What is Depression?
Depression is a pervasive illness affecting millions of people around the globe (almost 3 million in Canada alone). Epidemiological studies have found a 13 percent lifetime prevalence rate, which means that nearly one in four people will experience a depressive episode sometime in their lifetime. Research shows that past history of depression can dictate future episodes of depression. A person with one prior episode of depression has a 50 to 60 percent chance of having another bout of depression. The risk of having future episodes rapidly increases for someone with two (70 percent chance) and three (90 percent chance) prior episodes. Early childhood experiences can also act as a risk factor for experiencing depression – particularly child-parent separation, parental death and divorce. Parental styles, either overly protective or neglectful, may also impact the development of depression. Along with these causes, there is a genetic component to depression, making first-degree biological relatives nearly three times more likely to experience depression.
Cost of Depression?
There are economic, social, emotional and psychological costs associated with depression. Estimated costs of depression are $43.7 to $52.9 billion dollars a year. What is not included in this figure are the hidden costs of having depression, including decreased work productivity, employee absenteeism, unemployment and the emotional and psychological turmoil experienced by individuals and their loved ones.
How to Detect Depression in Clients?
Depression may present itself in different ways depending on the age, gender and cultural background of your clientele. Women are twice as likely to experience depression than men, and adolescent girls are five times more likely to have depressed mood than pre-pubertal girls. Because of cultural and gender differences, clients may complain of somatic problems, such as having headaches, stomach pains, instead of their mood. They may also complain about the training session as a way of distracting themselves from their own feelings. Children and adolescents may appear more irritable than sad, more socially withdrawn, fatigued and low self-esteem. Their grades and athletic performance may suffer due to difficulty concentrating, fatigue, and loss of interest. Signs of depression can easily go undetected, even for trained professionals. However, by becoming more familiar with the signs and symptoms of depression, chances of detecting the illness increases.
Do any of your clients have these symptoms?
- Feeling sad
- Sleeping too much or too little
- Loss of energy
- Weight loss or gain
- Concentration problems
- Difficulty making decisions
- Loss of interest and/or pleasure
- Thoughts of death
- Feeling worthless or inferior
The central feature of depression is sadness. Clients may appear unmotivated, tired and have problems concentrating or performing to their normal fitness level. They may also appear more negative in the way they view themselves, others or the world in general. They may be more sensitive to criticism, while being very self-critical and disapproving of themselves. Weight fluctuations are noticeable. Some clients may crave more carbohydrates and dramatically increase their caloric intake, while others may skip meals and snacks. Because depressed people lose interest in activities, they may cancel appointments regularly or fail to show up in some cases.
Often, depressed individuals isolate themselves and find it extremely difficult to have the physical energy or the will to get the day started. They may have confessed to their trainers or coaches that life has no meaning or that they are experiencing difficulty getting through the day. For these individuals, their day feels excruciatingly long and filled with darkness. They may also express feeling helpless and hopeless about their future. In many cases, these individuals contemplate ending their life.
Helpful Tips to Use with Depressed Clients
- Practice patience. Clients may just need some time to adjust and get back to their normal self. They probably are very aware that they have not been their usual self. Chances are if trainers are noticing a change in mood, their family and friends have already commented on it.
- Educate clients on the benefits of exercise. Research has shown exercise to be effective in decreasing feelings of depressed mood and anger, as well as reducing tension and fatigue. People who exercise tend to feel more optimistic and pleasant.
- Provide them with resources (referrals to clinics, reading materials, web sites).
- Do not try to diagnose them. It is negligible to give a diagnosis without obtaining a doctorate in Psychology. Instead, try discussing the areas you believe they are having problems with (e.g., unable to bench press their usual weight), and ask them what they are feeling. If you have established a good rapport, perhaps you could ask them what they believe is interfering with their workouts.
- Don’t take it personally. It is difficult to train people without experiencing empathy for them. If your client is experiencing stress, personal loss, or other problems, it does not mean that you are responsible. Try to remain optimistic in knowing that you are helping them reach their goals, and in improving both their physical and psychological health.
- Reward yourself. If your client is sad, chances are you may feel exhausted at the end of your session. Try to incorporate a reward for yourself. Go see a movie, meet up with some friends, or relax with an enjoying book and bath.
- Take a break. If you are feeling drained at the end of a training session, or you are unusually irritable and impatient, you may be in need of a break. It may be helpful to reduce the number of working hours by scheduling training sessions over an elongated time period. Another option is to take a mini-vacation and not schedule any appointments for a week.
The intent of the article was to introduce personal trainers to the world of depression. Depression was defined, and various aspects of depression were discussed with particular reference to how depression can be detected in clients. Part II of the Exercise and Depression series will specifically outline the benefits of exercise on mood. Depression represents a very common and sophisticated illness that expands beyond the responsibility of a personal trainer. However, understanding depression and its adaptation to exercise, both physical and psychological, can tremendously benefit both the trainer and client.
- National Alliance for the Mentally Ill - 800-950-NAMI (6264)
- National Foundation for Depressive Illness, Inc. - 800-248-4344
- National Mental Health Association - 800-969-NMHA (6642)