Iatrogenic depression: I’ll be right with you, sir

An iatrogenic illness is one which results from healthcare treatment, and iatrogenic depression is typically a side effect of medication. I take a broader view of “treatment” and think of iatrogenic depression as a customer service failure. I see nursing home residents who have become depressed as a result of interactions with staff that left them feeling unimportant and with nursing home systems that resulted in feelings of powerlessness. The good news is that this type of iatrogenic depression can be cured by training staff and adjusting systems to be accountable to the residents.

Resident/Staff Interactions

Without Accountability

Staff: “I’ll be right back.” (Never returns.)

Resident: feels neglected, invisible, possibly paranoid (why are they doing this to me?), angry, anger turns inward to depression

With Accountability

Staff: “I’ll be back in about 10 minutes, after I finish up with someone down the hall.” Returns in about 10 minutes.

Resident: knows how much of a wait to expect, which reduces anxiety; feels cared for and respected

Or, Staff: “I’m sorry about yesterday. I meant to come right back to you, but I had an emergency and didn’t remember until I was halfway home. Please accept my apology.”

Resident: will probably take some time to forgive and begin to trust again, but feels better having the situation acknowledged

Nursing Home System

Without Accountability

Resident Council Staff Representative/Leader: “Great suggestion. I’ll bring it up with the administration.” (Turns out to be the last time the group will hear about it.)

Residents: feel bringing up concerns is pointless, the resident council meaningless, and that their experiences aren’t valued

With Accountability

Resident Council Staff Representative/Leader: “The administration and I discussed the suggestion raised by the group at the last meeting, and we’re going to begin the project by taking this first small action.”

Residents: feel their recommendations and experiences are valued and that they’ll get their needs/wants met by a responsive organization; feel energized as a group

Or, Staff Rep: “The administration and I discussed last month’s suggestion, but there were some obstacles in the way. Let’s work as a group to think of ways in which we might overcome them and move forward with the project.”

Residents: feel respected and included in decision-making even though they might be disappointed their suggestion wasn’t immediately implemented.

Dr. Barbera is an author and a licensed psychologist consulting in long-term care facilities in the New York City area. She frequently lectures on subjects related to psychology, aging, and nursing homes. Dr. Barbera is available for private consulting with organizations, institutions, and individuals around eldercare issues. Visit her personal blog at www.mybetternursinghome.blogspot.com.

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