At The Medical and Dental Consultants Association of Nigeria(MDCAN), UBTH Chapter, Edo State, NigeriaI was at the 1st Biennial General Meeting And Scientific Conference of the Medical and Dental Consultants Association of Nigeria(MDCAN) that held in Edo State, Nigeria. At this conference, depression was emphatically mentioned and talked about.
Special attention was paid to the management of cases of depression amongst Doctors, but it is no news that depression also affects many other vulnerable groups and professions. So, I decided to X-ray and amplify the recommendations at the conference. Perhaps, it will be able to address issues of depression beyond just the medical professionals as the program primarily intended.
Depression is reported as one of the leading causes of disability and is a major contributor to the disease burden worldwide. The link between depression and disability may not be directly arrived at but you will agree with me that the varying manifestations of depression, including suicide and suicidal ideation, has done more harm than good in recent years. It will be necessary to note that the global prevalence of depression and depressive symptoms has been on the rise in recent decades.
Depression has a neurohormonal explanation that seeks the explain the pathophysiology of the disease. However, we are also aware that some other factors play an important role in the development of depression
Depression is reported amongst people of varying socio-cultural and economic climes but at the Biennial General Meeting, the emphasis was placed on doctors, for good. This may be from one of two reasons, first of which is the fact that it was one of the very few in-reach programs out of the many other outreaches that doctors organize in a year in Nigeria. The doctor is busy looking after other people through clinical practice and organization of outreaches, at the expense of himself. This is practically important seeing the rate at which suicides have been reported amongst doctors in Nigeria and all over the world. The need to address the issue amongst doctors now becomes extremely important.
Is there any difference between how depression manifests in doctors from how it does in other professionals, age groups, and people? The answer will be a big "no" of course. And so I aim to make this discussion more encompassing as much as possible.
From the biennial conference, depression can be triggered by adverse working environments of any worker. It is no news that stressful work environments and other socio-economic factors including fulfilment of salary schedules amongst others can directly trigger depression amongst workers of the index firm. This is not to rule out depression amongst the non-working class, like students and teenagers. But for the sake of this post, it shall be loosely restricted to the working population.
Let us now explore the factors that could win as the leading triggers of depression amongst workers in any given profession.
Common Triggers Of Depression At WorkThis list is not exhaustive but these triggers may include the following:
- Lack of Adequate Working Conditions: In the clinical environment of many developing countries of the world, the doctor-patient ratio has risen from the ideal 1 doctor to 600 patients to greater than 1 to 6000 patients in Nigeria. This has turned the working conditions to war zones for the doctor, whereas he is still expected to put his best for the wellbeing of the patients. One important statement that I heard at the biennial conference is "the doctors are the worst patients". That is to say, the doctors are supposed to be doctors for patients, not patients. But when the system of things pays no attention to him but expects him to do more than enough, it will become possible to have more doctors as patients.
This also goes for other workers in other professions. Their job description becomes so overwhelming for relatively meagre pay.
- Problems With Workers Salaries: Depression amongst other mental illnesses have a basis of psychological distortion which may have its roots in many factors including economic factors like salary adequacy and their timely payment. This has been a major problem in Nigeria and other parts of Africa.
- Lack Of Communication Amongst Workers: At the doctors' biennial conference, one point hit me strongly and it relates to communication amongst workers. A senior doctor could excuse another ill doctor for rest or treatment. But in these climes, senior doctors do not even pay attention to the wellbeing of their junior colleagues and they would have no excuse but to continue to work even when they are obviously supposed to be patients at such points. Communication will enable colleagues to detect other problems including emotional issues plaguing each other bearing in mind that when left unchecked, they could metamorphose into depression and its associated complications.
The keynote speaker at the conference also recommended that it could also go the other way round when junior doctors could reach out to their seniors when they observe that some hard-to-overcome issues are surfacing in their practice of the profession.
This can be extrapolated to other professional groups or any group where people interact with each other. At this point, we must learn to be our brothers' keepers.
- Extremely Stressful Conditions: Physical stress is a major trigger for depression. People's response to stress differs from individual to individual. And it will be difficult to set a threshold of the acceptable level of stress but it remains that physical stress is only one facet of the complex of stress, others being emotional stress, psychological stress, amongst others. Therefore, the co-existence of other forms of stressors and triggers seen above could drastically reduce the individual's positive response to stress, and shifts the balance more towards depression.
The Doctors' Recommended Solution To Workers' DepressionThis is not based on any theoretical knowledge but daily trials and observations have shown that an act of care and understanding of workers physical and emotional conditions may just be the very important thing to do in order to address depression amongst them. Bosses and senior colleagues had better draw closer to their subordinates both physically and emotionally and be willing to make an excuse for them when necessary. On the contrary, in reality, seniors would not even listen to genuine excuses from their subordinates who may actually need help at the moment.
As much as the financial and physical conditions matters, the emotional component must be addressed. This is done by being empathic, that is, willing to see things the way your workers do sometimes and not necessarily enforcing strict disciplinary measures at the expense of their wellbeing. That is the case in many hospitals, schools and companies across Nigeria and the world at large.
Especially in the medical sector of resource-poor and developing countries, where doctor-patient ratio is alarmingly high and the salary is not commensurate to the work done, adequate two-sided communication and understanding of all medical, social and emotional needs of fellow doctors will go a long way to reduce the rate of depression and suicidal ideation amongst doctors.
It is important to state that drug abuse is often only an offspring of depression, and the nuisance that both have caused, everyone can testify.
Conclusively, this emotional care that is recommended should be two-sided, that is to say, it should go either way of up to down or down to up. Where the bosses and seniors show this care to their subordinates in the former and vice-versa in the later.
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