Your risk of depression may be lower than you think


Tuesday, 02 April, 2019

Your risk of depression may be lower than you think

People with a family history of depression or bipolar disorder can now evaluate their risk of developing them, thanks to a new website launched by UNSW researchers.

‘Links: Understanding depression in the family’ was developed by UNSW, Neuroscience Research Australia (NeuRA) and collaborators at other universities to address a gap in treatment that is currently not available to people concerned about their own or family members’ vulnerability to depression. According to a study published in the journal BMC Psychiatry, which reported on a trial of the website with 202 participants, the site fills a gap in knowledge that is unmet by existing online interventions.

“There aren’t really any specialised genetic counsellors who cover psychiatric illnesses in Australia,” said Professor Bettina Meiser, head of UNSW’s Psychosocial Research Group and lead author on the study.

“The vast majority of genetic counsellors do prenatal genetic counselling or cancer genetic counselling. So we identified a gap and for that reason we set up this website to cater for what we believe is a sizeable group of people.”

After setting up a free account at https://links.neura.edu.au, users begin with a short anonymous questionnaire about the individual’s and immediate family members’ history in experiencing episodes of major depressive disorder (MDD) or bipolar disorder (BD). The user is then taken on an educational journey about the types of depression, the degree to which genetics and environmental factors play a part, the likelihood of experiencing MDD or BD if there is a family history, and prevention and coping strategies.

Part of the user’s education involves using a tool that estimates the likelihood of developing MDD or BD if these have been experienced by close blood relatives (parents, siblings or children). And Prof Meiser said people may be relieved to find out that the chances of developing MDD or BD if there is already a family history are not as high as people typically think.

“The good news is that while there is certainly a genetic component to both MDD and BD, the chances of a child developing the same condition as their parents is considerably lower than 50/50,” she said.

For example, a person with two or more close blood relatives who have bipolar disorder has an 18% chance of developing the condition themselves in their lifetime or 12% in the next year. This compares with 1% when looking at the Australian population as a whole for both timeframes.

“Our study showed that many people with a family history of MDD or BD greatly overestimate the risk of passing on this condition to their children,” Prof Meiser said.

“So this is clearly a resource that can allay fears around this, and we believe it may also lead to decreased self-stigmatisation about having the condition.”

While assessing genetic risk is an important component of an understanding of depressive disorders, the Links website shows that environmental factors are critical in determining whether or not a person develops MDD or BD. To illustrate this point, the website uses an analogy called the ‘mental illness jar model’. This model says that everyone is born with a fixed number of genetic factors in their ‘jar’, which will not change over their lifetime. The space left in the jar represents someone’s vulnerability to MDD or BP. Once the jar is filled up by environmental factors added over time, a period of depression can occur.

“So someone who has more genetic factors in their jar may take fewer environmental factors to become full,” said Prof Meiser, referring to things like relationships, work, stress, socioeconomic backgrounds, social networks and health.

“But it is possible to have all these genetic factors and still not develop MDD or BP due to resilience and good prevention strategies.”

The website lists a number of tested prevention strategies, with the most effective listed as psychological strategies (including therapy and mind exercises), regular physical exercise and adequate amounts of sleep. Interestingly, seeing a mental health practitioner is recommended as a pre-emptive strategy for people with a family history of MDD or BD, even if they are showing no symptoms of the illness.

Prof Meiser said the Links website has increased users’ intention to adopt psychological therapy as a preventative measure against depression, according to the results of the study. “In fact,” she said, “the increase in the proportion of individuals who intended to undergo or had undergone psychological therapy from before and after undertaking the online educational course was 22%.”

More than 5000 people have registered for the website already and the researchers plan to promote the tool further through mental health and GP organisations.

Image credit: ©stock.adobe.com/au/Chanintorn.v

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