Depression: involvement of the occupational therapist

Depression is one of the most common mental illnesses. In Quebec, 10% to 15% of people will experience depression during their lifetime. The World Health Organization states that by 2020, depression will rank second among the leading causes of disability, just behind heart disease. Although medication has been shown to be effective in treating depression, occupational therapists (OTs) can play a critical role in helping people with depression resume everyday activities. This overview provides a better understanding of depression and of the OT’s role in promoting mental health.

Identifying depression

Depression is considered a mood disorder. It is characterized by sadness or a marked decrease in interest and pleasure, and evidenced by cognitive, behavioural, physical, and emotional signs and symptoms. These signs and symptoms result in:

• Sad mood, feeling of emptiness
• Fatigue or loss of energy
• Feelings of excessive guilt and worthlessness, or low self-esteem
• Difficulty concentrating
• Changes in appetite and weight
• Behavioural disorders
• Persistent thoughts of death or suicide
• Sleep disorders such as hypersomnia or insomnia
• Agitation or lethargy
• A significant decrease in interest and enjoyment of activities

According to the DSM-5 criteria established by the American Psychiatric Association, an individual must display at least five of these nine symptoms every day, for a period of more than two weeks, to be diagnosed with clinical depression. These symptoms must be affecting the person’s daily routine; people with depression abandon their hobbies, have more difficulty in keeping up social roles, limit their outings, and stop working, among other signs. There is a loss of routine activities, and a certain inactivity which exacerbates depressive symptoms.

Resuming activities: how to drive change

Since occupational therapists (OT) work to help people become autonomous and regain satisfactory functional levels, they can support you in resuming your activities following recovery from depression.

When treating depression, introducing a routine is essential since it acts as a significant mood regulator. To do so, the OT relies heavily on the concept of the occupational schedule, or the way in which a person structures and allocates activities throughout the day.

The OT can focus on developing an activity program using a concrete list of in-clinic activities. Doing so allows the OT to better understand, and then share with you, how current energy levels affect your performance, which activities are most challenging to reintegrate into your routine, why these specific activities remain difficult, and the complex interconnections between your mood and your activities.

This functional analysis further enables the OT to set up an action plan to help you gradually resume your activities, while taking your priorities, values, and difficulties into consideration. The objective is to properly balance your lifestyle to ensure good mental health and prevent a relapse. The OT will support you in developing your own strategies, so you can play a key role in your own rehabilitation.

Here are some techniques the OT can implement with you as part of your activity program:

•  Participating in pleasant activities

People with depression give up enjoyable activities and hobbies, due to a decrease in pleasure and interest. It’s important to start by assigning pleasant activities that provide a sense of accomplishment. This enables you to gradually regain both interest and energy. These potential activities may include walking outdoors, meeting friends for coffee, taking a bath, or listening to music.

• Gradually increasing the number of activities and their degree of complexity

In order to resume all of your activities, it is important to calibrate the degree of complexity of the sessions with your abilities. For example, we might start with personal care tasks such as dressing in the morning, doing the dishes, or taking a walk with a friend in a peaceful location. The gradual resumption of personal care, domestic, and social activities will increase your sense of well-being and control, and help reduce social isolation.

• Planning activities in advance

A lack of organization (a common symptom of depression) may also affect the resumption of activities. Planning is a solid strategy to overcome this barrier and promote action. By carefully outlining the steps required to carry out a given activity, it is easier to target potential difficulties and deploy appropriate strategies to overcome them, thereby reducing apprehension and creating winning conditions.

• Engaging in activities according to available energy

The fatigue associated with depression can represent a major barrier to resuming everyday activities. Therefore, it’s important to understand your fatigue and your symptoms, thus allowing the OT to guide you in developing various routine energy management strategies. For example, better recognizing signs of fatigue throughout the day enables you to carry out an activity without exhausting you. Sleep, diet, physical activity, hobbies, emotions, thoughts, and strategies to complete your daily activities are all aspects to consider, as they influence your energy level.

• Integrating activities that support a return to work

It’s important to gradually re-engage in activities that will eventually enable you to return to your former work capabilities, and to develop a routine that promotes involvement at work. For example, if you work in a warehouse, gradually regaining your physical abilities in order to be able to lift loads or spend a shift on your feet would be extremely important milestones. The OT can support you in resuming these routine activities.

• Returning to work: the ultimate objective

The OT can develop numerous other actions to support your return to work while ensuring close collaboration with care partners (your physician, insurance company, psychologist, etc.) A number of diverse barriers such as overwork, conflict with your employer, or a fear of relapse may affect how you feel about your ability to return to work. The OT can help you identify these barriers, and develop concrete strategies to overcome them, in order to support your continued employment.

Contact the occupational therapists of our clinics for more information!

By Marie-Lyse Foucault, occupational therapist for the Physiothérapie Universelle St-Eustache clinic.

References:

• Cambridge, M.A., Murray, C.J.L., et Lopez, A.D. (éditeurs) (1996). The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. 

• Schene, A.H., Koeter, M.W.J., Kikkert, M., et al. (2007). Adjuvant occupational therapy for work-related major depression works: randomized trial including economic evaluation. 

• Ordre des ergothérapeutes du Québec. (2009). L’ergothérapeute au sein des services de santé mentale en première ligne adulte.

• Opp, A. (s.d). Occupational Therapy and Depression: Reconstructing Lives.

• Fortier, P. (2017, 15 et 16 mars). Activation comportementale et thérapie cognitive dans le traitement et la réadaptation des personnes souffrant de la dépression. 

• Christiansen, C.H. (2005). Time use and patterns of occupations. Dans C.H. Christiansen, C.M. Baum, et J. Bass‐Haugen (Eds.). Occupational therapy: Performance, participation, and well‐being