The U.S. Preventive Services Task Force recommends that all people, starting at age 12, be screened for depression. Screening for depression helps find depression early. And early treatment may help you get better faster.

Depression is a disease. It’s not caused by personal weakness and is not a character flaw. When you have depression, chemicals in your brain called neurotransmitters are out of balance.

Depression causes adults and children to feel sad or hopeless much of the time. It’s different from normal feelings of sadness, grief, or low energy. Always tell your doctor if you feel sad or have other symptoms of depression. Many times, people are embarrassed by these feelings and say nothing. Depression can be treated, and the sooner you get treatment, the better your chance for a quick and full recovery. Untreated depression can get worse, cause other health problems, and may last for years or even a lifetime. It can have a serious impact on both you and the people you care about.

Adults

To find out if you are depressed, your doctor may do a physical exam and ask you questions about your health and your feelings. Some questions may not seem related to your mood. But your honest answers can help give the doctor clues about how depression may be affecting you. Your doctor may ask you about feelings of sadness, changes in hunger or weight, energy level, concentration, guilt, thoughts of death and suicide, sleep, general interest in everyday activities, and more.

Some diseases can cause symptoms that look like depression. So your doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

Children and teens

Symptoms of depression in children and teens can be different from adult symptoms.

To find out if your child is depressed, the doctor may do a physical exam and ask your child about his or her health and about how he or she thinks, acts, and feels. The doctor may ask your child about grouchiness, temper tantrums, headaches, stomachaches, social withdrawal, and more. It is common for children with depression to have other problems, such as anxiety, attention deficit hyperactivity disorder (ADHD), or an eating disorder. The doctor may ask questions about these problems too.

The doctor may also ask you or a teacher to fill out a form about your child’s symptoms.

Some diseases can cause symptoms that look like depression. So the doctor may do blood tests to help rule out physical problems, such as a low thyroid level or anemia.

For information about Magellan events during National Depression and Mental Health Awareness and Screening Month, downloadable materials and more free resources, visit our website here.

Adapted with permission from copyrighted materials here from Healthwise, Incorporated.  Healthwise, Incorporated disclaims any warranty and all liability for your use of this information.

Q: What is the cumulative effect on mental health of COVID-19, social distancing and now the protests/riots on African-American and other BIPOC adults, both immediately and in the long term?

A: The COVID-19 pandemic has worsened longstanding ethnicity-based healthcare disparities that have resulted in disproportionate infection, morbidity and mortality rates for BIPOC adults, specifically Black Americans. Black Americans represent approximately 11.9% of the workforce, however they make up 17% of the front-line, essential workforce that is at higher risk for contracting and transmitting the virus[1]. At a time when the pandemic has resulted in an employment loss of 17.8% among Black workers compared to 15.5% among White workers, the risk to individual health safety is compounded by the risk of occupational hazards, job loss and financial insecurity[2]. As such, the compounded crisis of police brutality and increased social awareness of protest movements and civil unrest adds an additional layer of uncertainty, worry, fear, anger and sadness. Studies show that Black Americans are more likely to develop both physical and mental consequences to prolonged exposure to the chronic stress associated with discrimination and socioeconomic status, particularly high blood pressure, asthma, diabetes, depression and anxiety[3] [4]. In the week following the release of the George Floyd police brutality video, the rate of Black Americans experiencing depressive or anxiety symptoms increased from 36% to 41%, and among Asian Americans, the rate jumped from 28% to 34%[5].

Q: Are there unique signs of mental distress in African-American and other BIPOC adults that differ from those presented by Caucasians?

A: Though various forms of mental distress are characterized and diagnosed by commonly reported symptoms and behaviors, it is not unusual for individuals to have unique experiences that don’t look or sound the same, depending on who’s experiencing them. Additionally, cultural and spiritual norms specific to certain ethnic populations can influence the ways in which we communicate our pain, worry, sadness, anger and fear to healthcare providers, which often leads to misdiagnosis and/or ineffective treatment planning for ethnic minorities. Moreover, a 2019 study conducted by Rutgers University, indicates that Black Americans with severe depression are more likely to be misdiagnosed with Schizophrenia, which reveals significant provider bias in overemphasizing psychotic symptoms compared to mood symptoms[6] . In these instances, it appears that Black respondents’ endorsement of mistrust, hopelessness and paranoia due to extenuating sociocultural and political circumstances can result in unique clinical presentations that pose significant obstacles to understanding and healing, and that this effect is heavily influenced by the identity and implicit bias of both the patient and the provider. Ethnic minorities are also more likely to somaticize mental health symptoms, meaning they often report physical complaints like pain, fatigue or headaches, as well as sleeping difficulties as their chief complaints, rather than attributing the combination of symptoms to a mental health condition like depression or anxiety. This dichotomy often leads to further limitations in access to care, weakening of trust in the healthcare system, and escalating feelings of traumatization, oppression and isolation for marginalized demographics.

Q: How can African-American and other BIPOC adults help each other process their thoughts and emotions about the general unrest in our country?

A: It’s often said that there’s strength in numbers, and this is equally true as it relates to emotional support for marginalized communities in times of social unrest and collective trauma. Generational exposure to workplace and community discrimination is a shared experience for many ethnic minorities, and this commonality may make it easier for individuals who are feeling distress to share their thoughts with friends, family and providers who have a firsthand experience with the same issues in our society and across the world. This familiarity may also reduce mistrust within the healthcare system, if BIPOC patients feel they have an opportunity to share their feelings without judgment, misdiagnosis or repetitive traumatization and discrimination. Likewise, ethnic minorities are more likely to rely on spiritual or other cultural leaders for support and guidance in times of stress or civil unrest and are more likely to benefit from clinical behavioral health services when these alternative modalities are considered and integrated as fluidly as possible.

Q: Are there unique barriers to mental health treatment for African-American and other BIPOC adults?

A: Apart from generalized limitations in access to healthcare that have been noted for Americans across the spectrum, behavioral healthcare remains out of reach for millions of people, including those who actually have healthcare coverage. Shortages in available providers, clinics and hospitals means that there are longer wait times for appointments, and fewer resources available for maintenance of chronic mental conditions. Many mental health providers have moved to cash pay only practices, and this may serve as an obstacle for people who don’t have the disposable income available to pay out of pocket for psychotherapy or medication management. Inpatient bed shortages and the lack of long-term behavioral healthcare facilities are also shown to contribute to chronic homelessness, frequent ER visits and more interactions with the criminal justice system, which has become the largest provider of mental healthcare and boarding for chronically mentally ill patients over the last few decades[7]. Finally, stigma remains a very prominent barrier to seeking care for many ethnic minorities. In some cases individuals may fear judgment, mockery, maltreatment or discrimination due to their mental illness, while others may simply lack adequate information about the mental health field due to relatively less cultural reliance on these modalities within certain ethnic groups.

Q: What would you recommend to Caucasian individuals who want to reach out to their BIPOC friends and acquaintances and show their support, but don’t know what to say or are afraid it would not be received well?

A: In times of social division, strife and unrest, marginalized groups who are experiencing emotional distress and traumatization are likely to be concerned about safety, survival and stability. Allies and systems of support outside of ethnic peer groups can be helpful in building trust and solidarity across demographics, and this may aid in the development of healthier coping and conflict resolution strategies. It’s important that friends, family and coworkers be mindful that not every BIPOC person experiences distress or social events the same way and be open to simply listening to how the person feels first, before rushing to offer apologies or solutions that may not be indicated or helpful. MLK said that riots are the language of the unheard, and it is indeed the case that marginalized identities continue to live social and emotional experiences that so often go unnoticed, misunderstood and unaddressed by the ethnic majority. An expression of willingness to hear, care and help despite not knowing all the answers or solutions is sometimes all that’s necessary to convey empathy, sympathy and solidarity.

[1] https://www.epi.org/publication/black-workers-covid/

[2] https://www.epi.org/publication/black-workers-covid/

[3] https://www.ajmc.com/focus-of-the-week/high-levels-of-chronic-stress-high-blood-pressure-linked-in-african-americans#:~:text=African%20Americans%20who%20report%20high%20levels%20of%20chronic,serving%20as%20possible%20catalysts%2C%20according%20to%20study%20findings.

[4] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[5] https://www.washingtonpost.com/health/2020/06/12/mental-health-george-floyd-census/?arc404=true

[6] https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201800223

[7] https://www.theatlantic.com/politics/archive/2015/06/americas-largest-mental-hospital-is-a-jail/395012/#:~:text=As%20sheriff%2C%20Dart%20is%20also%20responsible%20for%20Cook,considered%20the%20largest%20mental-health%20facility%20in%20the%20nation

Stress in the workplace can negatively impact job satisfaction and productivity, leading to low morale and employee turnover. In a 2018 Korn Ferry survey of nearly 2,000 professionals, 76% said that stress at work has had a negative impact on their personal relationships and 66% said they have lost sleep due to work stress.¹ Common causes of stress at work include: fear of being laid off, more overtime due to staff cutbacks, pressure to work at optimum levels all the time and lack of control over how work is done.² So what can employers do to support employees and create a culture that fosters mental and physical health?

The Building Blocks of an Emotionally Healthy and Safe Workplace

According to the American Psychological Association, while every organization is unique and faces different challenges, there are five practices that make up the foundation of a healthy workplace: employee involvement, work-life balance, employee growth and development, health and safety, and employee recognition.³

Employee involvement and engagement requires honest and regular communication between top management and all employees. A Gallup poll of more than one million American employees showed that the top reason people leave their jobs is because of their bosses, not because they dislike their position.4 Methods to empower and motivate employees include ensuring they have the tools they need to do their jobs, allowing flexibility, encouraging collaboration and teamwork, and showing appreciation.

Work-life balance is also vital. Programs and policies, such as employee assistance programs (EAPs), offer resources to help employees with all aspects of life, from childcare to financial concerns. Opportunities for employee growth and development include educational offerings, tuition assistance, mentoring, and leadership development. Investing in employee development helps employees develop their skills, increases staff motivation, and attracts top talent.

Health and safety initiatives encourage mental and physical well-being. Examples are wellness programs that promote a healthy lifestyle, such as smoking cessation, stress management, weight loss, and more. Again, EAPs offer a wealth of resources for all employees on how to achieve and maintain physical and emotional health.

Finally, expressing appreciation and recognizing employee contributions go a long way to promote job satisfaction. Recognition does not necessarily have to be monetary. Studies have shown that while compensation and benefits are important to workers, feeling valued and respected is even more critical.

Benefits

It may take time to tailor these approaches to fit with company culture, build trust, and meet the needs of employees. But the benefits of an emotionally healthy and safe workplace are many: higher morale, improved performance, reduced absenteeism and turnover, and a positive reputation that attracts and retains employees. Employees who are motivated and engaged are also better able to handle organizational change and other stressors.⁵

1 (2018, November 18). Retrieved from https://www.kornferry.com/institute/workplace-stress-motivation.

2 Segal, J., Smith, M., Robinson, L., & Segal, R. (n.d.) Retrieved January 6, 2020 from https://www.helpguide.org/articles/stress/stress-in-the-workpalce.htm

3 Retrieved January 6, 2020 from https://www.apaexcellence.org/resources/creatingahealthyworkplace/

4 Retrieved January 6, 2020 from https://www.linkedin.com/pulse/employees-dont-leave-companies-managers-brigette-hyacinth/

5 Retrieved January 6, 2020 from https://www.apaexcellence.org/resources/creatingahealthyworkplace/benefits/

One suicide is too many. Yet more than 47,000 Americans die each year as a result of suicide. Because suicide is the 10th leading cause of death in our nation, we at Magellan Health believe it is nothing short of a public health crisis. Thankfully many experts and organizations agree.

Recently, Magellan had the privilege to host a suicide prevention conference in Boise, Idaho. The free conference brought almost 200 local and national leaders together to exchange ideas, share successes and discuss solutions around the challenges we face together in addressing this crisis in our communities. Suicide is a topic that’s difficult, but we must talk about it and deal with it by creating an environment for genuine caring for one another. To have the greatest impact possible, this should start by encouraging those who are struggling to ask for help, and we need to remind one another to watch for signs and signals with our family, friends and colleagues.

The suicide crisis is particularly impacting the state of Idaho. In 2017, Idaho’s suicide rate was 22.9 per 100,000 residents. The state’s suicide rate is 58 percent higher than the national rate and reflects a 44 percent increase over the past 10 years.

During the conference, Dr. Michael F. Hogan, principal, Hogan Health Solutions, LLC, gave one of three keynote addresses. He spoke about opportunities to prevent suicide in all healthcare settings. As I shared in my remarks at the conference, I wholeheartedly agree with his perspective. From the examination room to the boardroom, healthcare leaders and executives play a critical role in helping solve this crisis. We must lead the charge—drawing in other key stakeholders like providers, lawmakers, teachers and family members to support efforts to make this crisis visible, reduce stigma and drive solutions.

One important place to start is by ensuring people understand the signs of suicide. First, we must increase education and awareness and promote community and statewide educational programs. We should focus on an audacious goal, a path to zero suicides, to drive the sense of urgency needed to get community-wide buy-in. In addition, we should invest in suicide training for family members and peers of those with a mental health diagnosis. Such training fosters early detection and, in the case of peer support, provides a common frame of reference, making individuals more likely to engage.

Second, we must work to break the stigma around mental health issues — and normalize the need for care. As Dr. Thomas Joiner, The Robert O. Lawton Distinguished Professor of Psychology at Florida State University, said during his keynote address, “Reach out and tell someone when you see that someone is desperate. These person to person connections as we look out for each other can have such a significant impact in reducing suicides. It is important to keep in mind that all of us hold an important role in caring for one another.” Creating opportunities for open dialogue in the community, like the workshops during our Boise conference, helps shine a light on the problem and engages more people in helping others before it’s too late.

Finally, improved access to care and early screening will go a long way toward reducing the risk of suicide. Ensuring people of all economic status and backgrounds have access to behavioral healthcare is key. However, finding specialists who are skilled in suicidology isn’t easy. One study in Maricopa County, Ariz., determined that only 30 percent of behavioral health professionals in the county believed they had the necessary skills and support to treat at-risk patients. We need increased funding for suicide training among all medical professions.

As many as 38 percent of people making a suicide attempt did so within a week of a healthcare visit. Our healthcare system must look for ways to support early detection by making depression screenings part of every primary care visit. To help identify patients with mental health conditions, Magellan Healthcare has developed SmartScreener^SM. SmartScreener is a digital application that contains standard screening tools used by behavioral health professionals like counselors, psychologists and psychiatrists. While the patient waits to be seen by the physician, he/she completes the screener. Answers are confidential and only shared with the physician, who will discuss the patient’s results during the appointment and can help with next steps.

This routine screening is making a difference in identifying patients with behavioral health concerns. In a six-month primary care SmartScreener implementation, approximately half of the patients screened positive for a behavioral health concern. About 38 percent were deemed appropriate to be referred to digital cognitive behavioral therapy (DCBT). Fifty-four percent of these appropriate patients then enrolled in DCBT, getting help for which they may otherwise never have been referred.

The path to zero suicides requires that healthcare leaders—and the nation as a whole—treat suicide as a public health crisis and that we normalize discussions about mental health, suicide and treatment. I hope everyone who attended our Boise conference left as inspired about the urgency of this issue as I did. Let’s all commit to strategies that involve our communities in suicide prevention and draw upon multiple resources for continuing education and improved access to treatment.

 For more information about suicide prevention, read our other blog articles here.

As we observe National Minority Mental Health Awareness Month, we sat down with Dr. Rakel Beall-Wilkins, a former Magellan Healthcare medical director.

 Magellan Health Insights: Dr. Beall-Wilkins, thank you for speaking with us today. Of course, everyone’s mental health is critical, but why is it important to pay particular attention to the mental health of Black, Indigenous and People of Color (BIPOC)?

Dr. Rakel Beall-Wilkins: We know that mental health conditions can be successfully treated. However, BIPOC are significantly less likely to receive treatment for mental health conditions, including substance use. And it’s reaching crisis levels, especially among our young people. For example, suicide is now the third leading cause of death among African American males who are 15-24 years old.

Magellan Health Insights: What are the barriers to BIPOC receiving high quality mental health treatment?

Dr. Rakel Beall-Wilkins: BIPOC are less likely to seek treatment, both for their physical and mental health. However, when they do reach out for assistance, they are less likely to receive consistent, high-quality treatment.

There are many contributing factors to these barriers. The high costs of care can be a deterrent. Most BIPOC in the U.S. (with the exception of Asians) have higher than average rates of poverty. BIPOC are more likely to lack insurance coverage, and may only seek emergency care, which costs more and is less effective than sustained treatment. Medications or diagnostic procedures may be viewed as too expensive. Or reliable transportation for follow-up care may not be available.

There are also what are called the social determinants of health (SDoH). These include factors such as consistent transportation, the availability of healthy food, safe and affordable housing, access to education, public safety and working conditions. BIPOC are more frequently negatively impacted by the SDoH. For example, these members are more likely to be homeless or move frequently, which interferes with maintaining consistent treatment. They may lack adequate nutrition and are at greater risk for having associated medical conditions like hypertension or diabetes.

Further, the stigma around mental health conditions, while improving, is still a deterrent to seeking treatment—for everyone. Some cultures may see it as taboo to request help or be seen as someone who needs help.

When BIPOC patients do seek treatment, there may be no one available who speaks their language. In some clinical settings I’ve been in, it could take a week to arrange for an interpreter or a therapist who was proficient in the patient’s language. They may not have a primary care physician (PCP) to help with screening for mental health conditions or provide follow-up care. In addition, the community clinics where BIPOC are more likely to receive care may be understaffed, overcrowded and have long wait times. Understaffing may lead to inadequate screening or even misdiagnosis. And, frankly, the clinic also may not be in a place where the member feels safe traveling so, they may hesitate to go in the first place or return for continued treatment.

Magellan Health Insights: How can everyone, including healthcare professionals, best support minority mental health?

Dr. Rakel Beall-Wilkins: Everyone can help eliminate stigma. Be open to talking and hearing about mental health conditions, and make it clear that you know that having a mental health condition is nothing to be ashamed of. When someone you care about is going through a difficult time, encourage them to get help, and learn ways you can support someone who coping with a mental health challenge.

As healthcare providers, we personally can help by:

• Ensuring we are taking into account each person’s wishes when referring them to other providers: We should ask every patient whether they prefer to see someone of a specific race, ethnicity, gender or sexual orientation.
• Educating ourselves to be more culturally competent and making cultural training a priority for our staff.
• Expanding our workforces with staff from various backgrounds, sexual orientations, cultures and with varied linguistic skills particularly for the unique cultures that are most prevalent in the community.
• Screening for psychiatric conditions during routine visits. Many patients will report physical symptoms instead of talking about the underlying mental health concerns. PCPs and others see many cases of mild or moderate depression during routine care, and screening every patient can help prevent costly emergency visits and admissions. Self-screening tools can also help.

Beyond what we can personally do to educate and equip ourselves and our staff, I believe that the best solutions come from an integrated, collaborative approach. Everyone can help eliminate the disparities. If we work with leaders in the community, for example in churches and schools, we can raise awareness of mental health conditions, destigmatize treatment seeking, help address the social determinants, and improve the lives of everyone in our communities.