It is possible to find happiness again after major depression

golden rays of the sun through the black clouds

By Christian Jarrett

Living through depression can feel like being in an emotional prison, but there is a way out, at least for some. Writing in Psychiatry Research, Esme Fuller-Thomson and her colleagues describe their analysis of survey data from 20,000 Canadians, which showed that 2528 individuals had previously been diagnosed with major depression, and that two fifths of this group were now fully recovered, meaning that they’d been completely free of mental health problems for over one year and felt happy or satisfied with life on an almost daily basis in the preceding month. “Our findings provide a hopeful message for both clients and clinicians: it is within the grasp of many individuals who have previously succumbed to depression to fully flourish and achieve complete mental health,” they said.

Understandably, a lot of research into depression has been concerned with ways to help reduce the symptoms associated with the condition – in other words, to study the therapies and other interventions that might best help those with the diagnosis find some reprieve. This new study was different in that the researchers were interested in identifying the background factors that affect people’s chances of attaining complete mental health recovery.

So what was different about the two fifths of people who’d had depression but were now fully recovered, compared with those who continued to have problems? The single most important factor seemed to be having supportive relationships. Participants with a history of depression who agreed with the questionnaire item “I have close relationships that provide me with a sense of emotional security and well-being” were seven times more likely to have fully recovered than those who answered this item negatively.

Other important factors were related to physical health, such as experiencing good sleep, being pain free and being physically capable. In fact, collectively, these three physical health factors were the most important life domain related to complete mental health recovery. The researchers said this was a reminder that it is important to treat “physical health problems in tandem with psychological interventions.”

Also positively related to chances of complete recovery from depression were income (those earning more than $80,000 per year were more likely to be fully recovered than those earning less than $20,000 per year) and having religious faith and taking part in physical exercise. Older people and women were also more likely to have fully recovered. On the negative side, people who’d experienced abuse in childhood or who’d been diagnosed with anxiety disorders in the past were less likely to have attained full mental health.

A promising message from the research was that the duration of earlier depressive episodes was not related to chances of being completely recovered – for example, someone who’d experienced a two-year long period of depression in the past was just as likely to have fully recovered as someone who’d previously been depressed for one month.

Despite the optimistic messages to come from this research, it’s also important not to downplay the seriousness of experiencing an episode of major depression. To put this in perspective, consider that those survey participants who had no history of depression were five times more likely to be in a state of complete mental health than participants with a history of depression.

The research does also have some limitations that mean the findings should be treated with caution. For example, the survey wasn’t comprehensive in its questions about mental health issues experienced in the preceding year – there were no questions about schizophrenia or borderline personality disorder, for instance. Potentially this could mean some participants were categorised as fully recovered when they shouldn’t have been, but as the researchers pointed out, this seems unlikely as people with such a serious mental health diagnosis would probably not report that they had enjoyed happiness or life satisfaction most days of the preceding month.

From a practical perspective, the researchers highlighted that several of the factors related to full recovery that they’d identified were “modifiable” – such as helping manage people’s physical pain and encouraging exercise and providing social support. Also their results could help “target outreach and interventions towards those least likely to achieve complete mental health,” they said.

Flourishing after depression: Factors associated with achieving complete mental health among those with a history of depression

Christian Jarrett (@Psych_Writer) is Editor of BPS Research Digest.

8 thoughts on “It is possible to find happiness again after major depression”

  1. In the absence of an objective definition of depression, is it not the case ‘depression’ is likely to be diagnosed by criteria that closely match those correlate factors cited here as indicators of propensity to full recovery? So, for example, those who are able to say “I have close relationships that provide me with a sense of emotional security and well-being” are not likely to be diagnosed as experiencing ongoing depression. You might as well say that people who still describe themselves as “depressed” are seven times less likely to have fully recovered than those who answered this item positively!

    Or was it the case that these people who had now achieved full recovery had been able to say “I have close relationships that provide me with a sense of emotional security and well-being” DURING the time that they were defined or self-defined as experiencing depression?

  2. @John Sprackland raises a very good point, the usual problems with correlation-not-causation studies applies here too. All the “factors” that are implied to be causative agents for recovery, can easily be seen as *effects* of depression instead:

    * “close relationships that provide me with a sense of emotional security and well-being” – depressed folks are usually unable to form new close relationships, old relationships also often get more distant (mainly due to other people’s inability to understand depression), and even if they do have close relationships, they’re unable to feel emotional security and well-being from it (because that’s part of depression – emotional numbness and exhaustion)

    * “experiencing good sleep, being pain free and being physically capable” – depression is often associated with insomnia, and extreme fatigue that makes you physically incapable. The “pain free” part might be an interesting finding, unless it’s a combination of: depressed folks feeling minor pain as more unbearable (and hence more likely to report it), plus a psychosomatic manifestation of the mental anguish.

    This is not to say studies like this are useless and shouldn’t be conducted, just remember to keep pinches of salt handy when interpreting the results.

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