The end of the boom has led to an increase in patients suffering from depression arising out of financial collapse, writes MICHELLE McDONAGH
THE STRONG link between economic decline and the onset of mental illness, particularly depression, has long been recognised. Now, a new study suggests that patients who have developed depression as a direct result of the collapse of the Celtic Tiger actually have different symptoms to the “classical” depressive patient.
The typical classical depressed patient was younger, female, had moderate or mild symptoms, a past history of depression, an anxious dependent personality and was of middle or lower class.
The new Celtic Tiger patient, on the other hand, tends to be male, older, employed, of a higher socio-economic group with severe and acute onset of symptoms with associated suicidal thoughts. They tend to have driven personalities, significant debts and an internal loss of control.
Mauling of The Celtic Tiger, a case study of new patients admitted with psychiatric difficulties since the beginning of the economic decline, was carried out by a team drawn from St Patrick’s University Hospital, the Department of Psychiatry at Trinity College Dublin and the HSE.
It was presented in poster format at the recent annual meeting of the Irish College of Psychiatry in Belfast – where it won an award – and the authors hope to publish a more extensive paper in the coming months.
Using a prospective case review of patients admitted to St Patrick’s University Hospital, they compared the complete set of admissions from 2009 with those of 2008 to investigate if there were any discernible differences in clinical profiles.
What they found was a subgroup of new patients admitted in 2009 with new-onset depression directly related to the economic decline that had never been encountered before by the services – a finding, which the authors point out, impacts significantly on service provision.
Medical director of St Patrick’s and consultant psychiatrist, Prof Jim Lucey, points to a significant increase in new patients received solely through its referral line to its community-based network of Dean Clinics since the collapse – from 664 new patients (including 44 adolescents) in 2009 to 858 new patients (including 166 adolescents) in 2010.
“We are seeing an increase in patients suffering from depressive symptoms arising directly out of a collapse in their finances which is causing domestic and personal stress. What is clear is that these people, who are presenting with different symptoms to the ‘classical’ depressed patient, may not ever have been referred to the mental health services if not for the collapse,” he comments.
Over the past year, Lucey says there has been a 25 per cent increase in suicide in this country. At the end of last year, nearly 50 people from the farming community took their own lives – only one example, he notes, of a group of people who would never have died if the recession had not happened.
“This boom in suicide is among people who have never attended the mental health services. We are not getting to these people and I would argue that we need to,” says Lucey.
“It appears that the number of people who end their lives through suicide, having had mental health treatment, is no greater now than before the recessi on. In other words, the outcome of mental health treatment is overwhelmingly recovery despite the economic decline.”
The new breed of Celtic Tiger depressive, he says, are often great entrepreneurs who have an internal locus of control which means they tend to blame themselves for their problems whereby somebody with an external locus of control would blame the economic collapse.
“We hear a lot of people blaming society for getting greedy, but what we are actually seeing is a terribly morbid outcome of a misplaced sense of responsibility. The data shows us that the people who are ending their lives are those who have condemned themselves to death because they feel so hugely responsible for the situation they find themselves in.
“It’s not for us as a society to make a judgment like this which has a capital outcome, we should be helping people to develop resilience to stress and to reach an outcome hopefully of recovery.”
Since January 1st, access to mental health assessment in the Dean Clinic network is being provided free of charge to patients referred by GPs. The regional mental health clinics are located in Capel Street, Glasnevin, Donaghmede and Lucan in Dublin as well as Mahon, Cork, and a Dean Clinic will be opening in Galway city later this year. Only one in 10 patients who attend for assessment in the Dean Clinics require admission to hospital.
Prof Jim Lucey will be addressing GPs in the Munster area on the topic of Maintaining Mental Health in the Current Challenging Times tomorrow evening as part of a series of meetings. The evening takes place at the Maryborough Hotel, Maryborough Hill, Douglas, Cork, from 7pm. Treasa O’Sullivan, consultant psychiatrist, will speak on Cognitive Behavioural Therapy At A Glance. GPs interested in attending can e-mail admindeancork@stpatsmail.com or tel: 01-6477733.
The support and information service at St Patrick’s can be contacted at tel: 01-2493333 or by e-mail at info@stpatsmail.com
