Occupational Therapy and Depression: Reconstructing Lives
By Ashley Opp
The proliferation of commercials for various antidepressant medications has convinced many Americans that managing depression is as simple as popping a pill. Although medication can be an important component of treating depression, occupational therapy practitioners can help those with depression to restructure their daily lives, find meaning in daily occupations, and redefine their sense of identity.
What Is Depression?
“From an occupational therapy perspective, people with depression typically do not have the energy or drive to participate in the things that are important to them,” says Lisa Mahaffey, MS, OTR/L, an occupational therapist at Linden Oaks Hospital in Naperville, Illinois. The symptoms, she says, depend on one’s age. Children with depression tend to be quick to anger and focused on their inability to do things. Other signs of depression include clinging to parents, fear of a parent dying, and refusal to go to school. Adolescents with depression typically are socially withdrawn, very irritable or angry, and at times express suicidal thoughts to friends or family. According to the Centers for Disease Control and Prevention (2003), suicide is the third-highest cause of death for teenagers.
Adults have more varied symptoms of depression. Like adolescents, they stop participating in their leisure, family, and home maintenance roles. This lack of energy can also affect their work, if they are working at all. Adults with depression find it difficult to get up out of bed, dress themselves, care for themselves personally, work out problems, engage in activities, or go out with friends. “There may be marked sadness, irritability, and lack of attention to detail, such as messing up money management tasks or not remembering appointments or important dates,” Mahaffey says.
For the older adult population, depression is manifested more as physical symptoms. “These somatic symptoms include headaches, stomachaches, or bowel and bladder complaints, which after much assessment are determined to be [linked to] depression and anxiety,” Mahaffey says. Some older adults are too anxious to leave the house, which can be a symptom of depression. An older adult might break a wrist or a hip and, unlike younger people, be unable to adapt or see the break as a temporary interruption in his or her life. Instead the reaction is to become discouraged and increasingly more fearful of falls. This fear results in inactivity, lowered endurance and flexibility, and greater isolation, which, paradoxically lead to an increased risk of additional falls and greater degrees of depression.
Older adults who are depressed often are experiencing a culmination of losses—not just loved ones, but sometimes their health. Depression correlates with loss of independence, and depression rates skyrocket when people enter facilities, particularly nursing homes and hospitals. According to the National Institute of Mental Health (2007), persons 65 years of age and older make up only 12% of the U.S. population, but they accounted for 16% of suicides in 2004.
What Causes Depression?
The causes of depression vary. For some people, depression is caused exclusively by decreased neurotransmitters in the brain, and may be genetic. For others, “the cause can be life events—the inability to gain satisfaction from their relationships, or life experiences that failed to provide them with the skills to manage and cope with their responsibilities,” Mahaffey says. “However, an argument can be made that although some forms of depression can be traced to a person’s life events, the thinking patterns of people with depression affect the brain’s ability to produce neurotransmitters. There is a mind–body connection, which might be why people respond so well to antidepressant medications that raise neurotransmitters, allowing them to engage in other forms of therapy and skill development.” These in turn may reduce the need for medication.
How Can Occupational Therapy Help?
Occupational therapy practitioners can examine the life roles that are meaningful to clients with depression and help adapt their responsibilities to give them the opportunity to participate and gain a sense of accomplishment. “Usually I go through the roles important to a client—worker, student, family member, friend, hobbyist—and we talk about how all of those roles have a set of responsibilities that, when met, have an outcome that is both desirable and rewarding,” Mahaffey explains.
Practitioners then determine what interferes with a person’s ability to meet those responsibilities, such as a getting to work late everyday or finding work tasks overwhelming. “Sometimes I’ll break down tasks. For example, I might have a mom identify some simple meals and make a shopping list so she can get her kids fed while she works through her depression,” says Mahaffey.
Self-esteem and identity also play large roles in managing depression. “I look at self-esteem from the perspective of how choices that we make in our lives impact how we think and consequently how we feel about ourselves,” Mahaffey says. Practitioners might talk with clients about structuring the day and replacing bad habits with good ones. For example, what will persons with depression do to fill and structure all of that time previously spent alone, maybe in bed or in front of the TV?
Occupational therapy practitioners can help persons with depression examine how to balance leisure, work, and relationships. “We look at daily structure and include certain occupations and strategies to ensure that clients follow through on things so that they meet the responsibilities of the roles that are meaningful to them,” Mahaffey says.
A Case Example
In one unusual case, a very intelligent 45-year-old man had started a successful business. He had a daughter and a great marriage. “He came into the hospital suicidal and depressed and couldn’t understand why because his life was going so well,” says Mahaffey. Mahaffey did an Occupational Performance History Interview (Keilhofner, et al., 1997) and an interest checklist. “Together, we learned that throughout the early part of his life he had set goals, and he always worked hard to meet them. He had gotten to a point in his life where he had met every goal he’d had and could no longer gain a sense of meaning in his day,” says Mahaffey. The client identified oil painting as a past interest, but he had given it up. He still had the materials, so with encouragement from Mahaffey, he set a goal to dig them out and paint something for his house. A year and a half later, he had a gallery opening.
Although this client’s case is unusual, it demonstrates how closely occupation—the things people do—is tied to one’s sense of purpose and identity, and this is where occupational therapy thrives. As Mahaffey puts it, “Occupational therapy is in a really good position to help people develop their occupational identities and start to get satisfaction out of things they do.”
Find an Occupational Therapy Practitioner
Physicians, case managers, and other medical professionals can refer you to occupational therapy practitioners in your area. Although most occupational therapy practitioners who specialize in depression work in hospital settings, if you are seeing a psychiatrist you can ask for a referral to an occupational therapist.
Centers for Disease Control and Prevention. (2003). Suicide among youth . Retrieved September 20, 2007, from http://www.cdc.gov/healthmarketing/entertainment_education/tips/suicide.htm
Keilhofner, T., Mallinson, T., Crawford, C., Novak, M., Rigby, M., Henry, A., & Walens, D. (1997 ). A user’s guide to the Occupational Performance History Interview-II (OPHI-II) (version 2.0). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.
National Institute of Mental Health. (2007). Older adults: Depression and suicide facts . Retrieved September 18, 2007, from http://www.nimh.nih.gov/health/publications/older-adults-depression-and-suicide-facts.shtml
Ashley Opp is AOTA’s senior staff writer.