When depression comes knocking

Depression is common among wheelchair users shortly after their spinal cord injury (SCI). MARISKA MORRIS learns more about the signs, treatment and prevention

The prevalence of depression and anxiety among people who have suffered an SCI is between 20 to 45 percent, notes Dr Lissele Botha, who is based at Life Riverfield Lodge in Fourways, Gauteng. This is simply because patients who now depend on a wheelchair for mobility will experience a period of loss. For many wheelchair users, this loss of independence is aggravated by feelings of isolation and loneliness, especially during prolonged periods in hospital.

Head social worker at Western Cape Rehabilitation Centre Tertia McKee says: “From my experience, it appears that depression is more prevalent as of three months or more post-injury. If the patient is going to experience depression, more often than not it occurs six to 12 months after discharge from rehab.”

She adds that this is when the reality of the situation sets in and the patient receives less attention from the household. Patients, who might have held onto hope that they would walk again, start to lose that hope around this time. It can also exhaust a new wheelchair user’s emotional reserves to try to navigate an environment that is not wheelchair accessible.

For many wheelchair users in South Africa, all these feelings are aggravated by their socio-economic situation. Clinical psychologist Antoinette Oakes from Western Cape Rehabilitation points out: “Wheelchair users, specifically those dependent on the government health system, often experience many challenges.”

“They are often from poor socio-economic backgrounds and return to areas with poor infrastructure, which are poorly resourced. For instance, they may struggle to find employment after becoming wheelchair users or are unable to use public transport to get to work.”

A 2011 census by Stats SA showed that people with disabilities were often unemployed, struggling with lower income and decreased access to housing and other basic services. All this could contribute to the patient’s feelings of low self-worth and hopelessness.

Clinical psychologist Christopher Langsfeild, of the South African Depression and Anxiety Group (SAGAD), notes: “Wheelchair users often lack the motivation to develop a meaningful outlook of their condition.”

Luckily, like most diseases known to man, depression can be managed and cured. Oakes points out: “Depression is a medical disorder and therefore it is important to seek professional help if you are experiencing symptoms. Depression is managed through a combination of medication, therapy or counselling, and lifestyle management, for example exercise and healthy eating.”

“Most people respond well to treatment using a multidisciplinary approach, especially if they have good social support. It is important to seek support from family and friends, and try to be open about how you are feeling. Others may never fully understand the experience of being a wheelchair user but family and friends are often very willing to try to understand and do what they can to support the individual,” she adds.

Langsfeild supports this view.

“Support groups can be helpful as they allow one to see that they are not alone in their suffering and it allows an opportunity for one to talk about and express their pain to people who can relate,” he says. The SADAG frequently hosts discussion forums on Facebook, during which a medical profession answers questions about depression and anxiety.

Other lifestyle changes that can also assist in managing depression are keeping a diary, following a healthy routine and trying something new.

“If you are unable to do something new, then try something as simple as a regular exercise routine. Exercise releases endorphins which can assist with feeling down, hopeless and helpless,” says Langsfeild. This is especially true for wheelchair users.

“Adequate nutrition and exercise is of the utmost importance. Multiple studies have been conducted to assess the psychological state of wheelchair users who compete in sports, compared to those who don’t, and the results indicate a significant difference between the two groups. Users who participate in sports have a lower incidence of depression and anxiety and show increased self-esteem,” Botha says.

She adds that it’s important to consider the unique physical challenges that wheelchair users face, such as pressure sores: “Physical deterioration or complications may impact on a patient’s psychological wellbeing, and therefore this needs to be managed too. The prevention and treatment of complications include pressure care, catheter care, wound care and pain management.”

While depression can be managed with professional assistance, the best approach is still prevention. “Due to the high probability of depression and anxiety among wheelchair users,” she says, “it is best to follow a proactive approach. Patients and their support systems need to be educated about the warning signs and a plan should be in place in the event of diagnosis.”

It is useful to monitor sleeping patterns, eating habits, energy levels, concentration and interest in activities. This can assist in identifying depression as early as possible so that treatment can be sought.

“Consult a doctor if there’s a noticeable disturbance in any of these aspects. The most important measure is to apply early diagnosis and intervention practices and to include the patient’s support structure,” Botha says.

Other preventive measures, as suggested by Langsfeild, include these:

• Live a healthy and active lifestyle

• Have a confidant to talk to in difficult situations

• Take care of yourself by reducing stress and pressure.

“Taking regular ‘time-out’ moments to breathe and reflect on your situation is a must. In addition, finding enjoyable activities or hobbies to destress and declutter your mind on a regular basis is invaluable,” Langsfeild concludes.

The SADAG can be contacted on its helpline at 0800 21 22 23, on Facebook at The South African Depression and Anxiety Group, via Twitter with the tag @TheSADAG, or its website  www.sadag.org.