DEPRESSION: A Global CrisisWorld Mental Health Day,OCTOBER 10, 2012
World Mental Health Day(BACKGROUND)• 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 WFMH.• This year, the 20th anniversary, we have chosen the theme – “DEPRESSION: A Global Crisis”
DEPRESSIONA Global Public Health Concern• Depression is a significant contributor of global burden of disease in all communities across the world.• 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 direction. (WHO, 2012)
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 responsibility.• At its worst, depression can lead to suicide.
• Almost 1 million lives are lost yearly due to suicide , which translates to 3000 suicide deaths everyday.• For every person who completes a suicide, 20 or more may attempt to end his/her life. (WHO, 2012)
• 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 manic episode.• 1.Depressive episode.• 2.Bipolar affective disorders.
1.Depressive Episodes• Depressive Episodes symptoms such as depressed mood, loss of interest and enjoyment, increased fatigability.• 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. (WHO 2008).• 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 NEXT GENERATION.
MANAGING DEPRESSION• DEPRESSION is the disorder that can be reliably diagnosed and treated in Primary Health Care.
Treatment options at primary healthcare 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 severe depression.• But , it is not a first line treatment for cases of mild depression.
• 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 countries. (Andrews et al, 2011).
• Despite the known effectiveness of treatment for depression, the majority of people in need do not receive it.• 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 disorders.
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. 2.brief psychotherapy.
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 FACT SHEET• 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 relatives.• 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- up .• Recognizing that these negative thoughts are part of your depression is one step towards recovery.
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 manageable.• 7. Limit or curtail alcohol and substance abuse.• 8. Organizing and planning daily routine.• 9. Be patient with yourself.
SYSTEM STREGHTHENING• In 2008 the World Health Organization (WHO) published “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 community and• 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 governments, non-governmental 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 government budgets.• 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.
• But,• There are several situations where depression precipitates murder, and then sometimes suicide.
-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 ACTIONWorld 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 behavioral disorders2.to promote mental health and wellbeing and3.to prevent mental disorders.
RECOMENDATIONS• 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 Legislation.• 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