When it is not just your finances getting you down | August 2014

Human beings have been aware of a group of symptoms that has been labelled as melancholia or depression since the time of Hippocrates in ancient Greece. Today, people often use the term “I am depressed” when in fact they are fed up, have failed an exam or not been offered the job they wanted.

These are simply ups and downs of everyday life, whereas clinical depression is a group of physical and psychological symptoms, the main one being a low mood, which can last longer than two weeks.

Depression is a fairly common disorder. The World Health Organisation estimated in 2012 that 350 million people worldwide suffered from depression8. In the general population, 1 in 4 females will develop symptoms of depression that require treatment while only 1 in 6 or 1 in 10 (depending on the reference) males will develop symptoms of depression over their lifetime.

Due to the stigma attached to the diagnosis of depression, not every person with depression will seek medical attention. The South African Depression and Anxiety Group (SADAG) estimated in 2013 that only 16% of people in SA suffering from a mental illness were receiving treatment for it.

Depression may be long-lasting or recurrent and can affect an individual’s ability to cope with work and even day-to-day living. At worst, depression can lead to suicide with the suicide rate in people with depression being 20 times higher than that of the general population.

Are you at risk?

There are certain groups of people who are known to have a higher risk of developing depression:

• Females, especially after delivering a baby and at the time of menopause
• People with a family history of depression in a parent, sibling or child
• Those with a history of a previous episode of depression
• People with current alcohol or substance abuse

Significant stressful life events, including severe illnesses such as chronic medical conditions and neurological disorders such as brain trauma, dementia and Parkinson’s disease, are all associated with an increased risk of depression.

Depression is commonly found in people with cancer, heart conditions and/or disorders of the immune system such as systemic lupus erythematosus and rheumatoid arthritis. Depression associated with these medical conditions can worsen the outcome of that medical condition and increase the risk of mortality from the medical condition or even suicide.

Lack of family or social support structures such as having no friends and being alone puts one at risk for developing depression.

Seasonal affective disorder is major depression that varies with the seasons of the year. Grief, in 15% to 35% of people, may trigger major depression.

Depressed or just having a bad day?

Major depression is diagnosed when at least 5 of the following symptoms are present at the same time and for at least 2 weeks:

• Material weight loss or gain
• Insomnia or excessive sleepiness
• Loss of interest or pleasure in leisure activities
• Sadness for the greater part of the day. This symptom needs to be present in all cases for a diagnosis of depression to be made
• Agitated or slowness of movement
• Decreased energy levels or fatigue
• Recurrent fear of death or suicidal thoughts
• Feeling useless, inadequate or hopeless
• Poor concentration and lack of confidence

These may be further divided into mild, moderate or severe cases. With mild depression, an individual will have some difficulty with daily and social activities, whereas someone with severe depression will have very limited ability to perform these activities.

Is depression treatable?

Mild depression can generally be treated by a GP, while more severe depression will need specialist intervention. Treatments available for depression include antidepressant medication and cognitive behavioural therapy.

If the depression is severe and has gone on for a long time, a doctor will recommend a course of antidepressants that help the patient to cope better with daily life. Antidepressants, although not tranquillisers, will also help the patient to feel less anxious and agitated.

Cognitive behavioural therapy helps identify unhelpful thought processes and behaviours and finds new and more helpful ways for the patient to deal with life.

Will depression affect my insurance cover?

Depression is a complex disorder and is therefore generally challenging for the insurer to assess. As with all disorders seen at underwriting stage, the more reliable the information that the underwriter receives, the better the decision that the applicant receives will be.

Most insurance companies will request both the applicant and the applicant’s treating doctor to fill in a questionnaire regarding the depression.

These are some of the factors that an underwriter will take into account when underwriting an applicant with depression:

Favourable	Unfavourable
Stable personality	Behaviour problems, history of violence
Stable home & occupation environment	Work or financial difficulties
Good social support, no overt marital or relationship problems	Marital or family problems, family history of mental illness
No criticism of habits	Alcohol and/or substance abuse, adverse motor driving history
No underlying physical illness, no other psychiatric problems	Chronic or disabling physical illness, other psychiatric problems
No suicide attempts	Suicide attempts
Regular maintenance follow ups	Frequent visits to psychiatrist

Will my insurance pay out for depression?

Assessment of claims is equally as challenging as assessing the risk at underwriting stage, especially as there are no specific tests that can be done to make the diagnosis.

The claimant will need to provide the insurance company with sufficient information for the assessment of the claim against the product conditions. This may include a medical statement from the treating doctor, namely a psychiatrist, which needs to include a diagnosis, the treatment the claimant may be on, the response to treatment and future treatment options to name a few. Claims may be a long drawn-out process as the disorder may require several treatment changes. If there is a lump sum disability claim, occupational details may also be required.

In conclusion, depression is neither an easy diagnosis to make nor an easy disorder to live with. For the insurance industry it represents an ever-increasing percentage of the claims payouts and is a challenge for both underwriting and claims.