“Since his retirement my husband is very depressed. He hardly gets out of his bed, is grumpy all the time, and avoids any human contact. But he does not want to get help. I have tried everything, but he refuses even to see his general practitioner. What should I do?”
Avoiding treatment is more common than most people think
It is well known from research that a large part of people with depression do not want to get treatment. It has been estimated that less than 40% of people with depression, anxiety, or substance use disorders receive any form of treatment. There are several groups in which the uptake of treatments is even lower. That is for example the case in adolescents, young adults and students, older adults, minority groups, and groups with lower socioeconomic status. And that is the current situation in high-income countries. In low- and middle-income countries the uptake of treatments is much lower.
Why people don’t seek help
There are many reasons why people don’t seek treatment. In many countries there are simply no clinicians available, or patients do not have the resources to pay for treatment. But there are many other reasons why people with depression don’t seek treatment, even if these are available and affordable. Many people do not believe that talking can solve their problems, they do not trust clinicians, they deny that they are depressed, they think that talking with friends is just as good or believe that the problems will go away after a while.
Reluctance to seek treatment is also a characteristic of depression. Someone with depression is pessimistic about many things, including the effects of treatments.
What you as a partner can do
The patient must decide for themselves if they want treatment. You as a partner cannot make that decision. Treatments can only work when the patient is motivated to get it. What you can do as a partner is say what the benefits of treatment are, that most people with depression get better when treated. You can also point at the consequences that the depression has for you and others in your family.
But in the end, it is up to the patient to make this decision.
How to support without making things worse
But there is more that you can do. You can learn yourself about depression, what it is, where it comes from, and what can be done about it. It is also important not to try to “treat” the patient, by giving advice about what to do and what not to do. Advice to interpret things less negatively usually doesn’t work and can make the patient feel even more helpless. It is important to avoid critique and too much involvement and try to “let the patient alone” more. You can also make life simpler, avoid complicated decisions, make daily schedules, and try to stick to fixed times for meals and other joint activities.
Take care of yourself
Another important thing to do is take care of yourself. It is well known from research that many partners of patients with depression become depressed themselves after a while. It is important, therefore, to make clear to the patient what you want and do not want to do as caregiver. That gives clarity for your partner but also for yourself. And make sure that you have your own life and continue to do the things that are important for you. If needed, you can also ask professional help for yourself.
A note on the evidence
Several of the recommendations that are given are not based on evidence about what works for caregivers and what not, but they are all based on a considerable body of clinical experience. If you are Dutch, you can download a digital copy of a book that I have written for relatives of people with depression, based on clinical work with relatives of people with depression. The book has many concrete examples and case descriptions. You can find it here.
Pim Cuijpers is professor emeritus of clinical psychology and scientific director of Metapsy. He has been involved in more than 1,100 scientific studies, mostly on psychological treatments of mental health problems. This is one of a series of evidence summaries in which Prof. Cuijpers tries to answer questions from patients and clinicians, based on what is known in science about treatments. The knowledge is mostly drawn from collective work of the Metapsy collaboration of at least 15 years. Do you have other questions you would like Prof. Cuijpers to discuss? Feel free to contact us.
