DEPRESSION: A Global Crisis
World Mental Health Day,
OCTOBER 10, 2012
World Mental Health Day
• World Mental Health Day was
established in 1992 by the work of
Richard Hunter (Dick).
• The first World Mental Health Day was great
success with participation of 127 countries.
• Many countries now adopted the day as a means
of promoting mental health.
• Every year a theme is chosen and educational
material are produced and distributed by
• This year, the 20th anniversary, we have
chosen the theme –
“DEPRESSION: A Global Crisis”
A Global Public Health Concern
• Depression is a significant contributor of global
burden of disease in all communities across the
• According to the WHO, unipolar depressive
disorders were ranked as the third leading
cause of the global burden of disease in 2004
and will move into first place by 2030.
• Today, depression is estimated to affect
350 million people.
• The World Mental Health Survey conducted in
17 countries found that on average about 1 in 20
people reported having an episode of
depression in previous year.
• Depressive disorder often starts at a younger
age, and they reduce people functioning and
often are recurring.
• For these reasons, depression is the leading
cause of disability in terms of DALY.
• A recent World Health Assembly called on
the World Health Organization and its
member states to take action against this
What is “Depression”?
• Depression is a common mental disorder that
presents with -
- depressed mood
- loss of interest or pleasure
- decreased energy
- feeling of guilt or low self worth
- disturbed sleep or appetite and
- poor concentration.
• Moreover , depression often comes with anxiety.
• These problems become chronic and
recurrent and lead to substantial impairment
of individuals ability of his/her everyday
• At its worst, depression can lead to suicide.
• Almost 1 million lives are lost yearly due to
suicide , which translates to 3000 suicide
• For every person who completes a suicide, 20 or
more may attempt to end his/her life.
• There are multiple variations of depression that
a person can suffer from.
• Most general distinction being depression in
people who have or do not have a history of
• 1.Depressive episode.
• 2.Bipolar affective disorders.
• Depressive Episodes symptoms such as
depressed mood, loss of interest and enjoyment,
• Depressive episodes can be categorized as mild ,
moderate, or severe.
2.Bipolar affective disorder
• It typically consist of both manic and depressive
episodes separated by period of normal mood.
• Manic episodes involve elevated mood and
increased energy, resulting in over activity,
pressure of speech and decreased need for sleep.
• The burden of depression is 50 % higher for
female than for male.
• Research in developing countries suggest that
Maternal depression may be a risk for poor
growth in young children .
(Rahman et al,2008).
• This risk factor could mean that maternal
mental health in low income countries may
have substantial influence on growth during
childhood, with the effects of depression
affecting not only this generation but also the
• DEPRESSION is the disorder that can
be reliably diagnosed and treated in
Primary Health Care.
Treatment options at primary health
care level consist of –
1. Basic psychosocial support combined with
antidepressant medication. or
2. Psychotherapy (such as)
- cognitive behavior therapy.
- interpersonal psychotherapy or
- problem solving treatment.
• Antidepressant Medication can be very
effective form of treatment for moderate and
• But , it is not a first line treatment for cases of
• As adjunct to care by specialists or primary
health care, Self -help is an important approach
to help people with depression.
• Innovative approaches involving self-help
books or internet-based self-help
programs have shown to reduce or treat
depression in numerous studies in Western
(Andrews et al, 2011).
• Despite the known effectiveness of treatment for
depression, the majority of people in need do not
• Where data is available this is fever than 50%
globally, but less than 30% for most region
and even less than 10% in some countries.
Barrier to effective care includes-
• 1. lack of resources.
• 2. lack of trained health care providers and
• 3. the social stigma associated with mental
REDUCING THE BURDEN OF DEPRESSION
• While the global burden of depression poses a
substantial public health challenge but well
defined and evidence based strategies -
- at the social and economic levels and
- at clinical level
can effectively address and combat this burden.
At Primary Health care level
• Economic analysis has indicated that treating
depression in primary health care is feasible ,
affordable, and cost-effective
• For common mental disorders like Depression
can be managed in Primary Health Care
settings, the key interventions are-
1.treatment with generic antidepressant drugs.
Prevention of depression
• Effective community approaches includes -
- strengthening of protective factors and
- reduction of risk factor.
• On an individual, community, and
national level, it is time to educate,
ourselves about depression and
support those who are suffering
from this mental disorder.
Depression around the World
• Life time prevalence rates across the populations
around the world range from approximately 3%
in Japan to 16.9% in the United States.
• Most countries prevalence is in between 8-12%.
• The World Health Organization recently studied
the “treatment gaps” in mental health care .
• The median rate for untreated depression
worldwide is approximately 50%.
RISK FACTORS (worldwide common )
• 1. GENDER- Depression is 2-3 times more
common in women.
• 2. ECONOMIC DISADVANTAGE - poverty.
• 3. SOCIAL DISADVANTAGE - low education.
• 4. GENETICS - 2-3 time more risk in first degree
• 5.Exposure to violence.
• 6.other Chronic illness.
Living with Depression
• Living with depression, specially if it is chronic
and recurrent, can make you feel exhausted.
• These feelings can often make you want to give-
• Recognizing that these negative thoughts
are part of your depression is one step
TAKING CARE OF YOURSELF
• 1. Exercise daily.
• 2. Balanced diet.
• 3. Meditation.
• 4. Healthy sleep habits.
• 5. Avoid and reduce stress.
• 6. Keep your working hours predictable and
• 7. Limit or curtail alcohol and substance abuse.
• 8. Organizing and planning daily routine.
• 9. Be patient with yourself.
• In 2008 the World Health Organization (WHO)
“Integrating Mental Health into Primary
Care: A Global Perspective”
which highlighted patient preference for
receiving mental health care in primary care.
• The aim is to develop resilience at the individual
and community level by delivering an evidence-
based health service approach.
• The emphasis can be placed on strengthening
those elements that already exist in the
• integrating them through a comprehensive
primary care network.
• In 20th
anniversary of World Mental
Health Day, the theme Depression: A
Global Crisis, provides us the opportunity to
focus on how we can best work together using
the resources at our disposal to build increased
resilience at individuals and society level in
order to reduce the burden of disease.
• Averting this global crisis will require
continued collaboration between
organizations, pharmaceutical companies
and civil society to pool our resources and
strengthen the health services.
THE ECONOMIC IMPACT OF DEPRESSION
• 1. Across the globe it imposes a significant
economic burden, not just on individuals with
the disorder, but also on their families,
communities, employers, and general
• 2. Depression also perpetuates the cycle of
poverty which leads to decreased social as well
as economic productivity.
DEPRESSION AND DANGER TO OTHERS
• Depression is not generally associated with
dangerousness to others.
• A hallmark of depression is dangerousness to
self—that is, suicide.
• There are several situations where depression
precipitates murder, and then sometimes
-Infanticide and postpartum depression.
-Filicide: The killing of a child by a parent,
which accounts for 60% of all child homicides.
-Adolescent parricide- killing of parents.
-Mass murder followed by suicide.
CALL TO ACTION
World Mental Health Day 2012
• Annual goals of World Mental Health Day is -
1.to encourage and promote informed advocacy and action
for the improvement of services to those with mental and
2.to promote mental health and wellbeing and
3.to prevent mental disorders.
• Provide Treatment in Primary Care.
• Make Psychotropic Medications Available.
• Give Care in the Community.
• Educate the Public.
• Involve Communities, Families and Consumers.
• Establish National Policies, Programs and
• Develop Human Resources.
• Link with Other Sectors.
• Monitor Community Mental Health.
• Support More Research.
“On an individual, community, and
national level, it is time to educate
ourselves about depression and
support those who are suffering from
this mental disorder.”
“This year’s World Mental Health Day
provides us with an opportunity to think
about the practical things that we can
do. Doing nothing is not an option.”
- Dr Gabriel Ivbijaro