Iatrogenic Depression: I’ll Be Right With You, Sir

An iatrogenic illness is one which results from health care 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 ten minutes, after I finish up with someone down the hall.” Returns in about ten 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.” (The last the group hears 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.

3 thoughts on “Iatrogenic Depression: I’ll Be Right With You, Sir”

  1. Dr. El,

    This is so important! All nursing home staff should be inserviced on this topic. It makes a huge difference. Positive interactions with staff members from the start (the "critical period") can hugely impact on a residents adjustment to nursing home life. It is amazing how positively residents, including those with cognitive impairments, respond to interactions "with accountability."

  2. This sounds somewhat like the Cultural Change movement, but it takes a different, "accountable" spin. I like it.

    P.S. Thanks for adding a link to my site in your sidebar.

  3. Sue, that's a good point about starting the accountability from the critical period upon entry to the nursing home. That way the staff isn't trying to rebuild the confidence of the residents in their ability to reliably care for them, but has engaged them from the start.

    ElderGuru, I'm a firm believer in Culture Change, and I think it can happen in different ways within an organization. Most nursing homes aren't committing to the entire Culture Change process, but this blog is filled with ways to make small changes that can make a big difference in nursing home life.


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