Depression is considered to be a mood disorder and a distressing emotional state that affects an individual?s body, feelings, thoughts and prevents him/her from living a happy, healthy and productive life. The symptoms of depression include low mood, an overwhelming sense of despair, lack of motivation, feelings of helplessness and worthlessness, lethargy, irritability and loss of interest in usual activities. Depression is one of the most common mental illnesses that affect individuals irrespective of their age, gender, ethnicity or socioeconomic class. It is often the result of a combination of biological and psychological factors. Certain changes in a person?s life have been found to trigger it.

A number of recognised life changes can cause stress, including positive ones. Such stressful life events include losing one?s job, breaking up with a partner, death of a loved one, mid-life transition, prolonged illness but also getting married, getting a job promotion, having a baby or moving house. Each individual reacts to stress differently. What may be stressful for one may not be perceived as such by another. Among individuals who face stressful life changes, 43% develop depression (National Institute of Mental Health, 2005). In actual fact, life changes do rattle emotions and can set off depression, as seen below.

■ Employment and redundancy

Unemployment and redundancy can cause depression. Failure to secure satisfactory employment can lead to feelings of apathy, tension, irritability, worry and smoking and drinking excessively. Recent studies indicate that a high percentage of individuals develop depressive symptoms within six months of becoming unemployed. Since depression affects the way an individual usually functions and triggers defeating thoughts, it can make it even more difficult to get a new job. A study by Willenz in 2002 revealed that job losses can have lasting effects on those who go through it. In his study, it was found that 71% of re-employed individuals still experienced symptoms of depression two years after their job loss.

After relationship difficulties, unemployment is the most likely factor to cause depression. This is not unexpected since employment is an important basis of self worth and fulfilment. Maslow, a humanistic psychologist, once said: ?I think I am just most happy and most fulfilled and most myself when I am involved in my work.? In general, individuals report several positive attributes to being employed including feelings of self-esteem, personal identity, self confidence, independence, a sense of providing for their family, being a role model for their children and feeling like an active member of society. When an individual loses his/her job, he/she changes from a position of control, to one of uncertainty, resulting in a loss of self confidence and low mood.

■ Post-natal depression

Post-natal depression covers the spectrum of emotional and mental distress women may feel within the first few months following childbirth till up to a year later. Those most at risk have usually had an episode of depression in the past. Moreover, women who have had an unwanted pregnancy, have experienced a complicated labour or delivery, who lack social support and have experienced major stress such as the death of someone close, are at increased risk (Psychology Today, 2008). Mood changes may occur due to changes in hormones and are to be expected, since having a baby also leads to a change in lifestyle and requires substantial adjustment.

According to the National Childcare Trust, 52% of new mothers report symptoms of depression following the birth of their child. This is characterised by tiredness, feeling tearful and anxious, experiencing headaches, insomnia and hostility towards their partner and sometimes their baby. New mothers may feel guilty about being unable to cope and may be particularly worried about cot death, their baby?s sleeping and eating patterns, mishandling their infants and whether their baby is crying too long or being too quiet. Usually, these symptoms are short lived but sometimes they persist into puerperal psychosis ? a condition characterised by mania, severe depression and aggressiveness towards their infant. Indeed, puerperal psychosis is a serious condition and cases of infanticide linked to it, have been reported in many parts of the world, including Mauritius.

■ Mid-life crisis

Mid-life crisis is a term used to describe an internal process of change and a period of reassessment and reflection occurring during the middle years of life, generally from 38 to 55, as individuals feel the passing of youth and embracement of middle and old age. Sometimes, life transitions such as departure of children from home, ageing parents, menopause and work-related issues may all trigger mid-life crisis. Another factor that can trigger mid life crisis is the death of an individual?s parents. This may bring about the realisation that illness and death are bound to happen in life.

During the mid years of life, individuals may feel discontented, bored, wanting something completely different, questioning the meaning of life and being confused about their identity and where their life is heading. The result may be an impulsive change in career and relationship, which may sometimes be very damaging and regretted later. Women are commonly known to suffer from the empty-nest syndrome, characterised by feelings of sadness and loss, when their children leave home for university or to get married.

■ Chronic illnesses

A person with terminal illness may, at some point, face depression. The rate of depression occurring with medical illness is quite high. 40% to 65% of individuals having had a heart attack experience depression while 40% suffering from multiple sclerosis and 25% of those suffering from diabetes experience it (Cleveland Clinic Health System, 2007). Studies of psychological reactions in hospitalised cancer patients revealed that half of all patients suffered from some type of depression before they died. These individuals believed that their major organs had ceased to function. In fact, sufferers often have to adjust to the demands of their illness as well as to the treatment. Their illness may have an impact on their mobility and independence and may change the way in which they perceive themselves and relate to others. Symptoms of depression in individuals with chronic illnesses manifest themselves by withdrawal, loss of interest in daily activities, fear, anger and obsession with recurring thoughts and old memories. Any chronic condition may trigger depression, but the feelings may be accentuated by the severity of the illness and its disruption on the person?s life.

Individuals suffering from depression at different stages of life are affected by a wide array of negative emotions. It may be helpful for them to seek professional help as the aim of psychological care is to enable individuals to explore their thoughts and feelings, gain a new perspective into their situation and look at effective ways of coping.

Doreyya MOHUNGOO-PEERBACCUS Health Psychologist