Symptoms. Depression, anxiety, or both are the most common symptoms associated with patients’ financial difficulties, survey respondents say. Other symptoms include insomnia, hopelessness, helplessness, loss of trust, anger, bitterness, resentment, suicidal ideation or attempts, numbness, desires for retaliation, increased alcohol/drug use, fear of being unable to afford medications or of losing a job, paranoia, and marital problems. Readers’ comments include:
- Augusta, GA: “Patients with depression and anxiety symptoms have increased in the emergency department.”
- Portland, OR: “I see people giving up and planning to live on unemployment as long as possible.”
- Fresno, CA: “Some married people are wishing they were single and did not have children.”
- Red Bank, NJ: “Some who have adapted are doing well, often with a low-overhead business, meeting a specialty need, or entering into a business that meets an emerging need.”
Who is affected? Overall, readers estimated that 70% to 100% of affected patients had pre-existing psychiatric disorders, whereas 20% to 30% had not sought treatment in the past. “Individuals with preexisting problems are having considerable difficulty,” one psychiatrist said.
Similarly, Dr. Jeffrey Rediger, medical director of the adult psychiatric inpatient service at McLean SouthEast, Brockton, MA, told Current Psychiatry, “For some people who were functioning marginally before the recession, this stress has pushed them over the edge. But we’re also seeing a number of young to middle-aged adults who are seeking treatment and hospitalization for the first time.”
Reader Reactor survey: Psychological effects of the economic recession
The Current Psychiatry editorial staff conducted the survey reported in this article. The following questions were emailed to 45 Current Psychiatry Reader Reactors March 20, 2009. Fifteen responded by March 30 (response rate 33%).
Current Psychiatry is preparing an article on the psychological effects of the economic recession. We would like to know about the experiences of practicing psychiatrists. Would you please take a few minutes and answer the following questions?
- Are you seeing an increase in patients describing psychological reactions to the effects of the economic recession?
- If so, when did you notice this increase?
- What symptoms are you seeing in your patients?
- What event or events seem to be causing your patients the greatest psychological distress (loss of a job, worry about losing a job, mortgage foreclosure, loss of value in retirement savings, other)?
- What proportion of these patients has pre-existing psychiatric disorders versus persons who have not sought psychological/psychiatric treatment in the past?
- In what area of the country do you practice (city and state)?
Feel free to provide additional comments you may have.
Interview: Emerging patterns
When interviewed March 17, 2009, Dr. Rediger, Dr. Palmer, and Dr. Kauffman discussed their experiences, provided case examples, and suggested treatments they have found useful for recession-stressed psychiatric patients.
DR. PALMER: People went into panic mode in September/October. Losing a job, a retirement plan, or a home is about who we are and our worth as human beings. My sense is that most people are resilient and adaptive and will be fine despite the recession, but a portion of the population is impaired in adaptability.
DR. REDIGER: Would you explain what you mean?
DR. PALMER: A lot of people become so defiant, so angry, that they withdraw instead of adapting to a new way of life that they consider inferior. They’re humiliated; they feel complete and utter failure. For example, the contractor who owns his own business and says there’s no way he’s going to work for somebody else. He may have to go work for somebody else, get his personal finances in order for a year or two, and then start up a business again. But he has to survive in the meantime.
DR. REDIGER: People are walking around with a lot fear and self-blame. They don’t talk about this very easily; they may say things are fine, but they feel terrible. I wonder how much people are blaming themselves, perhaps for overextending their credit.
DR. PALMER: I think most of these people sensed their finances were marginal before the recession hit. They felt out of control, but their options were limited as housing prices rose beyond affordability. Clinically, I’m seeing increased rates of depression, anxiety, hopelessness. Denial is a big one; there’s a mindset that this can’t be happening.
Helplessness and dread
DR. KAUFFMAN: I resonate with the hopelessness. A lot of people tell me they are experiencing a sense of free fall, and I’ve been working with them to recalibrate a sense of empowerment. First I try some reality testing. I’ll say, “Maybe you’re feeling anxious, helpless, a little denial, fear. Is your survival in danger? Yes or no?” If the answer is no, then I’ll say, “So what can you do so you’re not living as if your survival is in danger?”