The Importance of Addressing Phase of Life Issues in Depression Treatment

Phase of life issues arise as you enter a new stage of life brought on by either the natural course of aging or specific disruptive events that force you to live in a new way. While some of these stages may be positive turning points, others can be deeply painful, disturbing the way you see yourself and relate to the world around you. When phase of life issues become overwhelming, they can contribute to the development of depression, or significantly exacerbate existing depression. Common phase of life issues include:

Divorce

Divorce can change your life in both practical and emotional terms. Regardless of whether you or your partner initiated the divorce, the loss of a partner and the reality of living as a divorced person is often profoundly disorienting, causing significant psychological distress. Conflict related to divorce proceedings and child custody issues, loneliness, financial stress, potentially losing friends, redefining yourself as a single person, and coping with the causes of marital breakdown can be overwhelming and push you into a depressive state.

In many ways, divorce is an ending—not only of your current relationship, but of your present identity and your vision for the future. As such, it tends to fuel a grieving process not unlike what is often experienced after losing a loved one. “Most people going through divorce experience some degree of situational depression as part of the normal grieving process over all the losses the end of a marriage brings,” says one divorce coach who specializes in guiding people through the divorce process. “If not dealt with properly, situational depression can linger for much longer than it needs to.” Unfortunately, many people attribute the depression after a divorce to natural grief, failing to recognize that their feelings run deeper and require mental health treatment.

Death of a Spouse

The death of a spouse is one of the most difficult experiences most people will go through. Whether their passing was sudden or expected, finding yourself without your partner can cause profound loneliness, sadness, and even anger as you struggle with your new circumstance. As the National Institute on Aging explains, “When your spouse dies, your world changes. You are in mourning—feeling grief and sorrow at the loss. You may feel numb, shocked, and fearful. You may feel guilty for being the one who is still alive.” These emotional experiences can be accompanied by a host of physical and even cognitive symptoms, including sleep disturbances, loss of appetite, and concentration difficulties, both reflecting and further exacerbating your psychological distress.

While mourning the death of a spouse is an inherently painful process, that mourning may go beyond healthy grief and trigger depression, sometimes expressed as complicated grief. Researchers have found that this is particularly true for older people and women. Unfortunately, many people fail to recognize their symptoms as depression, believing them to be natural reactions to the loss of a partner, thereby missing opportunities to get the help they need to heal. “Spousal loss should spark extra energy in terms of exploring the possibility of major depression,” says Dr. Robert B. Wallace, co-author of a study suggesting that depressive symptoms after the death of a spouse are both common and often durable. “We always need to be looking out for it.”

Retirement

Retirement is often considered the beginning of the golden years, a time when you finally have the freedom to enjoy the fruits of your labor. For some, however, retirement can be fraught with emotional turmoil for a number of complex and often overlapping reasons, including boredom, financial strain, loss of purpose, and changes to your sense of self. “For a lot of [people] it really is a loss of a sense of identity—something that we get from work,” explains Marnin Heisel, a clinical psychologist and associate professor at the University of Western Ontario. “For a lot of [people], they lose that social network and social connection [that comes with working] … and the meaningful contribution they get out of what they do.”

Indeed, researchers at the Institute of Economic Affairs have found that retirement increases the risk of clinical depression by 40%. Their findings also suggest that people who truly enjoyed their jobs, as well as those who experienced sudden retirement due to job loss, appear to be the most vulnerable. However, depression often doesn’t start immediately upon retirement; many people experience “high levels of satisfaction directly after retirement,” only to see those levels fall over time.

Empty Nest Syndrome

Parenting isn’t always easy; raising another human being to adulthood is a difficult project, placing overwhelming demands on your time and emotional resources. However, for most parents, the work of parenting is also accompanied by deep joy and purpose, and when your child leaves the home to take those first steps toward true independence it can deeply disrupt your psychological well-being and even your most fundamental sense of self. “I was really surprised by how absolutely bereft I felt when [my children] left,” says one woman. “I have always tried to keep my identity as a person as well as my identity as a mother. It wasn’t just that I missed them, it was a feeling that I had moved into a different phase of life. Despite having several part-time jobs and plenty of interests, my primary identity was being a mother.” As one mother writes in a moving article about empty nest syndrome for The Independent, “It’s a horrible, queasy feeling. Other mothers describe the same kind of visceral wrench: a hand goes to the heart as they say they feel bruised, ill, hollow, empty when a child leaves home.”

While it is natural to struggle to some degree with the changes that come with having an empty nest, for some, this struggle can fuel depression. This may be particularly true for women and stay-at-home parents, whose sense of purpose is often deeply tied up in parenting. However, anyone with children can experience depression as the result of empty nest syndrome.

Chronic Illness

Health is perhaps our most precious resource. Due to the extraordinary impact health issues have in our lives, chronic illness can thus deeply disrupt both our practical abilities and our emotional wellbeing. “You may be facing new limits on what you can do and feel anxious about treatment outcomes and the future,” explains a writer for the National Institute of Mental Health. It may be hard to adapt to a new reality and cope with the changes and ongoing treatment that can come with the diagnosis. Your favorite activities may become harder to do.” Indeed, chronic illness can fundamentally change the possibilities that are open to you, provoke deep anxiety and fear, strip you of a sense of self-determination, and change the way you think about yourself.

While for some, these feelings are temporary, for others they persist and develop into or augment depression. In fact, depression is one of the most common comorbid conditions for people who have a chronic illness, affecting approximately “one-third of people with a serious medical condition.” Additionally, people who have a chronic illness and comorbid depression typically have more severe symptoms of both than those who have just one illness, severely impacting their quality of life and even prognosis. As such, it is imperative to recognize depression as soon as possible in order to potentially decrease symptom severity and improve treatment outcomes.