Nearly nine out of 10 people with significant debt problems also appear to be suffering from mental health disorders, particularly depression and debilitating anxiety. This alarming statistic, which comes from the Consumer Credit Counselling Service (CCCS), helps to explain why so many banks are now setting up special mental capacity and health units in their debt collection teams, and why the Office of Fair Trading (OFT) has just issued guidance in the area.

CCCS – which advised more than 400,000 consumer debtors in 2010 – employs a questionnaire as the first step in its online debt counselling service. Users of this facility are not told at the outset that the questionnaire also tests for possible mental health issues. When compiling the statistics over a month, CCCS found that 86 per cent of people indicated positively for potential mental health problems, ranging from mild to serious. CCCS then recommends to these people that they take further tests or see their GP.

What is unclear is the cause and effect link between debt and mental health problems. On its "debt and mental health" home page, the Royal College of Psychiatrists (RCP) states: "Debt may be a cause and a consequence of mental health problems." Talking of potential correlations between debt and mental health issues, Frances Walker of CCCS says: "There is definitely a link but it's quite hard to see which comes first." Maggie Kirkpatrick, managing counsellor of CCCS South East, says that the 86 per cent figure "seems incredible but it's probably true". A mental health issue "is almost synonymous" with a debt problem among her clientele.

The statistics add a strange new gloss to the world economic crisis which was partly triggered by the mis-selling of loans to people who could not afford to repay them. When banks packaged up these loans and began selling them to one another, panic spread as bankers began realising that many such packages could be near worthless. If many problem debtors are also struggling with mental health concerns, then the financial value of these packages is even more questionable.

The current economic crisis marks a turning point. In September the OFT published guidance for institutions which might lend to people with mental capacity issues such as manic depressives. Only this week the RCP issued an e-learning training package for debt collection staff.

"More and more creditors and debt collecting companies are becoming aware of mental health and are taking a more serious and mature approach," says Anthony Sharp, chair of the Money Advice Liaison Group. He welcomes the OFT guidance and also feels that rules on "treating customers fairly" from the Financial Services Authority have made a big contribution.

"A lot more work is being done," says Maggie Kirkpatrick. "Most creditors are putting together special departments." As advice agencies can go straight through to these units, they are immediately dealing with people trained in the law and other issues.

Research from the RCP, which pre-dates that of the CCCS, will be published this month in the Mental Health Review Journal, saying that 50 per cent of people with debt arrears of more than a month have mental health problems. This would mean, according to Chris Fitch, a research fellow at the RCP who specialises in debt, that people with debt issues are twice as likely to suffer from depression and anxiety problems as the population overall. Although the RCP research does not tally with that of the CCCS, it shows that there is a consensus on the gravity of the problem.

Only five years ago statistics were hard to come by. But the issue has risen up the agenda. With UK household debt (excluding mortgages) averaging £8,000, according to the charity Credit Action, many individuals could be plunged into repayment problems if they lost their income.

Some of these statistics may suggest that a rethink is needed on the causes of debt problems. It may be an oversimplification to try to correlate debt to poverty. A neglected link may be that between mental state and debt. One particularly controversial group are the "narcissists", which are sometimes estimated to make up 1 per cent of the population. Narcissism, while listed as a mental health illness by the World Health Organisation, has been little studied. Compulsive spending is a common feature of this form of megalomania. If someone admitted to compulsive spending, the CCCS "would refer them to a GP", says Maggie Kirkpatrick.

Another 1 per cent of people are thought to suffer from schizophrenia. The Sheffield Mental Health Citizens Advice Bureau (CAB) is based in Sheffield's Michael Carlisle Centre, a psychiatric hospital. A "large proportion" of patients have debt problems, says the volunteer adviser David Miles. Debt "almost certainly" makes mental health problems worse, he says. But some of the money issues are, potentially, easy to solve."One of the big problems is that they haven't necessarily got their [social security] benefits in place when they are released," he says.

The CCCS does help people with schizophrenia but rarely during the acute stages. "We prefer not to deal with people in mental health establishments," says Maggie Kirkpatrick. "We do encourage them to contact us as soon as they are discharged."

People with bipolar disorder are regularly seen by the CCCS. The mental health laws in England and Wales, as restated in the OFT guidance, make it hard for creditors to press for repayment of a debt if someone accrues debts in a manic phase, has no assets with which to repay them and there is some medical evidence of the problem (from a GP, for example).

"Creditors are looking very sympathetically at these cases, provided they have full evidence, medical and financial," says Maggie Kirkpatrick.

Another route for people with bipolar disorder is to ask credit rating agencies to attach a note to their file saying they should not be given extra credit. "It is something we do from time to time," says James Jones, spokesman for the credit rating agency Experian.

But it is important to strike a balance. Chris Fitch of the RCP says: "If people have the mental capacity to understand the terms of a loan and the financial means to repay it, then they should be able to take out that loan. Mental capacity – the ability to make a decision – is not the same as mental health. Many people with mental health conditions have the mental capacity to make an informed decision about taking out a loan."

Advice agencies are used to setting up arrangements (such as direct debits or the involvement of a friend) for depressives and others which will be stand up well even if the person goes into an acute stage.

Case study: Sam's story

Now in his sixties, Sam (not his real name) has suffered from depression for decades. Although he is good at maths, he was never taught budgeting. His life was turned upside a few years ago when he ended up being threatened with bankruptcy, had to sell his house to pay the debts and then downsized to rent a flat and try to live within his means.

His story ends happily. "Life is better," he says now. But he wasted much of his life in the debt/depression cycle and he had to abandon a career as a highly regarded freelance writer. "Debt stress is particularly bad," he says. " You are frightened you could end up in the street or in a mental hospital. They are awful places."

What got him into trouble was a very precise part of his condition. "I panic and freeze," he explains. So, even though he was earning well (at twice the level of the average salary), he got into difficulty as he became too frightened to open his bills. This simple unfortunate response turned him from being a self-sufficient freelancer with money to spare into someone who spent all his income as it came in (particularly on expensive books) and let his debts build up, over five years, to the point that he could not pay them off.

What brought issues to a resolution was his getting so frightened that he took his unopened pile of bills to the local Citizens Advice. "I said: 'Would you open it for me?' They did that for about six weeks. They wrote to my creditors."

The killer debt was his unpaid income tax, but he also had outstanding utility bills and council tax. HM Revenue & Customs began bankruptcy proceedings and he was saved from that, in the day before the hearing, when his friends clubbed together to lend him the five-digit sum he needed to satisfy the tax debt. He paid back his friends shortly afterwards when he sold his house.

Nowadays, he lives simply on social security, including disability benefits. Receiving money weekly is far easier for him (a potential book spendaholic) to manage than getting it monthly or sporadically. He also pays his utilities in advance. And he is very relieved that he never took out a credit card.

He thinks that steps can be taken to spare others the anguish he went through. "Teaching schoolchildren to budget and manage their finances is one of the cleverest ideas I have heard of," he says. For instance, he learnt late in life to go into supermarkets with a shopping list. "It makes an amazing difference. You spend far less."

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A special community health and wellness day has been scheduled for Saturday, Nov. 12 at Calvary Baptist Church, at 3318 River Rd. in Chemainus. From 12: 30 p.m. to 2 p.m., a health and wellness forum will bring together a number of professionals to discuss the experiences of depression and anxiety. They'll deal especially with the way these problems show up when dealing with post-partum depression, chronic pain, grief and loss and seasonal affective disorder (SADD).
 
There will be an opportunity for a question and answer period. Depression and anxiety have been in the news recently, particularly as they affect teenagers so here's a chance to learn more.  Later, starting at 2 p.m. and running until 5 p.m., a series of drop-in events include: depression and anxiety screenings, relaxation massage, an educational video on depression and anxiety and a health and wellness resource table.

From 3 p.m. to 4 p.m., there is also a discussion about anger as it relates to depression and anxiety. Child minding and even refreshments are available. The event is free of charge and everyone is welcome.

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The bodies of Claudia Oakes-Green, 44, her son, Thomas, 13, and daughter Eleanor, nine, were found in February. Her husband Iain, a specialist in wind energy, was working abroad. Police broke into the family’s detached house, in Shepshed, Leics, after they were contacted by a concerned relation. The children were found in their bedrooms with stab wounds to their neck and chest. Their mother, a devout Roman Catholic, was in the bathroom with multiple knife wounds to her arms. An inquest in Loughborough heard that Mrs Oakes-Green’s mother, Betty Oakes, called police after she was unable to contact her daughter.

She had talked to her by telephone the day before when Mrs Oakes-Green, a lecturer at Wyggeston and Queen Elizabeth I College, Leicester, had sounded “very down” about her job. She was also worried about the health of her son, an asthmatic. Mrs Oakes alerted neighbours who checked the house and saw bloodstained bedding but no bodies. The hearing was told Mrs Oakes-Green bought several knives on three shopping trips in the week before the tragedy. She used a family laptop to research “suicide, depression and self-harm”. Mr Oakes-Green attended the inquest but did not give evidence. Caroline Molotnikoff, a family friend, said Mrs Oakes-Green was “depressed”.

“I was concerned just after Christmas when she talked to me and said she was feeling down,” Mrs Molotnikoff said. “She explained she was worried about her job and concerned about Thomas’s health. I remember saying she perhaps should go to the doctor, but she laughed at that. I didn’t think it was that bad.”
Mrs Molotnikoff said she next saw Mrs Oakes-Green at the beginning of February when she was with her husband after he returned from a work trip to India. “She was still down at that time,” she said. “She did not spend much time chatting with me. She was quieter.”

Mrs Molotnikoff last saw her on Feb 22, two days before the deaths. She said: “We arranged to go for a swim with the children. She was very quiet but not relaxed.”Det Insp Simon Cure said three notes were found. They were not read to the inquest. Phone records showed Mrs Oakes-Greene ordered a pizza hours before she killed her children. The coroner Trevor Kirkman recorded verdicts of unlawful killings on the children and suicide on Mrs Oakes-Green. In a statement after the hearing Mr Oakes-Green said: “I love and miss Claudia, Thomas and Eleanor very much. Now I want to be left alone to grieve.”

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Children who live with a father who has mental health problems and depression have higher rates of behavioural and emotional problems themselves, according to a new study. Though the effect of mother's depression upon her children is a well known, this study is the first to the reveal the influence a father's depression may have on his children, the Daily Mail reported.

The team, led by Dr Michael Weitzman at NYU's Langone Medical Center, looked at a nationally representative sample of almost 22,000 children over four years. They found that 11 per cent of children with depressed fathers had behavioural and emotional problems. For children without depressed parents, the figure was just six per cent; while for a child of a depressed mother, the number was 19 per cent.

It is believed that a parents' depression affects the way he or she interacts with a child, in turn contributing to a child's behaviour. Dr Weitzman told Good Morning America that the study is "remarkable" because it is the first of its kind. The researchers hope the study will add to more successful treatment of depressed fathers and better education of health care workers.

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Combining the results of 17 studies on depression and stroke, researchers found that people who had depression at some point in their lives were about a third more likely to suffer a stroke than those who haven`t been depressed.

The analysis "seems very convincing," said Maria Glymour, a professor at the Harvard School of Public Health, who was not involved in the study. What is not understood, she added, is whether depression is somehow causing the increased risk of stroke, or whether the two diseases have the same underlying causes.

A previous study by Glymour and her colleagues was included in the latest research, led by Dr. Li-Qiang Qin at Soochow University in China. Qin`s group compiled data from 17 studies, totalling more than 200,000 participants, that looked at whether people with depression were more likely to suffer a stroke than people who did not have symptoms of the mood disorder.

Each of the studies began with people who had not yet had a stroke, and followed them for anywhere from three to 29 years. Two studies reported that depression was tied to a lower risk of stroke, and another two found nearly no difference in risk between those with depression and those without.

The other 13 studies showed an increased risk of stroke for people with depression, and when the team combined all 17 studies, they found that the risk of stroke was 34 percent higher among those with depression.

Stroke is the third leading cause of death in the United States. Some 800,000 Americans -- or 26 out of every 10,000 -- have a stroke each year, according to the Centers for Disease Control and Prevention. A 34 percent increase in the number of strokes would raise that count to 35 out of every 10,000 people.

A study earlier this year, which pooled the results of 28 research projects on stroke and depression, also found an increased risk of stroke among people with depression. Neither study determined whether one disease is causing the other, and Glymour speculates that the association between stroke and depression is likely explained by unhealthy behaviours.

"For example, we know that depression affects the behaviour that influences your stroke risk, such as diet, physical activity, adherence to health advice," Glymour told Reuters Health. "Those things take a certain amount of energy, and being depressed might affect your ability to do them."

The study authors also note that depression is linked to the development of diabetes and hypertension, which are also risk factors for stroke. Glymour said it will be important to figure out if treating depression symptoms will lead to a decreased risk of stroke.

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This one's for all the mommies-to-be - If you are someone who's not enjoying the wait for your little bundle of joy, and are depressed because you are pregnant, then help is at hand.

There is no need to fight a lone battle anymore. Get out of that guilt-trap and listen to Dr. Asha Sharma, HOD, Obst & Gynecology at Rockland Hospital, who helps us understand how to effectively handle depression during pregnancy.

What causes depression during pregnancy? There is not a single cause of depression. About 13% of women suffer from depression during pregnancy. Several factors like a mental illness in the family, stressful life events such as the death of a loved one, taking care of an aging family member, or hormonal factors can be among the various reasons.

Symptoms of depression during pregnancy:
- Feeling of hopelessness and sadness.
- No energy or motivation in life, memory problems (forget things).
- Feeling worthless/aimless, adverse effect on diet (eating too little or too much).
- Sudden mood swings, withdrawing self from near ones and family.
- Stomach problems and frequent headaches.

Treatment of depression during pregnancy. Trained professional cognitive behavior therapy along with appropriate medication can help pregnant woman in fighting extreme depression during pregnancy. It is important to drink enough fluids, eat a healthy diet which includes foods such as bananas, fish, citrus fruits and so on. Also, adequate support from the spouse and family might help.

Prevention of depression during pregnancy. Prevention is always better than cure. Monitoring family history is very important. An early diagnosis of depression is important as depression usually goes undiagnosed. Due to mood changes and loss of appetite, diagnosis can be missed. Good antenatal care with good psychotherapy can prevent going in to depression. A pregnant woman in severe depression should be treated with proper anti-depressant drugs.

The spouse's role in handling the wife's depression during pregnancy. The spouse should should be supportive and understanding as a woman goes through tremendous mental and physical changes during pregnancy and chemical changes in the brain can cause depression. At this stage a woman needs emotional and physical support from her partner to overcome depression.

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The analysis "seems very convincing," said Maria Glymour, a professor at the Harvard School of Public Health, who was not involved in the study. What is not understood, she added, is whether depression is somehow causing the increased risk of stroke, or whether the two diseases have the same underlying causes.

A previous study by Glymour and her colleagues was included in the latest research, led by Dr. Li-Qiang Qin at Soochow University in China. Qin's group compiled data from 17 studies, totaling more than 200,000 participants, that looked at whether people with depression were more likely to suffer a stroke than people who did not have symptoms of the mood disorder.

Each of the studies began with people who had not yet had a stroke, and followed them for anywhere from three to 29 years. Two studies reported that depression was tied to a lower risk of stroke, and another two found nearly no difference in risk between those with depression and those without. The other 13 studies showed an increased risk of stroke for people with depression, and when the team combined all 17 studies, they found that the risk of stroke was 34 percent higher among those with depression.

Stroke is the third leading cause of death in the United States. Some 800,000 Americans -- or 26 out of every 10,000 -- have a stroke each year, according to the Centers for Disease Control and Prevention. A 34 percent increase in the number of strokes would raise that count to 35 out of every 10,000 people.

A study earlier this year, which pooled the results of 28 research projects on stroke and depression, also found an increased risk of stroke among people with depressio (see Reuters Health story of September 21, 2011).

Neither study determined whether one disease is causing the other, and Glymour speculates that the association between stroke and depression is likely explained by unhealthy behaviors.

"For example, we know that depression affects the behavior that influences your stroke risk, such as diet, physical activity, adherence to health advice," Glymour told Reuters Health. "Those things take a certain amount of energy, and being depressed might affect your ability to do them."

The study authors also note that depression is linked to the development of diabetes and hypertension, which are also risk factors for stroke. lymour said it will be important to figure out if treating depression symptoms will lead to a decreased risk of stroke.

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It may be possible to stave off depression before it even appears using brain-scanning software so simplistic in its design that even the psychologist testing it once bet it wouldn't work.

Ian Gotlib's group at Stanford University, California, studies girls aged 10 to 14 years whose mothers suffer from depression. Such girls are thought to be at higher-than-normal risk of developing the condition themselves, in part because they may inherit their mothers' tendency to "amplify" unpleasant information. Although none of the girls has yet experienced a depressive episode, Gotlib has found that their brains already overreact to negative emotional stimuli – a pattern they share with their mothers and other depressed people.

Gotlib is studying whether these young subjects can use interactive software and brain-imaging hardware to "rewire" their brains by unlearning this negative bias. In a pilot experiment, eight girls used a neural feedback display to learn how to control activity in a network of interrelated brain regions that have been linked to depression – these include the dorsal anterior cingulate cortex, anterior insula and dorsolateral prefrontal cortex.

The level of activity in this network was measured using an functional MRI scan and displayed to the girls in the form of a thermometer on a computer screen. The girls were shown sad or negative pictures that might ordinarily raise their "temperature", and tried to lower that "temperature" by adopting more sanguine mental states. They were then advised to try to recreate that mindset in their daily lives.

A control group unknowingly watched someone else's scan output instead of their own, so they didn't actually learn how to control their brain activity.

Accentuate the positive

Another set of girls in the pilot experiment received their training through a simple computer game instead. In this game, a pair of faces appeared on a screen every few seconds: they would be either neutral and sad, or neutral and happy. Then a dot replaced one of the faces, and the "game" was to click on the dot. For the eight girls in the control group, the face replaced by the dot was selected at random, but for eight girls in the experimental group, the dot always replaced the more positive face in the pair. Over a week of playing this game daily, these girls were in effect being trained to avoid looking at the sad faces.

Gotlib himself originally found this concept, called attentional-bias training, so simplistic that he bet Colin MacLeod, a psychologist at the University of Western Australia in Perth who pioneered the technique, that it would not alter psychological symptoms. Gotlib lost his bet.

In his pilot study, both kinds of training significantly reduced stress-related responses – for example, increases in heart rate, blood pressure and cortisol levels – to negative stimuli. These stress responses are a key marker of depression, and they diminished one week after training. The girls in the experimental groups also developed fewer defensive responses to negative faces, such as startled blinking. Control groups showed no such improvement.

Jill Hooley, head of Harvard University's clinical psychology programme, was impressed by the findings despite the small sample size: "This is highly innovative work," she said. "Ian is breaking new ground here."

Gotlib is adding more subjects to the training programme and plans to compare their long-term mental health with a parallel cohort of 200 girls, half of whom have depressed mothers, who aren't participating in the study.

He presented his results at the annual meeting of the Society for Research in Psychopathology in Boston in September.

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Economic depression remains the leading global economic risk, followed by the risk of sovereign default, according to a ranking of the top 15 extreme risks by consultants Towers Watson. The threat of hyperinflation follows in third place.
The rankings list events that would have a high impact on global economic growth and asset returns if they occurred. The change of ranking reflects a change of view regarding both impact and likelihood of each individual risk.
    
The survey reflects the sluggish economic recovery in the developed world during the past two years which the authors say increases the likelihood of further economic shocks. This is the second edition of the rankings, "Extreme Risks – the 2011 update".

The threat of sovereign default has increased from “medium” to “high”. Recent economic and political developments in the eurozone suggest that a break-up of the euro was more likely with this risk rising from “very low” to “low”.

Tim Hodgson, head of the company’s "thinking ahead" group, says the global environment continued to display significant imbalances and would not be in good shape to withstand more major shocks.

The rankings lists a number of events that could disrupt the recovery and long-term economic developments. They aim to help asset owners consider and better manage their investment risk, although the potential impact of many risks remains unknown and other as yet unknown risks may have a more damaging impact.

“Even with the best analysis, we will not be able to anticipate all risks. The important thing is to build our ability to adapt and learn, enhancing the resilience of the system,” says Hodgson.

Since the last report in 2009 the research added two extreme risks: resource scarcity and infrastructure failure. These replace the end of capitalism and excessive leverage.

Resource scarcity covers energy, metals, water or arable land. It assesses the likely mismatch between resources and rising demand from a growing population.

“Technology optimists argue that the contribution of technological advancement can help meet the increasing demand, but certain resources – such as water or arable land – have no easy substitutes,” said Hodgson.

Infrastructure failure includes the risks posed by the dependence of modern economies on computer networks and power grids. The cost of such a failure would rise exponentially the longer the networks remained unoperational, the research said.

Not all extreme risks can be hedged. Any hedge used is likely to be imprecise, according to the research. It cites the example of the outcome of a killer pandemic being highly uncertain and so its impact on assets and liabilities cannot be estimated.

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Vicious circle of depression, for asthma patients due to unhealthy living, has been found by an Israeli study. Inability to control poor habits not only welcomes depression but also helps in worsening it along with causing asthma.

It was a telephone based survey conducted by Aviva Goral and team from the Gertner Institute for Epidemiology and Health Policy Research, Israel. They surveyed 9,509 Israeli adults and found that asthma patients are vulnerable to depression their and condition gets elevated by unhealthy lifestyle.

Some of the key points of the study were depression as said is an easy host for those suffering from asthma than to those who are living normal life. Peculiar signals that could be found in asthmatic patients with depression are smoking, drinking, less than six hours sleep and slothfulness.

Goral was of the view that often asthma patients are also suffering from depression, but it is quite rare that it gets diagnosed. Probable reason of it could be that doctors are still not aware of the connection between depression, asthma and the role of unhealthy habits in this regard.

The study would be of some help for doctors, as they know would be able to understand the overlapping of asthma and depression. Though it could not be taken as final verdict as more research is needed in this regard, it could still be used for reference point of view.

One of the key recommendations made by Goral is ‘adequate sleep’. It would keep the mind at peace and would not let a person think negative. Some other recommendations that would benefit them are asthma management and workshops to maintain mental stability.

Smoking is said to worsen the cause, said Carole Madeley, M. D of respiratory health programs at the Ontario Lung Association. She further affirmed that asthmatic depressed patients are more likely to binge on smoking, making their health suffer in vicious circle.

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