General Enquiries
“Sir, how are you today?” That is one of the conversation starters used by some doctors in the clinic when meeting their chronic patients who came for follow up treatments. A simple enquiry like that can induce a greater response from the patient, not just focusing on the level of management of their physical illness but also the patient’s emotional state at the time. Apart from strengthening the understanding between the doctor and patient, it will also allow the patient to feel appreciated and more comfortable to open up about their current situation and any arising problems. This will indirectly encourage the patient to tell the doctors if they are feeling depressed or not. Yes, this is one of the strategies that we have taken and must take while handling patients in health clinics. Other methods include asking specifically to the ones who are at risk of depression regarding their depression symptoms if they have not informed their doctors of it.
Chronic Patients at Risk of Depression
Why are such enquiries so important? This is because if these questions are not asked, patients often would not want to or do not have the opportunity to share their feelings or possible symptoms of depression. Hence, the symptoms of depression accumulate and gets bottled up inside and finally bring negative consequences to themselves and their family. They might presume the doctors are busy and uninterested to their personal problems at home, what more the anxiety they are facing. Unknown to us, those who have chronic illnesses such as non-infectious diseases are also prone to long term depression. Often we misunderstand that only those with major problems or sudden change in life would experience depression. THIS IS THE WRONG ASSUMPTION. Studies have shown that patients of chronic illnesses such as diabetes, hypertension, kidney failure, asthma, seizures, and stroke have the potential for stress and depression. This stems from the physical effect of the illnesses itself that reduces the quality of the patient’s life compared to other people, worry if the illness becomes worse, financial stress and cost of treatment, as well as the feeling of guilt for being a burden to their families for having to care for them. How about parents and guardians of children with special needs and children with chronic illnesses such as heart problems, thalassemia, and down syndrome? Yes, they are at risk for depression although they do not the ones having the chronic illnesses. This is because the impact of an illness is not only on the patient but also to the caretakers, parents, and local community especially from social, economic, and mental aspect. Hence, all these groups at risk needs to be asked how they are doing.
Teenagers and the Elderly
These two groups are also at risk of stress and depression. However, the community and family often overlook them. Teenagers have the tendency to try new things and succumbing to peer pressure. They are prone to internal and external conflicts as they search for their identity. This includes pressures at home, peer pressure, or pressure at school. Without proper exposure and guidance, they can easily get into social problems and misuse of drugs in their attempt to escape their personal problems. What they need are attention, conversations, and love. Hence, behavioural changes and declining academic performance is something that needs to be paid attention to.
The elderly tend to be silent and keep their feelings to themselves to care for the feelings of other family members. They also display different symptoms compared to other groups. For example:
- Lack of focus
- Difficulty to pass motion
- Body aches
- Anxiety
- Difficulty to fall asleep
- Deteriorating mental health
- Weak ability to think
Therefore, apart from identifying the causes of illnesses such as dementia, the possibility of depression should be taken into consideration among the elderly.
Your Responsibility and Ours
Therefore, it is your responsibility as a family member and part of the community to identify changes in behaviour among your family member or even your friends from the very beginning. Ask them if they are facing problems. Give them support and quickly bring them to the doctor for confirmation and further treatment.
You are our AMBASSADOR at home, school, and in the workplace. This is because doctors only have the chance to meet the patients during follow up visits and appointments at the clinic. However, you have better chance of meeting and spending more time with your family and friends. Whenever you feel doubtful, it is okay to ask “general questions” and ask how they are doing.
How about you? Evaluate yourself wisely. If you feel stressed, lost hope, or losing interest in activities you usually enjoy, YOU MIGHT be having early symptoms of depression.
Does everyone need to go to the hospital?
If you think all patients of depression and stress needs to be hospitalised, YOU ARE WRONG. This is because MAJORITY of depression patients CAN BE TREATED AT THE CLINIC and community. Yes, the doctors will evaluate the level of depression you or a family are having based on extended interviews at health clinics. If you are at the early or moderately early stage, direct treatment can be carried out at the clinic. This includes medication, advice and support, as well as trained physiotherapy that can teach you how to reduce stress using stretching and breathing techniques. You must follow up with subsequent treatment to see the response towards medications provided. Only very severe and dangerous conditions that do not respond to early medications will require further treatment in hospitals.
This will indirectly reduce the stigma and negative connotation of society towards your depression. This is because nobody would know the reason you go to the nearby health clinic for your appointments apart from the doctor and yourself.
Prevention Steps
Prevention is better than cure. Practice healthy lifestyle which includes balanced diet, weight control, and enough rest and sleep. Physical activity such as exercises and stretches will improve the wellbeing of the body and also reduce stress. This is proven to be effective even among the elderly.
Improve relationships among family members and work colleagues. Spend more time socialising and eating with your family. Ask how they are doing every day. Avoid keeping feelings to yourself, misuse of drugs, and smoking.
Accept your own weaknesses and strengths positively. The desire to make everyone else happy should be discarded. To concede in an argument will also help to control situations and conflicts. Conceding doesn’t mean we lost, it shows our maturity in thinking. Always praise and tell yourself you are awesome and able to overcome existing challenges.
In conclusion, go and see the doctor in your community today. We are ready to help and evaluate your depression. Get help immediately. Don’t wait. Let’s ask how each other is doing!
Dr. Shaiful Ehsan is a Family Medicine Specialist and a lecturer at the International Islamic University Malaysia. He emphasises the importance of medical education to each of his patients. This article is translated from the original at https://www.mmgazette.com/pengesanan-awal-gejala-kemurungan-bermula-dengan-anda-dan-komuniti-reachout-dr-mohd-shaiful-ehsan/by Nur Nadhirah.
References:
- John Murtagh’s General Practice by John Murtagh
- Clinical Practice Guidelines Management Of Major Depressive Disorder
- Saringan Kesihatan Warga Emas – Portal MyHEALTH