, 4, 10
years
• several factors associated with low incidence of relapse
(All relational in nature!!)
– increases family independence
– decreased family conflict
– increase in stable friendships
Source: Moos et al (1998), J. Ab. Psych. 107 (3), 450 – 460

47. Working with whole family
3. Consider working with whole family if possible
• 93 families with at least one depressed member
– half received 2 information lectures
– half 6 – 11 group sessions tailored for them
– both helped
– second approach improved family function
and children’s well-being
Source: Beardslee (2000)

48. Living with the Blues
3. Consider working with whole family if possible
• 60 couples with at least one depressed partner
– CMT (a form of CBT) led to decrease in
person’s depression and marital conflict, and
an increase in relationship satisfaction
Source: Teichman (1997), Families on the threshold of the twenty-first century. Erlbaum.

49. Working with whole family
4. Consider working with whole family if possible
•
350 mums with depression
– when dad was able to show at least low levels
of warmth and maintain moderate levels of
structure it mediated against children
developing depression
– other studies have shown mum’s support is
protective for kids when dad is depressed
Source: Mezulis et al (2004), J. Fam. Psych. 18, 575

50. Helping Families
• Depression is nearly always treatable or
at least manageable
• by supporting both individuals and their
families real change is possible
• church communities can play a very
constructive role

51. What can anyone do?
• Know the symptoms
• Encourage the depressed person to seek help
• Be a friend and listen
• Stay in touch and check how they’re going
• Offer practical helps
• Don’t give cliché answers or make light of it
• Don’t pull away because you feel out of your depth
• Affirm the person’s strengths
• Take any comments about suicide seriously
• Help create aware and supportive churches
• Pray for the person (in their presence)