Having a close friend or two to talk to---someone on whom you can depend for emotional support---can be great when little things accumulate or you temporarily feel down in the dumps. But can a friend talk you out of depression or lessen its pernicious effects? A study recently published in the British Journal of Psychiatry examined the viability of "befriending" as a tool in the treatment of emotional distress and depressive symptoms. The findings suggest that friendships, even therapeutic ones, can't necessarily substitute for treatment.
Keep in mind the researchers weren't talking either about the garden variety of befriending (a term that has become common parlance among Facebook or Twitter users) or about a mild case of the blues. For the purposes of their study, the team of primary care researchers at the University of Manchester, Manchester, UK defined "befriending" as social support that was "initiated, supported and monitored by an agency" expressly for one or more parties to benefit. It was, by definition, a treatment for depression or emotional distress that was "non-judgmental, mutual and purposeful."
The meta-analysis (a systematic statistical analysis) looked at more than 24 studies that covered a wide range of depressed populations, including caregivers of individuals with dementia, adolescents, lonely widows, men with prostate cancer, and pregnant women. The frequency of befriending varied among the studies as well as the ways in which the befriending took place. Some contacts were made face-to-face, others were by telephone, and some were a combination of both. Befriending was delivered both by trained and untrained volunteers.
The researchers found that the befriending intervention was less effective than cognitive behavioral therapy (CBT) in adolescents with depression and in medication-resistant individuals with schizophrenia. It was also less effective than nurse cognitive-behavioral problem solving in caregivers of people with dementia. It was similar in effectiveness to a nurse education and self-efficacy intervention in older adults recovering from myocardial infarction, to local community support groups for new inner-city mothers, and to systemic family therapy in depressed adolescents.
Based on their data, the researchers were unable to conclude that "befriending" is an effective, evidence-based treatment. Instead, they suggested that more rigorous study was needed to compare "befriending" head-to-head with standard treatments (such as CBT and medication), and that individual preferences should be considered in determining what works, for whom, and under what circumstances. This study relied on meta-analytic techniques to look at the friendship question but it would be worthwhile for researchers to design more large studies that look closely at whether and how friendships can alter the course and outcomes of various types of depression.
The conventional wisdom is that the presence of social supports can serve as a buffer against depression. Sounds logical enough: Friendships offer an outlet for people to express their emotions, to put things into perspective, to feel less alone, to reduce stress, and to encourage someone who's feeling distressed to seek out professional help when needed. But people with severe depression often have a hard time reaching out to anyone and it is often equally difficult for friends, even very good ones, to know what to do to help them recover. There's a lot more to learn.
Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis
Nicola Mead, PhD, Helen Lester, MB, ChB, MD, FRCGP, Carolyn Chew-Graham, MB, ChB, MD, FRCGP and Linda Gask, PhD, FRCPsych, NIHR School for Primary Care Research, University of Manchester
Peter Bower, PhD, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK
The British Journal of Psychiatry (2010) 196: 96-101. doi: 10.1192/bjp.bp.109.064089
If you know someone who is depressed, it affects you too. The first and most important thing you can do to help a friend or relative who has depression is to help him or her get an appropriate diagnosis and treatment. You may need to make an appointment on behalf of your friend or relative and go with him or her to see the doctor. Encourage him or her to stay in treatment, or to seek different treatment if no improvement occurs after six to eight weeks.
To help a friend or relative:
• Offer emotional support, understanding, patience and encouragement.
• Engage your friend or relative in conversation, and listen carefully.
• Never disparage feelings your friend or relative expresses, but point out realities and offer hope.
• Never ignore comments about suicide, and report them to your friend's or relative's therapist or doctor.
• Invite your friend or relative out for walks, outings and other activities. Keep trying if he or she declines, but don't push him or her to take on too much too soon. Although diversions and company are needed, too many demands may increase feelings of failure.
• Remind your friend or relative that with time and treatment, the depression will lift.
According to the National Institute of Mental Health (NIMH), major depression is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once-pleasurable activities. An episode may occur only once in a person's lifetime, but more often, it recurs throughout a person's life. It is estimated to affect 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.