On Cape, no vacation from depression

High rate found among residents

FALMOUTH - The other side of paradise can be seen from a gun-metal gray house on a leafy road. John Stukas lives here, jobless, divorced, stuck in the quicksand of depression.

This wasn't how things were supposed to work out when he moved to Cape Cod more than two decades ago.

But the promise of the Cape can turn to desperation as quickly as the ebb and flow of the tide. And the fact that so many outsiders use it as a playground only magnifies the sense of isolation for someone like Stukas, a 53-year-old with sad eyes who has been given to bouts of anxiety since childhood.

A soon-to-be-released study offers the most extensive portrait ever of depression on Cape Cod, showing a rate substantially above national averages. When nearly 15,200 patients were screened at four community health centers, more than 40 percent showed evidence of depression.

The problem is so extensive, and the need for help so great, that Harvard-affiliated McLean Hospital is looking at expanding services in Southeastern Massachusetts, a region that includes the Cape.

"This environment is just harder on people who are depressed," said Stukas, his voice occasionally trembling. "In the summertime, you just feel like you're jammed face-first through a toilet-paper tube - nothing can be done fast enough or hard enough or well enough.

"And then we've got these long deadly winters - gray, rainy, you know?"

The high rate of depression, specialists and patients said, reflects the challenge of living somewhere whipsawed by extremes: The onslaught of summer yields to the dreary desolation of winter. The extravagant lifestyles embodied by mansions and yachts contrast with the hand-to-mouth existence forged by the low pay of a service economy and the high prices of a resort community.

Doctors, nurses, and social workers had seen evidence of broken lives for years. "This kept percolating up all the time," said Tim Lineaweaver, director of behavioral health at the Community Health Center of Cape Cod in Mashpee.

But they wondered: Just how deeply does the depression run?

So starting in 2004, community health center patients were asked to complete a nine-question survey designed to detect depression and its severity. The patient screening was the centerpiece of a nearly $1 million campaign by the Cape's community health centers to chart depression and improve mental-health services. Half of the money came from the Robert Wood Johnson Foundation, a major private underwriter of health services and research.

The questionnaire, widely used in medical practices and in research by major medical organizations, helps doctors and patients to begin a conversation about a topic they had long skirted.

"Cape Codders tend to be stoic, thinking, 'I'm just going to suck it up.' That does work for a while, I suppose," said Dr. Barbara Prazak, a champion of depression treatment at the Outer Cape Health Services in Wellfleet.

In private, patients complete the form, answering, for example, whether over the past two weeks they felt down, had little interest in activities, or thought they would be better off dead.

So far, the screening, done year-round, has identified more than 6,500 adults who suffer from depression, ranging from mild to severe - 43 percent of those who took the test. The National Institute of Mental Health reports that 26 percent of US adults cope with some sort of diagnosable mental health disorder each year.

Though the levels are not directly comparable because of different ways of measuring, the federal figures show that 6.7 percent of American adults suffer from major depressive disorder; in the Cape Cod screening, 11.5 percent of patients had depression rated "moderately severe" or "severe."

"I was very surprised that there was this much depression on the Cape," Lineaweaver said. "It just shocked me, I have to say."

The Cape's brew of social, economic, and geographic forces is a dangerously ideal environment for mental health and substance abuse problems, specialists from the state Department of Mental Health and McLean Hospital said.

There is, for example, the seasonal nature of employment and social interaction. During the long winter months, the Cape, population roughly 250,000, turns into a desolate way station where some people "have nothing to do but worry about their finances and drink," said Dr. Jeffrey D. Rediger, medical director of McLean Southeast, a branch of the psychiatric hospital that covers Cape Cod.

Studies show that admission rates for substance abuse among Cape Codders are 18 percent above the statewide average.

Peter Evers, Southeastern Massachusetts area director for the Department of Mental Health, describes the winter months as being "shrink-wrapped - everybody knows who the local guy is with such-and-such issue," he said. "I'm always struck by how that must compound one's feeling of isolation."

"You can live anonymously in Boston in poverty and misery - not so much on the Cape," he said.

Then there's the sense of economic promise and emotional regeneration that the Cape holds for people who move there.

The working poor are lured by talk of in-season jobs and arrive "with the vision that by coming to the Cape, things will be better," said Steve Jochim, site director for the Department of Mental Health on Cape Cod and the Islands. "But they're not."

Instead, they discover hourly wages of $10 or less, forcing them to take on multiple jobs and crowd into shared housing. Desperation sets in and, often, they seek comfort from the narcotics and alcohol that are widely available.

"The first time you see somebody, they can barely lift up their head because they're so depressed," Prazak, of Outer Cape Health, said. "So now, we're trying to track people with depression and make sure they respond to treatment."

John Stukas first sought help a decade ago. His marriage had just disintegrated. Work was proving unreliable. There was the time, for instance, he was a manager in a business, and then the owner died and the business closed.

The Cape, he said, is "an idyllic place, it truly is. If you have money, you can participate in that idyllic environment." For those without money, he said, all you can do is watch other people play, which only fuels depression.

In his case, money is especially tight these days. He lost his most recent job in January and subsists on unemployment aid and the generosity of his family. Treatment he gets at the Community Health Center of Cape Cod, has been, he said, "like the arresting cable on an aircraft carrier."

He receives counseling at the center and, until mid-May, got prescriptions for psychiatric medications.

Stukas, a quietly religious man, stays on the Cape, he said, to be close to his daughter, almost 18 now. Still, as the fog of depression drifts in, as the money gets tight and decent job opportunities dwindle, "you ask yourself, why do you stay?"

"You wonder about that."

Stephen Smith can be reached at stsmith@globe.com.