Independence at the Price of Depression due to Isolation

I just came from a month-long observership on HIV care in New York, USA.  I shadowed doctors, nurses, nutritionists, social workers and volunteers managing HIV-positive patients.  Many of the realizations I had were not necessarily healthcare-related.

INDEPENDENCE.  Many of the youth move out of their family home and live independently at an early age.  I am already a 38-year old professional, and I still live with my mom.  In the US, patients receive calls to remind them of their doctor’s appointments and they can come without any cash because their medical insurance would pay for the medical services and prescription medications.  In the Philippines, often doctors have to consider the cost of treatment because patients have to pay out of pocket.

ISOLATION.  Because children leave the homes early, many of the parents end up coming to appointments alone.  One taxi cab driver provided unsolicited advice that people should not build large houses because after a few years, you end up living alone anyway.  I also experienced isolation when I was housed in an expensive hotel room all by myself.

DEPRESSION.  There was a recurring commercial on television showing people telling a bald cancer patients things like “snap out of it…” or “you’re wearing me down…” or “stop with the pity part ok…” then ending with the conclusion “you don’t say this to a cancer patient, don’t say it to a person with depression.  Depression can kill…”  When people are isolated because it is the price of independence, then the ensuing depression is also a factor in the costs.  In the Philippines, you endure it when you get sad, mainly because there are a lot of people around you to talk things over with.  At one point, everyone is so snoopy they think your business is their business, hence the very active social media.  Is this better than a society that says loudly “mind your own business!” but relies heavily on professional (psychiatric) help when they feel sad or depressed?

This is also the plight of Filipinos who go abroad in search of financial independence for the sake of their families. People at risk of depression due to isolation would be overseas Filipino workers.

This is also the scenario of HIV patients who isolate themselves due to self-stigma to gain independence as a means of coping with their disease.  Often this also results in depression which necessitates additional support.

T1. How do we achieve the middle ground between independence and isolation?

T2. What strategies can be implemented to prevent depression due to isolation?

T3. How can healthcare service delivery help address mental health issues of isolation?