Depression, The Hyperendemic That We Don’t Understand

The hyperendemic that has kidnapped us all is no stranger; it’s cloaked in veiled silence as it tiptoes around us like a thief in the night; it steals our minds, our hearts, and our souls. It is called, depression, and I would argue that, it is, like all CDC hyperendemics contagious. The CDC defines endemic as the baseline level of a particular disease that is usually present in a community. This level is not necessarily the desired level, which may in fact be zero, but rather is the observed level. In the absence of intervention and assuming that the level is not high enough to deplete the pool of susceptible persons, the disease may continue to occur at this level indefinitely.

Epidemics occur when an agent and susceptible hosts are present in adequate numbers, and the agent can be effectively conveyed from a source to the susceptible hosts.
•    The recent introduction of the agent into a setting where it has not been before,
•    An enhanced mode of transmission so that more susceptible persons are exposed,
•    A change in the susceptibility of the host response to the agent, and/or
•    Factors that increase host exposure or involve introduction through new portals of
entry. (1)

The previous description of epidemics presumes only infectious agents, but non-infectious diseases such as diabetes and obesity exist in epidemic proportion in the U.S.

The CDC defines hyperendemic as persistent, high levels of disease occurrence. Figuratively, I would argue that depression is hyperendemic.  Just ask a mother, or brother, or lover of any 1 of 5 people it seizes upon and you will know its contagion; how quickly it can spread throughout their family, and to their friends.

Ask any elementary or high school school teacher, in any city across this country and you will hear about increased school absences of children too depressed or too consumed with anxiety to go to school. Among depressed children, who continue on to adolescence, 14% will die from suicide. The most recent CDC census report published in 2014— reflects aged data collected from the National Health Interview Survey, from 2011-2012. There is no cure for depression, and for many little access for diagnosis or treatment. The emotional and economic burden in not dealing with depression as a hyperendemic, an “uncontained, persistent, high level of occurrence” has far-reaching and discouraging, mortality consequences.

With each new story that unfolds, each powerful new book that is written, like Liza Long’s, The Price of Silence, her memoir borne from the viral response to her blog post about the Adam Lanza tragedy, I Am Adam Lanza’s Mother, we acknowledge our cultural imperative to be concerned, but that is not enough. Our mental health system is woefully inadequate in general—something that has already been well documented. 

I implore the CDC to do more, to allocate funding both at the national level for developing more effective treatment for depression, and at the local level, for immediate intervention. Police officer and primary physician training will, hopefully, be of value to some.  But for children, depression lurks right in our neighborhoods, in our local schools, where it is first detected by teachers, who see our kids every day, or by parents watching our children at morning drop off.  And it is teachers who, during the summer, work with kids at risk: a population that could end up either in juvenile prison, or could become among the adolescents who attempt suicide. Depression is not an adjective; it is our greatest unmanaged health care disease, and both the disease and what is has and will continue to steal from our humanity is a crime.

Los Angeles Unified School District is one of the largest and most diverse school districts in the country.  Kids are their most authentic selves at school; best understood by staff who see them on a constant basis; rather than a physician who sees them several times a year. Imagine that a voluntary, screening test for depression were administered to kids, in adherence to confidentiality, with results sent directly to the student’s home.  This could become a task for a rotating consortium of medical students to administer on-line, collect, and review student responses. The current criteria provide a simple, clear-cut list, scaled for diagnostic purposes. No one, no parent would be forced to do anything about their child’s screening results.  But imagine the relief for the many thousands of parents who would want to help their child, but who never had that opportunity, never even knew that their son or daughter was battling this illness.
1. Kelsey JL, Thompson WD, Evans AS. Methods in observational epidemiology. New York: Oxford University Press; 1986.

F.D. Raphael is a freelance writer, living in Los Angeles. She was a staff writer for The Middles Daily News in Massachusetts.