Mental illness is one of the most common conditions advisers encounter, yet underwriting clients with a history of depression can be complicated. Simon Taylor explains
One of the most common conditions the financial adviser and the underwriter will encounter is mental illness. This may take many forms, from simple stress, anxiety or mild depression to more severe psychiatric disorders such as schizophrenia or manic psychosis. For the purposes of this article we will deal with the category into which over 90% of applicants will fall ' depression.
A fact worth mentioning is that the underwriter will encounter depression more than the financial adviser. There is a certain stigma involved with depression and the applicant may be unwilling to disclose this when completing the application form, especially if they are no longer on treatment and consider the problem resolved. The history often comes to light when a GP's report is obtained due to other disclosures. It is also a condition that is very much under-disclosed, with the GP's report revealing a more significant history than the client has been willing to disclose.
The underwriting of depression is also fairly unique in that the risk remains fairly constant and largely unaffected. That is to say that where ratings for other conditions such as asthma and diabetes, may become more favourable due to advances in medical treatment showing improvements in survival rates, the risk associated with depression is a fairly constant one.
Types of depression
Depression can take many forms. There is acute reactive depression, which may be due to a family bereavement, work stress, or divorce for instance. This is normally short-lived and a full recovery is made although recurrent reactive events can indicate an underlying depressive tendency and lead to chronic depression.
Endogenous depression is where there is no definite cause and this is usually due to an underlying depressive tendency. Most adult personalities are sufficiently developed to enable them to deal with the day to day stresses of modern life but personality development in others is not sufficient to enable their own coping strategies to deal with these stresses. Often this leads to chronic depression requiring long term medical care.
Treatment
Treatment may involve medication only. Counselling or psychiatric referral may also be required and this will be determined by the severity of the symptoms and the GP will decide what method of treatment is best. Where there is evidence of self-harm, suicidal thoughts or actual suicide attempts, then the GP or psychiatric specialist may decide hospital admission is required. This can involve the patient being sectioned under the Mental Health Act if they are unwilling to be admitted voluntarily. Patient treatment can, in the more serious cases, involve electro convulsive treatment (ECT). Most cases the underwriter will encounter are mild and are managed by the GP only or with the addition of counselling and are easily and well controlled with baseline treatment such as Prozac or Dothiepin.
Simon Taylor is a senior life & disability underwriter at Scottish Equitable Protect
Depression: the statistics
• One in five people will, at some point, suffer from depression.
• More than 2.9 milliion people in the UK at any one time are suffering from depression.
• The most common age group for depression is 25 to 44
• The World Health Organisation estimates by the year 2020 major depression will be second only to chronic heart disease as an international health burden, measured by its cause of death, disability, inability to work and medical resource costs.
• 91 million working days a year are lost through sickness in the UK, at a cost of £12bn.
• In 1995 there were 13.2 million prescriptions for depression.
• The average GP will see at least one case of depression in every surgery session.
• One in six people who experience severe depression will eventually commit suicide.
• 20% of all deaths by young people are suicides.
• 75% of UK suicides are by men.
• Suicide rates have increased by more than 50% since 1990
• In the UK and Republic of Ireland there were 6,399 suicides in 2000, that is 12 per 100,000 over the age of 14.
• There is one suicide every 82 minutes.
Source: Scottish Equitable Protect
