The World Health Organization estimates the current cost of depression and anxiety disorder costs the global economy $1 trillion each year. And every $1 invested in treatment for depression and anxiety returns $4 in terms of health and the ability to work, according to the organization
Echoing that is Victoria Ngo, a behavioral and social scientist at the RAND Corporation and an adjunct assistant professor of psychiatry and biobehavioral sciences at UCLA. In a recent interview, she shed light on the causes of depression and the methodology to treat it in women who live in Vietnam.
Ngo has integrated depression care with microfinance services in an innovative program called LIFE-DM. And the program’s success rate is high – in the 80th percentile of giving women the nudge they need to feel better about themselves. By teaching women coping techniques, problem-solving skills and giving them a microloan ― a small amount of money to pursue a business or income-generating project ― the program is turning lives around.
“One woman, as part of an exercise in our program, she decided she wanted to dance again. Like many other depressed women in Vietnam, she did very little for herself and ignored her own needs to take care of her family. She retreated from friends and family and isolated herself at home, making her depression worse. “We asked, ‘What do you used to enjoy?’ She’s like, ‘Oh dancing.’ And she started watching YouTube videos; practicing dance in front of her house at the street corner; even gathering some of her girlfriends and neighbors. They started dancing,” Ngo said.
“It started out as a neighborhood group for her to practice her dance. … Now that group is performing in the city all over Da Nang. They have a flash-mob dance group. It’s all these older women who make videos and do charity work. On the weekend, they go to the hospital, orphanage. They get together and go take care other people, and it’s just really beautiful. They even have uniforms.”
Other women have used their loans to buy supplies and pay for income-generating equipment, such as a sugar cane stand, so that they can either expand or start a business.
Success stories from these women encourage Ngo to expand her program, which she created to help depressed women to be active and live their lives productively and purposely.
She spoke with Nguoi Viet’s Titimary Tran.
Nguoi Viet: Would you share with us about this depression care program?
Victoria Ngo: I was doing this work in the Los Angeles community, in the poorest area of Los Angeles. In that project we were developing a village of care around depression, bringing all kinds of organizations from parks and rec to mental health to health and then training all types of people how to identify depression and provide [psychological] education. Then I realized there are no mental-health providers in Vietnam. There are psychiatrists who work in hospitals and do in-patient care, but mostly around schizophrenia and maybe bipolar. There was no place where depression care was provided. So I worked with an organization called the Vietnam Veterans of America Foundation, which was funded by Atlantic Philanthropies to develop the model and implement the models in two provinces in Vietnam.
But we had a high dropout rate at the beginning because they didn’t see any value with depression care, which includes medication, therapy, specific kinds of therapy, interaction therapy. We were trying to figure out how to make people understand why it’s important [to have depression care].
We went to India and visited a program that had a cow bank shared by a community to support people with mental illness. So, we decided to integrate the depression care with microfinance services. And we actually were able to reduce depression in about 80 percent [of participants] in our program.
Q: How does the program work?
A: Participants learn how to manage their moods. They learn stress-management skills, coping skills, activities that they can do to promote their livelihood. For example, getting a person who is typically withdrawn, or at times isolated, lethargic and not moving around too much to go to the market and ask questions to people there about business so they can learn about different ways they could make money, what other people are doing. This not only improves their mood but also helps increase their social interaction.
So by doing that, we’re addressing the gap that they might have in their livelihood as well as helping them address their mood issue. So naturally if you’re going out and asking people about things, you’re going to start to get more energy, you’re going to start to feel better, and then when you made progress on the things you care about like making money, then your feeling of stress will decrease and your mood will improve. So it’s another way for us to treat depression without saying do you want depression treatment because most people are like, “I don’t have time for happiness.”
Q: How do they pay it back and what is the term of the loan?
A: Micro finance is a poverty-alleviation tool. What it provides is a small loan. Usually it’s a group-based loan program. Sometimes it’s an individual base. Because these people don’t have any credit history, financial literacy, or interactions with the financial system, it’s really hard for them to get a loan. But if they do this through a group, then the group guarantees loans will get paid back, and the amount is usually very small.
The program we worked with was 20 months. It’s $150, so they paid back maybe $5 to $10 a month. It’s not a lot, but the idea is to help them practice skills to generate income and to address depression care. There are also other health programs that have successfully integrated with microfinance.
Q: How do you address the stigma of mental health?
A: We would work with [service groups] that work in the community and educate those people because those people are the front men and women in the community. They are the ones that go out and talk to all these people. So when you educate them, they’re out there doing what they do. They do HIV promotion; they know everyone. They know when someone is alcoholic or he/she is at home. Because when we educate them and when they meet these people, they would be like, “Oh, you know, there is a program that can help you with not being able to sleep and not having energy — you know having a hard time just staying motivated, feeling hopeless. That is actually called depression, and there is something we can do about it. It’s not so hopeless, so maybe you want to try it out, to check it out.
“…When life is hard, you know it’s natural to feel stressed out, but when it gets to the point where you’re not able to function, when you can’t get out of bed, when you can’t work, that’s when it becomes problematic and it affects all different areas of life. It affects your family, your relationship, your ability to parent, your ability of work. It affects your ability to make money, it affects your health.
“You have to connect to the functional problems in their life. Otherwise, they just see it as, ‘Oh, it’s just about mental health and mental illness. It just seems so far away to them because they don’t identify it in themselves, they don’t notice it, or they think it’s a character flaw. Or it’s just my fate to be this way. You know this life is about suffering so what am I going to do about it.
Depression is an illness and its actually something we can treat pretty effectively.
Q: What do you want to convey most to people?
A: One of the things I like to do is to promote mental-health awareness. That is really important. It’s central to all aspect of our lives, and depression is a rising health burden. It is one of the top health burdens. The cost is incredible, like one in five people at some point in their lives will have depression, and it affects everything, and treatment is really effective. We know how to do it really well. We are not just talking psychotropic medications; we’re talking about a range of different things that you can do to manage depression, and most people don’t know how to get effective help. They don’t know what to do. The treatment gap is huge, and the rate of return on depression is five to one. It’s really high.”
Victoria Ngo is a Vietnamese American researcher at RAND Corporation. She is a boat refugee who came to the U.S. at the age of 2. She studied at UC Davis and UCLA, and earned her Ph.D. at Vanderbilt University. She lives in Southern California.