Studies show that often those who are have a chronic illness experience more depression. They might be worried, stressed or down about being ill, how to cope with their condition, and the implications. A natural reaction to diagnosis is ‘why me?’. Everyday activities may be limited, relationships with others may be affected, and treatment regimens difficult to stick to.

As such, peer supporters need to be aware of how to: 1) recognise signs of depression 2) support those who might be depressed.

However, remember that you will not be qualified to give a clinical diagnosis. If you are very concerned about someone, it might be a good idea to suggest they see a health professional.

The following video covers some of the social and emotional issues you might come across:

Recognising depression

A person who is clinically depressed will have at least two of the following symptoms for at least two weeks:

• An unusually sad mood that does not go away.
• Loss of enjoyment and interest in activities that used to be enjoyable.
• Lack of energy and tiredness.

They may also experience other symptoms such as:

• Loss of confidence or poor self-esteem.
• Feeling guilty when they are not really at fault.
• Difficulty in concentrating or making decisions.
• Having difficulty in sleeping or sleeping too much
• Loss of interest in food or eating too much, which may lead to losing or putting on weight.

Physical appearance

You may notice that a person looks sad, anxious or depressed, and may even be tearful. Also they may look more unkempt than usual and speak slowly in a monotonous tone, as well as be slow to move or think.

Frequent causes of depression:

When talking to the peer you may discover something very relevant is happening in their lives, such as:

• A break up of a relationship, or living in conflict.
• Loss of a job or difficulty in finding a new one.
• Caring for someone who has a long-term disability.
• Developing a long-term physical illness.
• Having an accident or long-term disability.
• Unresolved bereavement.
• Drinking too much alcohol.

Supporting those who you think might be depressed

Peer support training does not involve professional training in how to treat mental health problems, and for those who seem seriously depressed, the best course of action would be suggest they seek professional help.

However, often it is possible to offer immediate help. One of the most important steps in helping someone who is down is to talk with them and try and understand the problem. The very act of sharing problems is often therapeutic in itself. Non-judgemental listening is key so that the person who is depressed has a chance to share their experiences (see the listening section here)

Group exercise [writing this word reminds me of exercises in school text books. Might this seem daunting and we could use a better term e.g. case studies].

On the following pages we have created some case studies for you to consider.

Case 1

You meet an elderly neighbour whose wife died suddenly a few months ago. He was an active person you would see out in the garden in all weathers, but you have not seen him in a while. You ask him how he is doing since his wife died. He tells you that he is not doing so well. He keeps waking up early in the morning after a disturbed night. He has lost his appetite and isn’t much of a cook – his wife did all that. They had been married for 50 years. His only son lives in Australia.

1. How do you feel on hearing what he has to say?
2. What do you say to him?
3. What can you do, if anything?

Case 2

You are concerned about your peer. He is 54 years old and you have known each other for the past few months. You have noticed a change in him over the last few weeks. He was made redundant and has had a couple of temporary posts but nothing has worked out long term. He tells you his diabetes is out of control (he has forgotten his medication on more than a few occasions). He is struggling to get out of bed in the morning and constantly feels tired. He is worried about how this is affecting his relationship with his family.

1. What do you say to him?
2. What, if anything, do you offer to do for him?

Tools and links in this section

One useful tool you can use in peer support sessions in The Happiness Manifesto.

This is a list of small positive steps you can take to make yourself happier. It is probably best to subtly introduce it to a peer support group rather than directing it a particular person you suspect is depressed, unless you can do so in a very tactile way.

[Happiness manifesto here. Shorter version in training manual or link to longer version?] [Link here to NICE guidelines on depression?] Note Jonathan noted here there will be a lay summary and there is the NHS choices depression page.

[there were some websites suggested in training to help with depression – need to find these out] [do we want to talk about other mental health problems in this section? The other CMD would be anxiety/worry type problems – obviously there is overlap here with depression]