Major depressive disorder is one of the most common mental health conditions in America and affects more than 16 million adults each year. Different from temporary feelings of sadness, depression is a complex psychiatric condition that lasts for at least two weeks, or indefinitely without proper treatment. Depression typically impairs a person’s ability to work, attend school, maintain a daily routine and have fulfilling relationships. However, depression is treatable and professional care is available for people who face this illness.
A person who has depression may struggle with a range of emotions on a daily basis, experience harmful thoughts, act erratically or abuse drugs or alcohol to cope with the symptoms of this condition. Mental health crises, including suicidal thoughts and non-suicidal self-injury, are some of the most serious side effects of depression. Mental health first aid, a type of support anyone can provide, can be beneficial to address these and other mental health crises, and can encourage someone to seek professional help.
Mental health first aid can help someone regain a sense of calmness after a crisis related to any mental health condition, including depression. Mental health first aid training is open to anyone, and everyone can benefit from learning how to provide immediate support to someone in a mental health crisis. To sign up for a course in your area, visit Mental Health First Aid USA.
Types of Depression
Depression can affect anyone — including celebrity chefs and fashion designers — at any point in life. There are various types of depression, and each can co-occur with other mental illnesses or form after specific events. Some of the most commonly diagnosed types of depression include:
- Major depressive disorder
- Persistent depressive disorder, formerly called dysthymia
- Bipolar depression, or manic depression
- Seasonal affective disorder
- Postpartum depression
- Substance- or medication-induced depressive disorder
Each type of depression has harmful symptoms and side effects that can last indefinitely without treatment. All forms of depression are treatable, and mental health first aid can be a type of compassionate intervention that encourages someone to get the help they deserve.
Depression Risk Factors
Typically, depression does not stem from one root cause, but from a combination of psychological and environmental factors.
There are many different depression risk factors, and anyone can experience depression because of:
- Physical health issues: long-term medical conditions, drug or alcohol addiction, disabilities, changes in hormone levels, side effects of medications or drugs or childbirth complications.
- Mental health issues: the presence of another mental illness or a mental disability.
- Interpersonal relationship difficulties: bullying or victimization, the death of a loved one, an unstable marriage, mental or emotional abuse or being a caregiver.
- Environmental stressors: lack of exposure to bright light in winter, domestic violence, job instability or poverty.
People who face the highest risk of developing depression include people who:
- Have had a depressive episode in the past
- Have a family history of depression
- Experienced abuse or neglect during childhood
- Are emotionally sensitive
- Are female, as major depressive disorder is more prevalent among women than men
Depression Warning Signs
Regardless of the type and cause of someone’s depression, most forms of depression can change the way someone thinks, feels and acts. People who struggle with depression usually exhibit physical, behavioral and emotional warning signs, and these should not be ignored as they can worsen over time.
The two main warning signs of clinical depression are an unusually sad mood or a loss of interest in activities they normally enjoy. Someone who has depression may experience one or both symptoms every day for at least two weeks.
Mental health first aiders should be aware of other important signs of depression including:
- Lack of energy
- Feelings of guilt, worthlessness or hopelessness
- Difficulty concentrating
- Changes in sleeping habits
- Crying spells
- Loss of interest in eating, or overeating
- Neglecting responsibilities
- Becoming withdrawn from loved ones
- Talking about death or dying
For a first aider, knowing the risk factors and warning signs of depression is the first step toward helping someone who struggles with this condition.
Recognizing the warning signs of depression and acting immediately is one of the best ways to help someone who struggles with depression. Given that the symptoms of depression can be debilitating and long-lasting, early intervention from a family member, friend or first aider can be imperative.These resources from The Recovery Village can help anyone learn more about early detection and intervention for depression:
How to Provide Mental Health First Aid for Depression
Anyone can provide mental health first aid support to someone who struggles with depression. The mental health first aid treatment approach is a five-step action plan called ALGEE, which is a mnemonic for:
- Assess for risk of suicide or harm
- Listen non-judgmentally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other support strategies
Using these steps, a first aider can mitigate risk of harm to the individual with depression and provide them with empathetic support until professional help arrives or can be sought.
Assess for Risk of Suicide or Harm
With depression, there are two main types of mental health crises, and first aiders typically provide:
- First aid for suicidal thoughts and behaviors: This involves recognizing and responding to suicide warning signs, asking if the person is considering killing themselves and contacting emergency help if necessary.
- First aid for non-suicidal self-injury: To provide this kind of first aid, a person must be familiar with the forms and signs of self-injury and be prepared to talk openly about self-harm.
In either of these situations, if the person has a deadly weapon or threatens to harm themselves or others, a first aider should call 911 immediately instead of attempting first aid.
If the individual is not experiencing a crisis related to suicidal behaviors or non-suicidal self-harm, the first aider can start a private conversation in which they can express their concerns and offer help.
If the person is not in a crisis that needs immediate medical attention, then the first aider can approach the individual privately and engage in a conversation to understand more about the their situation. This step can help a person who faces depression realize that they can talk openly about their illness without fear of judgment. This candid conversation can be the first step toward the individual reaching out for professional help.
Questions that a first aider can ask during this conversation can include, “How have you been feeling lately?” and “How long have you felt this way?” They should be prepared to listen quietly and respectfully, not interjecting even when they disagree.
However, these questions should be among the only ones asked. It’s important for first aiders to realize that this conversation is not a chance for them to give advice or fix a person’s depression. It is an opportunity for someone who struggles with depression to talk and be heard by someone who cares, even if what they say doesn’t make sense or conflicts with the first aider’s beliefs.
First aiders can listen judgmentally by being cognizant of their attitudes and communication skills. Before and during a conversation with someone who struggles with depression, a first aider should:
- Reflect on their own mental well-being beforehand
- Not interrupt, and ignore the need to reply
- Maintain comfortable eye contact and open body language
- Use minimal verbal prompts, like “I see,” and “Ah,” instead of offering advice, which could shift the focus of the conversation
- Avoid fidgeting or looking at a cell phone
- Avoid expressing negative reactions
- Avoid voicing personal or religious beliefs
- Avoid saying, “I understand,” giving unhelpful advice like, “Pull yourself together,” or saying platitudes like, “Everything will be fine.”
By listening non-judgmentally, a first aider lets someone know that it’s OK to talk about depression and ask for help.
Give Reassurance and Information
One of the most important parts of a mental health first aider’s work is showing compassion. The societal stigma surrounding mental illnesses, including depression, can discourage people from speaking up about their conditions, or make them feel alone, isolated and ashamed. Someone who struggles with a mental illness needs support and encouragement and deserves to be treated with respect and dignity.
To offer reassurance to someone who struggles with depression, a first aider should:
- Not blame the person for their depression: Mental illness is never a person’s fault and does not stem from a moral failure or personal weakness.
- Offer consistent emotional support and understanding: Be patient as they talk, persistent with encouragement and offer kindness and attention, even if it’s not reciprocated.
- Give the person hope for recovery: Explain that with time and proper treatment, they can begin to feel better.
A mental health first aider should also offer practical help and information to someone who struggles with depression. This can include:
- Offering to help with daily tasks: Someone who faces depression may struggle with daily responsibilities like maintaining a household or grocery shopping. A first aider can offer temporary assistance around the house but should be careful to not offer to do every chore, as this can encourage dependency.
- Offer informational resources about depression: While a first aider should not assume that the person knows nothing about major depressive disorder, they can still recommend educational resources about how depression works and how it’s treated.
Encourage Appropriate Professional Help
Depression is a serious mental illness that deserves comprehensive treatment. Professional care for depression is warranted if someone has struggled with depression for at least two weeks and it has severely disrupted their daily functioning.
It’s important for first aiders to realize that people who struggle with depression may never seek treatment on their own. According to the World Health Organization, people who have mental illnesses like depression wait an average of 10 years before asking for help. For this reason, it’s imperative that mental health first aiders discuss depression treatment with the person who struggles with this illness.
To encourage appropriate professional help for depression, a first aider should:
- Discuss options for treatment: Viable treatment options for depression include mental health counseling, psychological therapies and medical care. Although the person who needs treatment must make their own decisions, a first aider can recommend options for care and offer to accompany the person to their appointments.
- Encourage the person to contact health professionals: People who can offer and recommend mental health counseling include primary care physicians, mental health counselors, certified peer specialists and psychiatrists.
To find appropriate treatment options in their area, the person can use the treatment locator tool from the Substance Abuse and Mental Health Services Administration.
What If the Person Doesn’t Want Help?
If the person is hesitant to get help, a first aider can ask about if the person has any specific concerns about getting treatment. The person’s reasoning may be based on false beliefs or rooted in fear. After this conversation, if the person still resists the idea of treatment, a first aider should be understanding and offer to help if the person changes their mind.
Essentially, all a mental health first aider can do is be supportive and point someone in the direction of treatment. It’s up to the person who faces depression to decide what to do with the information they receive.
Encourage Self-Help and Other Support Strategies
Mental health first aiders are not the only people who can help someone who struggles with depression, and the person may recover faster if they are surrounded by a network of supportive individuals. First aiders should encourage someone to reach out to friends, family members, faith communities or support groups to further discuss their experience of depression and receive support.
Additionally, a mental health first aider can suggest daily self-help strategies that can empower someone to form healthy coping mechanisms for as they heal from depression. These strategies can be small lifestyle changes and can include:
- Physical exercise, including walking
- Holistic herbal remedies, like St. John’s wort
- Self-help books
- Relaxation training
- Light therapy
Helpful Hotlines for Mental Health First Aiders
A mental health first aider should be prepared to recommend various hotlines available to people who struggle with mental illnesses like depression. Each of these lines are free and completely confidential, and representatives can offer advice and guidance on mental health and substance abuse issues.
- National Suicide Helpline: 1-800-273-8255
- Substance Abuse and Mental Health Services Administration’s National Helpline: 1-800-662-4357
- American Psychiatric Association Answer Center: 1-888-35-77924
- American Psychological Association Public Education Line: 1-800-964-2000
- The National Mental Health Association: 800-969-6642
- The National Poison Control Center: 800-222-1222
- Alcohol and Drug Abuse Helpline: 1-800-821-4357
- National Institute on Drug Abuse Hotline: 1-800-729-6686
If a person struggles with mental illness and substance abuse, a mental health first aider can recommend The Recovery Village hotline, 352.771.2700. This line is toll-free and confidential, and representatives are available to discuss addiction, depression and effective treatment options for co-occurring disorders.