In light of the recent and tragic loss of Robin Williams, it seems pertinent to reflect on interactions many of us have had with those struggling to fight depression. In the physical therapy world, this is often a daily reality. Patients come to us in pain, searching for healing; but they also come struggling with identity issues, or going through the series of emotions due to loss.
There tends to be three groups of patients for whom these issues are most prevalent. The first is among athletes. These people are used to being very active and often spend most of their time in a team environment. Once injured, they are usually isolated from the team that must practice and play in their absence. This leaves them without the social support structure they are most used to. Also, athletes' personal identities are usually centered around their sport and activity. When no longer able to participate as before, they can become lost and struggle with finding themselves and finding an outlet for their feelings.
The next group we, as physical therapists, see that can be prone to depression is injured workers. Those injured on the job may now be removed from their work environment. They begin to miss out on the daily social interactions and sense of purpose that filled their days previously. Couple this isolation with the reduced wages and stress associated with trying to support and provide for a family and doubt and despair can set in.
Unfortunately, in the last decade as some people have abused the worker's compensation system, the worker may also face pre-conceived ideas and notions of what they are experiencing or how fast they should be recovering from case managers and medical providers tasked to help them. This only serves to darken the experience and deepen any tendency toward depression.
The elderly are the third major group of patients with potential of depression that come to therapy. These patients may be wrestling with feelings of loss, helplessness and despair in many ways. They may have lost a life partner recently. They may be facing a loss of independence that changes their personal identity. Or perhaps they are facing increased isolation as their function mentally and/or physically begins to deteriorate.
It is of note that depression has been shown in several studies to slow down the healing process as well. Thus, not addressing and helping a patient through some of these feelings can prolong their time away from the people and activities they most need to get them back on track.
It is vital that physical therapists know and recognize the early signs of depression. Notice should be taken of patients that express feelings of isolation, trouble concentrating, lack of appetite, sleeplessness, irritability. Should any issues of overmedicating, substance abuse, or self-harm be uncovered the situation should be documented and addressed with the referring physician immediately.
Questions should be asked such as:
Have you felt isolated since your injury?
Have you felt down or depressed?
Have you had any thoughts of harming yourself?
Have you overused any medications, drugs, or alcohol?
You may find you are the first person to have asked these questions and you are throwing them a lifeline.
Every clinic should have informational resources on hand for the patient and be able to guide them to the assistance of organizations such as the suicide prevention resource center.
Good numbers to pass on in case of immediate need for help: 1-800-Suicide (784-2433) Or 1-800-273-TALK (8255)