A Harvard faculty member's fight to educate the public about depression has grown into a national crusade that reaches tens of thousands each year.

This year, that crusade has returned to Harvard to help Harvard faculty, staff, their family members, and retirees determine whether they are suffering from clinical depression.

Clinical depression is an illness marked by sadness, feelings of worthlessness, changes in weight, appetite, and sleep patterns, and sometimes even thoughts of death.

Associate Clinical Professor of Psychiatry Douglas Jacobs, founder of the National Mental Illness Screening Project, said that as many as 10 percent of any workforce suffer from depression at any one time. That results in a loss of productivity, increased use of sick time, and days out of work.

Depression not only affects a person's work life, it can also affect relationships with friends and family members.

The good news is that clinical depression is treatable with counseling and medication. Treatment can be successful within a few months.

That's why Jacobs founded the National Mental Illness Screening Project and why the Project has made its depression screening program available to employers across the country, including Harvard.

"The simple message is depression is an illness with signs and symptoms. The earlier one gets treatment, the greater the chances are of a positive response," Jacobs said.

One of the main difficulties in treating depression is getting depressed people in for treatment. Even with recent research showing that clinical depression is an illness, people still feel pressure to "pull themselves up by their bootstraps," "snap out of it," or "get over it," Jacobs said.

There is also the difficulty of distinguishing clinical depression from being a bit down because of negative events in life.

"Everybody gets the blues; that's a normal part of life," said Joelle Reizes, the National Mental Illness Screening Project's assistant director. "But the blues are transitory. You talk to a good friend and they go away. Clinical depression stays around two weeks or more and, if untreated, can stay around a long time."

Anonymous Screening

The screening program, available to Harvard faculty, staff, their families, and retirees through March, has been designed for people who may be suffering from clinical depression.

The program is accessed through a toll-free telephone number, which can be reached 24 hours per day. A recorded voice asks questions and the responses are tallied by a computer. The screening program asks no identifying questions and provides a telephone number for referral services to those needing further help.

"It's nonthreatening, it's completely anonymous," Reizes said. "If you want to call at 2 a.m. from a touch-tone pay phone, it'll work."

The screening program asks callers about how they've felt recently in order to determine whether they're suffering from symptoms of clinical depression.

Based on the caller's answers --entered via the phone's touch-tone keypad --the screening program indicates whether they may be suffering from clinical depression and, if so, whether it may be mild, moderate, or severe. At Harvard, the program also will refer possible depression sufferers to the Faculty and Staff Assistance Program's 495-HELP number for treatment referral. Other workplaces provide their own contact number.

"The survey is proven to be successful at reaching employees suffering undiagnosed and untreated depression, and encouraging them to seek help," said Carol Steinman, manager of the University's Faculty and Staff Assistance Program. "It allows people to privately seek out answers to their own concerns about feeling down. This gives them a chance to see if they're having more than just a bad week and, if they are, to get them help."

Harvard Roots

The screening project grew out of Jacobs' efforts in the late 1980s to educate the public about depression. With research showing depression as underdiagnosed and undertreated in the United States, Jacobs was looking for a way to get the message out to potentially millions of silent sufferers.

Jacobs collaborated with the American Psychiatric Association and Harvard-affiliated McLean Hospital in 1991 to found the first National Depression Screening Day, a community-based program that provides in-person face-to-face screening and referral.

After that endeavor proved successful, he founded the National Mental Illness Screening Project in 1992, and established similar screening programs for other illnesses.

The telephone screening program grew out of the face-to-face depression screenings the organization was conducting in the community. When the in-person screenings were attempted in the workplace, few workers showed up, kept away by fear of repercussions from co-workers and superiors.

"What we find is that face-to-face screening is not effective in a workplace setting because the need for anonymity is so high," Reizes said.

So the National Mental Illness Screening Project teamed up with another organization, the Harvard Telepsychiatry Project, which had been working on ways of using telecommunications technology to extend the reach of psychiatrists and psychologists into the community.

In the early 1990s, the Harvard Telepsychiatry Project had experimented with video conferencing as a way to provide counseling and treatment to people in remote areas where counselors were unavailable, according to John O'Laughlen, administrator for Harvard Medical School's Department of Psychiatry.

The Telepsychiatry Project found that video conferencing, though effective, was expensive, and set about looking at ways to use the telephone as a low-cost alternative. They approached the National Mental Illness Screening Project with the idea of using the telephone to help screen for depression, O'Laughlen said.

"We found that with high-quality, expensive technology, we could accomplish a lot. We could see the patient well, evaluate their demeanor, evaluate their mental health. That led us to see what other kinds of technology we could use that was less expensive," O'Laughlen said.

The first anonymous telephone screening program was launched in 1995 as a way to help people determine whether they had transitory blues or clinical depression.

The program has expanded and today it serves close to 300 companies across the country. Through those companies, the program is available to 3.5 million people, mostly employees and their family members.

This year, the National Mental Illness Screening Project is expanding the program again and has introduced a similar anonymous screening program for alcohol problems.

Faculty and Staff Assistance

There's no reason to believe clinical depression is more or less prevalent at Harvard than elsewhere, Jacobs said. The depression screening is available to Harvard faculty, staff, their family members, and retirees through the end of March at 1-800- 585-7518.

Those who take the anonymous screening and find they may be clinically depressed are encouraged to contact the Faculty and Staff Assistance Program, which will provide referral services.

"Our program sponsored the screening this year as an excellent opportunity for outreach on one of the services we regularly provide. We hope people will take advantage of it," Steinman said.

Feeling down? Harvard University's Faculty and Staff Assistance Program is sponsoring a free, anonymous Depression Screening Project for University faculty, staff, their family members, and retirees. To access the telephone screening program, call 1-800-585-7518.