Disability Raises Depression Risk

Seeking outside help and support when feeling depressive symptoms may head off a bout of depression

By Deborah Jeanne Sergeant

Missy Stolfi is the area director for the American Foundation for Suicide Prevention
Missy Stolfi is the area director for the American Foundation for Suicide Prevention

People with disabilities are more up to three times more likely to experience depression, according to the Centers for Disease Control and Prevention. Although limitations because of their disability may be part of the reason they experience depression, many other factors play a role.

“The disabled community has some of their own challenges and risks,” said Missy Stolfi, area director for the American Foundation for Suicide Prevention, which serves the area between Buffalo and Utica. “Access of mental healthcare is part of that.”

Although the law requires accessibility in public facilities, it is still more difficult to navigate with a disability that hampers movement than without one. For someone with communication challenges, finding a therapist who can easily communicate with them or a translator to facilitate sessions can also present barriers to care.

Considering the pandemic, some may not want to venture out as much because of the risk of catching the virus.

“Many people who live with disabilities, their disability can affect their immune system,” Stolfi said. “And that can influence their ability to seek mental healthcare and contribute to isolation. Many live day to day with their particular barriers to care.”

The physical factors that cause their disability may also increase risk of depression, according to physician Steven Dubovsky, president of UBMD Psychiatry and chairman at the department at UB.

“Parkinson’s is largely likely to cause depression as the changes in the brain are contributory to mood,” he offered as an example. “The same degree of limb disability like paralysis or sensory loss if it’s caused by a stroke has higher rate of depression than if it’s caused by an orthopedic injury. Stroke causes depression in about 50% of cases whether the person has physical limitations or not.”

That factor may speak to the brain changes stroke can cause.

He also said that people who have experienced depression in the past are more likely to become depressed again if they become disabled.

Physician Steven Dubovsky is the president of UBMD Psychiatry and chairman at the department at UB.
Physician Steven Dubovsky is the president of UBMD Psychiatry and chairman at the department at UB.

“If you factor that out, your average person with no vulnerability suffers a loss of function due to a disability, what contributes to that depression is a sense of loss, helplessness and anger,” Dubovsky said.

He indicated that some medications can contribute to depression. People who are born with a disability are generally able to adapt better but are not immune to depression.

“To the ability you’re able to work on those feelings and not feel helpless, you can deal with the loss of function in the same way you deal with the loss of a person,” he added. “You can form attachment to another way of functioning. People who have a disability because of an injury, they can have anger.”

While it may affect some life experiences, a disability does not predispose someone to depression. Focusing on what one can do can help reduce risk of depression.

Dubovsky said that a person’s thoughts, beliefs and expectations about the disability can also affect risk of depression, such as hanging self-worth on what one can or cannot do. Or, persisting in overly negative thoughts.

“For people who are physically disabled, it depends upon when it happened, who it occurs in and whether they’re very reliant on their physical prowess,” Dubovsky said.

Those heavily reliant on their physical prowess for self-identity and self-worth will find it more difficult than someone who relies more upon mental activity to derive meaning from life. For a planned disability, such as an amputation, it can help to formulate a plan as to how to compensate for lost functions.

“Find things that you can still do,” Dubovsky said. “There’s always something you can still do.”

He also recommends that people focus on the bigger picture: that their struggle is not meaningless. Dubovsky references the book of Job in the Bible, which relates a patriarch who lost all his possessions, health and family, with the exception of his wife who told him to curse God and die. Undeterred from his faith, Job did not follow her advice.

“The lesson is God doesn’t cause human suffering,” Dubovsky said. “He watches to see how you’ll do if you’ll make Him proud. Knowing someone is looking over your shoulder can help people realize life dealt you a bad hand but there’s still plenty you can accomplish rather than dwelling on what had has happened. You can inspire others and be productive.”

Seeking outside help and support from family, friends and providers when feeling depressive symptoms may head off a bout of depression. A provider may also offer treatments like psychotherapy and/or prescription medication for depression.

“Change is hard for all of us,” said Katie Coric, suicide prevention coordinator at VA Western New York Healthcare System. “If you have an injury that leads to disability, it changes how you go about life. It can be hard to make that shift mentally and practically. A good therapist who talks not just about the grief of what you lost and the opportunities about what is ahead can go a long way to reducing the chances of depression.”

While it may be easy to say remaining stoic is the best course, grieving the loss related to a disabling injury of illness represents a healthy way to move forward.

“There’s a place to explore what the next chapter of your life will look like,” Coric said. “It will be an adventure you hadn’t imagined.”