Depression is so pervasive in Denver that it’s hard to wrap the mind around how many people in the city are chronically sad.



Think about it this way. Imagine every person in Denver’s four largest neighborhoods — Montbello, Hampden, Westwood and Capitol Hill. That’s about 76,000 people, near the same number of Denver residents who reported signs of clinical depression at least eight days out of the prior month.



At any given time, one in eight Denver residents is depressed, according to a first-of-its-kind study from Denver Public Health that relied on electronic medical records and surveys to gauge the mental-health status of Denver.



“It’s common. It’s serious. It affects people throughout their lifespan,” said Dr. Bill Burman, the director at Denver Public Health.



The study, released this month, found that three in 10 students at Denver middle and high schools feel “persistently sad and hopeless” for more than two weeks at a time during the course of a year. And results showed one in four pregnant women who had a medical appointment at Denver Health was depressed.



To compound all that news, almost 70 percent of Coloradans who are depressed are not getting treatment.



The findings align with national statistics on depression, but until this report, there was a shortage of data regarding the scope of depression at a local level.



Knowing the numbers is important, Burman said, in order to improve treatment options and allocate funding. The report was released about a week after Denver voters approved a new sales tax that will raise $45 million each year for mental-health services, suicide-prevention programs and substance-abuse treatment. The tax, which amounts to 25 cents on a $100 purchase, begins Jan. 1.

Public-health officials hope the report will advance progress toward “integrated care,” a health care model that incorporates mental-health and substance-abuse treatment at the same place patients go for medical care.

MORE: Read the Denver Health study

Psychologists embedded in Denver Health clinics add mental health to other care

That integrated setup is already in place at several Denver Health clinics, including one for pregnant women.



KC Lomonaco, a clinical psychologist who specializes in pregnancy-related depression, works in the same office as the obstetricians, nurse practitioners and other medical staff at the Denver Health Women’s Care Clinic. The clinic, which sees about 200 women each day, has two “integrated” psychologists who are available to talk to patients who are feeling anxious and depressed.



“I like to say we are embedded in the clinic, like a reporter embedded with troops,” Lomonaco said.



She sees patients in her office, which is just down the hall from the gynecological exam room, and sometimes in the exam room before or after their medical appointment. The visits might happen once or might occur regularly throughout a woman’s pregnancy and into postpartum.



The clinic began screening women for mental-health issues in 2014 at three specific points — their first visit, the midpoint of the pregnancy and postpartum. The screening, which comes in 30 languages, asks how often a woman is “able to laugh and see the funny side of things,” whether she has been “so unhappy” that she has been crying, as well as other questions.



The questions are designed to determine whether a pregnant woman or new mother has clinical depression or is losing sleep and feeling overwhelmed simply because she is too uncomfortable to sleep or is up taking care of a newborn overnight.



The integrated-care approach is becoming more common, but it’s still much more common at federally qualified health centers, which serve a lower-income population, than it is in private ob-gyn practices, which are more likely to have patients with insurance, Lomonaco said.

The model is effective because, according to Lomonaco’s previous research, patients are four times more likely to see a mental-health professional if one is in the office than if they are handed a piece of paper referring them elsewhere.

Denver Health patients, on average, are at higher risk of pregnancy-related depression because of other “psycho-social” factors, including worries about money and housing, but depression affects one in five pregnant women nationwide. “Depression is not a disease of just the poor,” Lomonaco said. “It can strike almost anyone.”



3 in 10 Denver kids are clinically depressed overall with nearly 60 percent of gay students meeting criteria

The report tracked clinical depression, which is often chronic and has long-term physical effects such as headaches, aches and pains, and digestive problems. The symptoms of chronic depression include persistent sadness, hopelessness and low self-worth.



It’s different than situational depression, which is time-limited and typically the result of a specific life event such as a breakup, a death, or problems at work or school.



When surveying kids, the key question was to find out whether they felt “so sad or hopeless” for two consecutive weeks that they stopped participating in their usual activities. Three in 10 said they had. Among them, girls were more likely than boys to meet that definition of clinical depression, and youths who identified as gay or bisexual were far more likely to answer yes than heterosexual youths.



While 26 percent of heterosexual youths said they had been that sad or hopeless, 58 percent of gay students said the same.



Among Denver adults, 15 percent studied from 2012-16 said they had eight or more days of severe stress, depression and emotional problems within the prior month. That definition typically warrants a diagnosis of clinical depression, researchers said. Women and African-Americans were more likely to say yes to the question.



To get more people in treatment, “culture shift” around mental health must take place

Matthias Darricarrere, a 26-year-old psychology resident at Denver Health, saw himself reflected in the report “in a number of ways.”



As a teenager, he had depression but never received treatment. Instead, he heard the “classic messages,” including “Put a smile on,” “Don’t look so sad” and “Why can’t you brighten up?”



“There is a chunk of my memories where everything was in shades of gray,” said Darricarrere, who believes his depression was part of the reason he is working on a doctorate in clinical psychology. “I could not see color anymore in my life.



“I was pretty aware that something was wrong. For me, what I experienced was that there are so many occasions where these pieces of ourselves are kind of punished for being present. My own feelings of sadness and anger didn’t really have a space to live publicly.”



More than anything else, Darricarrere said, the country needs a “culture shift” to reduce stigma and “carve out space so that people can talk” about depression and mental health. “I think that’s where depression really becomes insidious, when it’s left to fester silently,” he said.



Improving depression occurs either through addressing biological markers, often with medication, or through environmental factors. For Darricarrere, his life and the people in it expanded to include “more richness,” and he poured his pain into running.



Now, as a student at the University of Denver, he works alongside doctors at the Peña Southwest Family Health Center, an integrated behavioral health clinic that has physicians, dentists, psychiatrists and other professionals in one building. Darricarrere is there to talk a patient through a cancer diagnosis — or help him figure out whether it’s the diagnosis, the recent divorce or the job loss, or some combination of them, that is causing mental-health problems.



Mental health is embedded in the entire practice, beginning with the physician asking patients not just about physical sensations, but also about thoughts and emotions. If a patient is feeling anxious or depressed, the doctor tells them, “There is someone here who can help you with that.”



“One of our really big benefits is that we can come in and slow things down,” Darricarrere said. “This is a way that once they are in the door, they can receive care for what they are needing in their lives.”



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