Holiday Stress and Depression can ruin your patients’ holidays and affect their health

Santa’s bringing a lot more to your office this holiday season; a whole line of stressed and depressed patients. Regardless of your specialty, the evidence suggests that each new generation is more susceptible to clinical depression than the one before. According to the Australian Family Physician, 20 to 25% of women will be affected by major depression at sometime during their lifetime and 7-12% of men.

The Diagnostic and Statistical Manual of Mental Disorders DSM-IV characterises major depressive disorder as one or more major depressive episodes lasting at least two weeks of depressed mood or loss of interest (anhedonia) accompanied by at least four additional symptoms of depression. Stress is defined as an organism’s total response to environmental demands or pressures. Stress impacts, in some form or another, everyone at some stage in their life, just in varying severity. A 1996 study found that 75% of adults felt abnormally stressed during their working week. This is a real problem and a real health issue. Stress may be implicated in up to 70% of patient visits to the family doctor. The relationship pressure, financial strain and physical demands affecting the everyday Australian this holidays are stressors that make depression worse at Christmas time. Unrealistic expectations posed by the media about how much time we should be spending with family only serve to exacerbate the problem. Consequently, the holidays instead become a revealing time of sadness, loneliness and stress/anxiety, and source a branch of depression known as Seasonal Affective Disorder (SAD). The DSM-IV describes SAD not as a separate mood disorder but as a “specifier,” referring to the seasonal pattern of major depressive episodes that can occur within major depressive and bipolar disorders. There is a regular temporal relationship between the onset of major depressive episodes at particular time of the year (unrelated to obvious season-related psychosocial stressors) with full remissions (or a change from depression to mania or hypomania) also occurring at a characteristic time of the year. The first and most important step in helping patients with SAD is to ask! 57% of depressed patients concede to being depressed, but only 1 out of 35 specifically consult their GP for depression. In this article we will outline 10 topics to discuss with patients you feel are at risk of succumbing to depression this holiday season.

1. Relationships – Holidays can intensify the normal pressures of relationships and marital problems. Given the time required to fully assess such problems, suggesting a referral to a marriage counsellor or psychologist is often a good first strategy.
2. Finding time for Yourself – It is critical to encourage patients to schedule time alone as much as they schedule appointments and meetings. In order to relax effectively, time needs to be set aside to do enjoyable activities, such as exercising, meditating, gardening or listening to music.
3. Plan ahead – Promote a micromanagement approach to issues. Research shows concentration and performance improves when the brain assimilates large tasks into smaller chunks.
4. Manage holiday spending – A study following 714 women who experienced financial loss found that depression symptoms increased proportionally based on the size of the loss. (Hobfoll, Johnson, Ennis & Jackson, 2003). Encourage patients to stick to a budget and find a format through which they can track their spending, be it a spreadsheet or a simple list.
5. Additionally, you can encourage patients to engage in lots of holiday activities that are free, such as looking at holiday decorations or attending a Christmas Carol concert.
6. Remind patients to be realistic about what they can and cannot do. There is a tendency for patients to fall into the “multitasking trap”. The “time cost” of refocusing your attention may be only a few seconds with each switch, but researchers have found that, over time, it reduces people’s total efficiency by 20% to 40%.
7. Remind patients not to put all of their energy into just one day (i.e. New Year’s Eve). The holiday cheer can be spread from one holiday event to the next.
8. Forget about perfection. Holiday TV specials are filled with happy endings. But in real life, people don’t usually resolve problems within an hour or two. Teach patients to expect and accept imperfections.
9. Encourage lonely patients to try volunteering some time to help others this Christmas. There are many worthy campaigns at this time of year, for example those St. Vincent de Paul and the Red Cross.
10. Encourage healthy habits! Remind patients that a little indulgence is OK, but moderation is important. A good strategy is to eat healthy snacks prior to a meal in order to satiate appetite and limit alcohol consumption to a few drinks over the evening.

Remember, the key to minimising your patients holiday stress and depression is for them to understand that holidays can trigger stress and depression. Promote acceptance of the concept that things may not always turn out exactly as planned. Encourage patients to take active steps to manage stress and depression during the holidays. They may just find they’re enjoying the holidays this year a little more than expected! (References: The Diagnostic and Statistical Manual of Mental Disorders DSM-IV: Australian Family Physician: December 2006.)