World Health Day 2017-
"Depression: let’s talk"
Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from WHO, more than 300 million people are now living with depression, an increase of more than 18% between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.
The new estimates have been released in the lead-up to World Health Day on 7 April, the high point in WHO’s year-long campaign “Depression: let’s talk”. The overall goal of the campaign is that more people with depression, everywhere in the world, both seek and get help.
These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves.
One of the first steps is to address issues around prejudice and discrimination. “The continuing stigma associated with mental illness was the reason why we decided to name our campaign Depression: let’s talk,” said Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO. “For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery.”
Urgent need for increased investment
Increased investment is also needed. In many countries, there is no, or very little, support available for people with mental health disorders. Even in high-income countries, nearly 50% of people with depression do not get treatment. On average, just 3% of government health budgets is invested in mental health, varying from less than 1% in low-income countries to 5% in high-income countries.
Investment in mental health makes economic sense. Every US$ 1 invested in scaling up treatment for depression and anxiety leads to a return of US$ 4 in better health and ability to work. Treatment usually involves either a talking therapy or antidepressant medication or a combination of the two. Both approaches can be provided by non-specialist health-workers, following a short course of training, and using WHO’s mhGAP Intervention Guide. More than 90 countries, of all income levels, have introduced or scaled-up programmes that provide treatment for depression and other mental disorders using this Intervention Guide.
Failure to act is costly. According to a WHO-led study, which calculated treatment costs and health outcomes in 36 low-, middle- and high-income countries for the 15 years from 2016-2030, low levels of recognition and access to care for depression and another common mental disorder, anxiety, result in a global economic loss of a trillion US dollars every year. The losses are incurred by households, employers and governments. Households lose out financially when people cannot work. Employers suffer when employees become less productive and are unable to work. Governments have to pay higher health and welfare expenditures.
Associated health risks
WHO has identified strong links between depression and other noncommunicable disorders and diseases. Depression increases the risk of substance use disorders and diseases such as diabetes and heart disease; the opposite is also true, meaning that people with these other conditions have a higher risk of depression.
Depression is also an important risk factor for suicide, which claims hundreds of thousands of lives each year. Said Dr Saxena: “A better understanding of depression and how it can be treated, while essential, is just the beginning. What needs to follow is sustained scale-up of mental health services accessible to everyone, even the most remote populations in the world.”
Depression is a common mental illness characterized by persistent sadness and a loss of interest in activities that people normally enjoy, accompanied by an inability to carry out daily activities, for 14 days or longer.
In addition, people with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.
Depression Facts
Depression is a common mental disorder.
Globally, more than 300 million people of all ages suffer from depression.
Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.
More women are affected by depression than men.
At its worst, depression can lead to suicide.
There are effective treatments for depression.
Overview
Depression is a common illness worldwide, with more than 300 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Close to 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29-year-olds.
Although there are known, effective treatments for depression, fewer than half of those affected in the world (in many countries, fewer than 10%) receive such treatments. Barriers to effective care include a lack of resources, lack of trained health-care providers, and social stigma associated with mental disorders. Another barrier to effective care is inaccurate assessment. In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.
The burden of depression and other mental health conditions is on the rise globally. A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level.
Types and symptoms
Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.
A key distinction is also made between depression in people who have or do not have a history of manic episodes. Both types of depression can be chronic (i.e. over an extended period of time) with relapses, especially if they go untreated.
Recurrent depressive disorder: this disorder involves repeated depressive episodes. During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks. Many people with depression also suffer from anxiety symptoms, disturbed sleep and appetite and may have feelings of guilt or low self-worth, poor concentration and even medically unexplained symptoms.
Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe. An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.
Bipolar affective disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.
Contributing factors and prevention
Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.
There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.
Prevention programmes have been shown to reduce depression. Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Interventions for parents of children with behavioural problems may reduce parental depressive symptoms and improve outcomes for their children. Exercise programmes for the elderly can also be effective in depression prevention.
Diagnosis and treatment
There are effective treatments for moderate and severe depression. Health-care providers may offer psychological treatments (such as behavioural activation, cognitive behavioural therapy [CBT], and interpersonal psychotherapy [IPT]) or antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Health-care providers should keep in mind the possible adverse effects associated with antidepressant medication, the ability to deliver either intervention (in terms of expertise, and/or treatment availability), and individual preferences. Different psychological treatment formats for consideration include individual and/or group face-to-face psychological treatments delivered by professionals and supervised lay therapists.
Psychosocial treatments are also effective for mild depression. Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.
Depression is one of the priority conditions covered by WHO’s Mental Health Gap Action Programme (mhGAP). The Programme aims to help countries increase services for people with mental, neurological and substance use disorders, through care provided by health workers who are not specialists in mental health. The Programme asserts that with proper care, psychosocial assistance and medication, tens of millions of people with mental disorders, including depression, could begin to lead normal lives – even where resources are scarce.
