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The Boston Globe
By Hamilton Kahn
June 26, 2008
RESIDENTS OF Cape Cod are used to being under the microscope of amateur anthropologists, who return each summer to ask such probing questions as: What do you people do all winter long? How can you live out here all year without going crazy?
It’s a small price to pay for living in a beautiful place so many others want to visit, because after we reap whatever benefits they bring, we’ve got the place pretty much to ourselves for the next nine months.
But this isn’t paradise. Cape Codders have problems just like other folks – financial, physical, emotional. If we’re to believe the results of a recent study, the percentage of Cape Codders who are depressed is nearly twice the national average. The survey of about 15,000 patients at five community health centers found 43 percent showing signs of depression, compared with a national depression rate of 20-25 percent.
What a bringdown. Can it be that living on the Cape is actually bad for your mental health? Hang on just a second. This study was conducted only on the Cape, and it used a survey created by pharma giant Pfizer, which has a financial interest in the number of anti-depressant prescriptions being written. And in a break from usual medical protocol, it was handed out in waiting rooms to people who, for the most part, had come to the doctor for reasons having nothing to do with getting help for depression or its symptoms.
That was the case last fall when I went to my doctor for a persistent chest bug. Without explanation, the receptionist handed me a survey that asked whether in the past two weeks I had “been bothered” by a list of symptoms, including “feeling down,” “trouble falling asleep, or sleeping too much,” “feeling tired,” “poor appetite or overeating,” and “feeling bad about yourself.”
Setting aside that my cough and fever had brought on most of these symptoms, I was startled by the aggressiveness of the inquiry, as well as the nonchalance of its administration. Unlike more typical medical forms that ask about diseases you’ve had in the past, this one seemed to be looking for a condition that hadn’t yet been diagnosed, for which the patient was not necessarily seeking treatment. And, unlike an effort to prevent a contagious disease from threatening the public health, this one targeted an affliction of a highly personal nature, not known to spread through physical contact, or even propinquity.
Now, all of a sudden, the nurse taking my blood pressure and weight was reviewing my completed survey and wondering if I should talk to the doctor about it, along with my nagging cough.
Now that the survey “results” have been announced, its purpose is clearer. As one of the clinic directors, Dr. Barbara Prazak of Wellfleet, told me recently, the survey’s primary intent was to “start a conversation” between patients and physicians that could identify unrecognized depression and lead to successful treatment. In many cases, she said, that’s what it did. But as far as measuring the percentage of people on the Cape who are depressed, particularly as compared with the rest of the state or nation, this survey was an unscientific method, Prazak conceded.
With $1 million of outside funding, this four-year depression screening project allowed each of the five participating Cape clinics to hire an additional social worker and support staff, while other medical staff got to attend out-of-town “informational” workshops on treating depression. If it results in a better life for those whose depression would otherwise be overlooked, then it’s got to be seen as a happy thing.
But as far as the slight against me and my fellow Cape Codders implied in the survey’s results, I find that depressing, but pretty much to be expected around this time of year, when we once again become objects of passing curiosity from tourists. Whatever conclusions you reach, don’t be scared from coming on down to visit us this summer. We’ll all do our best to muster up a smile every now and then, just to make you comfortable.
Hamilton Kahn lives in Wellfleet and is the host of “In The News” on WOMR FM.
© Copyright 2008 Globe Newspaper Company.