Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Each week our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #03: Depression & Families

IAN VO DOWN & UP INTRO

The Down & Up Show on Depression Is Real.org. A show dedicated entirely to the subject of depression, and the reality that there is hope for people dealing with this disease. Now, your host, Dr. Ellen Frank.

DR. ELLEN FRANK INTROS UNITED STATES CONGRESSMAN PATRICK KENNEDY OF RHODE ISLAND

Welcome to the Down and Up Show on Depression is Real.org. This week we're honored to have with us a very special guest, a devoted mental health advocate, United States Congressman Patrick Kennedy of Rhode Island. Having suffered with depression for years, Congressman Kennedy has seen firsthand the challenges posed by mental illness.

With help, he faced these challenges and is one of the leading voices on mental healthcare reform on Capitol Hill. Congressman Kennedy is the sponsor of the Mental Health and Addiction Equity Act of 2007 that calls for parity in the provision of mental health and substance-related disorder benefits under group health plans. Congressman, thank you for joining us today.

DR. ELLEN FRANK / CONG. PATRICK KENNEDY

PATRICK KENNEDY ANSWER:
It's a pleasure to be with you.

ELLEN FRANK QUESTION:
You are really one of the foremost leaders on mental healthcare reform on Capitol Hill. How much does this passion stem from your own experience with depression and chemical dependency?

PATRICK KENNEDY ANSWER:
Well, obviously, we're all shaped by our own experiences in life and, frankly, for most of my life I hid from my experience of depression because I was ashamed of it. And in my family I was led to believe that it was a sign of weakness, and I felt even more depressed at my condition of depression.

However, I was anxious to combat it only because I felt so defensive of my mother and the struggles that she had had and fought her lifeÑall of her life. And, I knew that, you know, in her condition that it was not a voluntary choice what she had suffered.

And in my own situation I was never quite sure that, you know, what I was facing wasn't just being a spoiled brat or ungrateful andÑyou know, and I wasn't sure that I didn't-I wasn't just somebody that wasÑwasn't happy and that should have been happy, that was-that it was just a-that it wasn't a chemical imbalance.

I knew in my mother's situation that it couldn't be anything but a chemical imbalance cause I had seen her go through so many different treatments and try so hard to become and remain sober and yet face trial after trial of efforts to remain sober and to remain positive in spite of her own depression.

It only became clear to me after, you know, seeing my own behavior and having it pointed out to me over a long period of time, and reading about my own behavior in the newspapers and in the headlines over a period of years and years. Had someone said to me that that's not behavior that's normal, that, you know, the depression that you're, you know, explaining is not normal, that it isn't just something that people always haveÉ

And until I got on medication, I thought that's the way people often felt. When I got on medication, I realized that the way I thought-I used to feel that was normal, that it wasn't normal. That, frankly, once I got on medication I started realizing, wow, I'm feeling really good and what I was feeling before was abnormal.

That I, like my mother, had had that chemical imbalance and, frankly, thankfully to treatment I was benefiting from treatment. And my experience told me that if more people could gain access to treatment like I did, then they too could come to the realization that it wasn't their fault, so to speak, that they were depressed, but rather that it was a chemical imbalance that they could have treated that could bring them back to a better sense of self.

ELLEN FRANK QUESTION:
What was it that finally led you to seek help for your depression?

PATRICK KENNEDY ANSWER:
Well, I had a chemical and alcohol dependence problems [sic] throughout my life and those were, I think, efforts to self-medicate. I alsoÉ Those led to a life of unmanageability for me which led to me having to confront that unmanageability in the form of last year a car accident which made headlines and forced me into drug and alcohol rehabilitation.

It was in that context that I realized that myÑI had a co-occurring disorder of not only addiction and alcoholism but, you know, real depression. I had been treated for depression, you know, earlier but clearly had not adequately dealt with it because I had still been self-medicating in ways that were not healthy.

And it wasn't until I got on the right regimen of medications after treatment that I was able to really come to a better place.

ELLEN FRANK QUESTION:
What positive experiences have come out of your openness about your depression and your addiction?

PATRICK KENNEDY ANSWER:
Well, the most positive for me is that being a public figure I am able to goÑeveryway I go in my own home state, people know that I have been in treatment and that I am in recovery. And theyÑthose that are also facing those same challenges come up to me and identify themselves and the same struggles they face on a daily basis with me.

And so wherever I go, I'm not anonymous in that respect and actually that's a benefit to me. I don't wanna remain anonymous because my disease was one of hiding from people. I did my best to have a public life and then to try to hide everything else in my private life and it led to an unmanageable existence.

My life now is more coherent, public and private. And, frankly, when I'm not in public I can connect with people to much more of a personal extent and a deeper extent because now it's just a more honest exchange. People are telling me about themselves in a deeper way, in a more human connection kind of way.

And I find that that helps me in my own recovery, because I make those connections every single day and that helps me remain more grounded in my recovery.

ELLEN FRANK THANKS CONG. KENNEDY / TRANSITIONS TO DR. MARION SILLS

Thank you Congressman Kennedy for sharing your personal story about the impact mental health issues have had within your family. We'll be hearing more from Congressman Kennedy in upcoming episodes when he joins us to discuss pending mental health legislation.

And now we're going to speak to Dr. Marion Sills, an emergency doctor at the Children's Hospital in Denver, Colorado and a Fellow at the University of Colorado Health Sciences Center. She's going to talk to us about research that she has done that looks at the association between parental depression and the health care use of children.

Welcome Dr. Sills.

MARION SILLS ANSWER:
Thank you.

ELLEN FRANK QUESTION:
Tell us exactly what your study was about.

MARION SILLS ANSWER:
This study was a review of a large data set from an HMO to determine the association between depression in a parent and the use of pediatric health care on the part of their children. Ours specifically looked at child health care utilization. In other words, how the children interact with the health care system, what types of health care do they use. But there are other studies that have seen impacts on child health and development and outcomes that are more related to the child's health itself. Ours specifically just looked at use of health care, of the health care system.

ELLEN FRANK QUESTION:
And what did you find?

MARION SILLS ANSWER:
Well, we certainly found that there was an association between having at least one depressed parent and patterns of health care use in the child. We certainly found a more costly pattern of health care utilization in the children, more specifically they tended to have a greater rate of emergency department and acute care visits across all age groups of children, even when you correct for the degree of medical illness in the child.

ELLEN FRANK QUESTION:
So why do you think parental depression might have that affect?

MARION SILLS ANSWER:
That's a very good question. And that was certainly outside the scope of this retrospective study. There are many speculations that one could make regarding that that go both directions; namely it could be that something about the parent's depression would lead to different patterns of health care utilization for the child or something about the child needing different patterns of health care utilization; in other words, needing to go to the emergency department or some other factor, leading to stresses that then manifest in depression in the parent.

ELLEN FRANK QUESTION:
Do you think it might be in part that depressed mothers and fathers because of their depression simply don't have the energy to do the kind of preventative health care that are typical ways of handling children's health care in this country and wait until things are really in a crisis before they seek help?

MARION SILLS ANSWER:
That's certainly something that has been seen in some other studies, and it's something that would be a good explanation for this. It was outside the scope of our study, but I think that that association would be something that would be a great topic of future investigations.

ELLEN FRANK QUESTION:
Is there anything that this study didn't show that you're still interested in learning or you wish you'd been able to study or to show?

MARION SILLS ANSWER:
There are many things. And one of them is certainly what you've gotten at in your why question, why is this association there, and that would be a very important next step. Another thing that we tried to look for in our study was something that you alluded to as well, which was are these children seeking, are the parents seeking less preventative health care services for their children.

We found that to be true in the older children, in the teenage age group, but interestingly did not find a lower rate of preventative service utilization in the younger child, in the younger age groups, before the teenage years. And that would be something that we would hope to study more in greater detail to see if there is an association between depression and the way parents seek preventative services instead of acute care services for their children.

ELLEN FRANK QUESTION:
Do you believe that it would be useful or perhaps should even be mandatory for parents to be screened for depression or for women who have just given birth to be screened for depression?

MARION SILLS ANSWER:
I think that it's a very important health care priority. And I hope that that's one of the messages that this study brings to greater light. Not only to providers; in other words, it's important for providers who are taking care of moms in labor and delivery or in the post-partum clinics, it's important for those providers and for pediatric providers and family medicine providers to screen for depression in the parents, so that's one priority.

But it's also important, one reason we focused on utilization is it's important to the health care financing bodies; in other words, health care systems administrators and hospital administrators and HMO administrators to recognize that this is an expensive problem, that the expenses, the costs of parental, of adult depression extend beyond the increased use of health care by those adults; it has impact on the next generation.

And so that added expense increases the urgency just from a purely financial standpoint of taking care of adults, identifying depression in parents, and making that a funding priority.

ELLEN FRANK QUESTION:
Those of us who study adult depression have certainly known for a long time that depression has this kind of hidden cost, that it leads to increased physical illness and increased use of physical health care resources and that if we treat depression appropriately that goes down, but I don't think we'd thought about the impact on the second generation until your paper.

You mention that you wanted to bring these hidden costs to the attention of policy makers, what are your thoughts about how that should be done and how policy makers should address this issue?

MARION SILLS ANSWER:
That's a great question. I think that the answers will lie more in the field of people who are little more policy oriented than I am, but it's something that certainly with the, you could get at with the increased cost of health care for children given that parents have depression.

I think that would certainly call attention to this issue. I think there's been a lot lately about how mental health services are not compensated as well, there's not as good health care insurance coverage for these services as there is for medical services. And my hope would be that this type of study would call attention to the fact that the two are really not easily separable.

And that this becomes quite a messy issue if we try to really regard mental health services as something that we can give very, that we can treat through benign neglect, that we can try not to give as a high priority in terms of health care coverage and really just aim at things we can treat with a pill.

This is something that you know although mental health care services appear expensive to policy makers at face value, as you say the hidden costs of not treating those, not screening for and treating those issues can be quite high.

ELLEN FRANK QUESTION:
Any final thoughts you'd like to leave with our listeners?

MARION SILLS ANSWER:
I think that this is an important, the final group that is important, you know, we've discussed providers and administrators and policy makers, this is also something that's important for parents to know about. And I'd like to cast that from two angles, first this is not something to feel bad about. I've had many reactions to this study from friends of mine, for example, who are parents who are concerned that perhaps their moodiness might lead to terrible outcomes in their children.

The second side of that is that I would like to you know have parents recognize that their moods and their mental health is a very important priority to care for. And so I would encourage you know on the eve of Mother's Day and Father's Day, the study did include fathers, to encourage parents to take good care of their own mental health and do what it takes to ... there's no time like the present to really ...

ELLEN FRANK QUESTION:
And if you won't do it for yourself, do it for your children.

MARION SILLS ANSWER:
Exactly.

ELLEN FRANK QUESTION:
Thank you Dr. Sills. Your insight into the affects of depression of parents on their children's health care is a really, really important topic. I hope your research encourages mothers and fathers to seek care for their own sake as well as for the sake of their children.

MARION SILLS ANSWER:
Thank you very much.

DR. ELLEN FRANK OUTRO (Music up half way through)

For the Depression is Real Coalition, I'm Ellen Frank. Join us next week for another episode of the Down & Up Show on depressionisreal.org. [music]

IAN VO CLOSE

Thanks for listening to the Down and Up Show. For more information, log onto www.depressionisreal.org. You can find us there and at iTunes. And remember stay subscribed.

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