Depression-A Silent Epidemic
It is time mental illness is rid of the erroneous tag of ‘madness’ and is viewed as any other health problem to be treated with equal urgency and care.
There is a saying that life is not to live but to be well. And there are no two ways about the fact that mental health is a significant measure of one’s well being. If treated, mental health can take care of many physical illnesses too. It is now estimated that 350 million people are affected by depression globally and by 2020, it will be the second leading cause of disability in the world. This alarming figure is a wake-up call that restoring mental health should get high priority. However, this medical area remains a subject of shame, stigma, discrimination and denial amongst many societies which makes it so difficult to effectively tackle the disease.
Indeed, mental health is an important factor in the overall health of a person. Without good mental health a person will be unable to work to his full potential. To this end, the world Mental Health Day is observed annually on October 10 to raise awareness about mental health issues worldwide. This year, the focus is on depression—a critical health issue for India. World Mental Health Day 2012 aims at encouraging governments and civil societies around the world to address depression as a wide-spread illness that affects individuals, their families and their peers. In fact WHO has indicated that by the end of the year 2020, depression would be number one illness in the world. Since the disease has been termed as a “global crisis”, the world health week was celebrated from October 4 to 10 to look for ways to remove barriers to mental healthcare and to enhance discussions on mental disorders. Efforts are on to provide information about depression as a treatable illness whose recovery is possible and achievable. It is also intended to encourage investments in prevention, treatment and promoting awareness of mental illnesses.
A separate day to acknowledge mental health was created by the World Federation for Mental Health in 1992 with the hope to create public awareness on mental health-related issues. The day is significant in drawing attention to issues—concerning not only mental illnesses but mental well being as well. Many countries adopted it as a means of promoting mental health.
The WHO describes mental health as state of well being in which the individual realises his abilities, can cope with normal stresses of life, can work productively and fruitfully and is able to make a contribution to his community. Emphasis should be given to early signs of depression disorder as it can affect anyone. Depression is a significant contributor to the global burden of disease and affects people of all communities across the world. The disorder often starts at a young age. It reduces functioning and the episodes are often recuring. For the same, depression is the leading cause of disability worldwide in terms of total years lost due to the illness. Therefore, the demand for curbing depression and other mental conditions is on the rise globally.
Depression is a common mental disorder that presents with depressed mood, loss of interest in activities previously found pleasurable, decreased energy, insomnia, disturbed appetite and loss of concentration. Depending on the number and severity of symptoms, a depressive episode can be categorised as mild, moderate or severe. Over time, these problems can become chronic and lead to substantial impairment of an individual’s ability to take care of his everyday responsibilities. At its worst, depression can lead to suicide. Almost one million lives are lost yearly due to suicide. While depression is the leading cause of disability in both males and females, the burden of the disease is 50 per cent higher for females than males, as reported by WHO in 2008. Research suggests that maternal depression may be a risk factor for poor growth of children which can affect not only this generation but also the next.
It is important for us to recognise that depression is like any other disease that usually requires treatment. Despite being one of the top five major causes of disability in the world, access to treatment is a problem in most countries. It causes greater decrements in health than most other chronic ailments like diabetics, arthritis and angina. Even then, in some countries fewer than 10 per cent of those who need treatments are able to get it. And this despite the fact that its complications affect both the sufferer and the people around.
Even otherwise fear of stigma dogs mentally ill patients. The disease remains the least understood and in our culture remains associated with intense shame and guilt. Uninformed fears have made the disease a taboo word for discussion. Stigma and discrimination create a vicious cycle. The victims do not disclose their condition since it means putting themselves and their families to all kinds of ridicule. This results in either patients being left without proper treatment or abandoned in mental asylums. In many cases where the disease is erroneously confused with madness, the patients are brutally handled and even chained. On the other hand, in rural areas quacks often mistreat patients suffering from various mental disorders obfuscated by wronged notions of spirits having entered their bodies.
In this context, the new Mental Health Care Bill prepared by the Law and Health Ministers that seeks to ensure that patients suffering from mental health ailments don’t get lodged in hospital or asylums for more than six months and are not given electric shocks without their consent is a step in the right direction. This welcome move that calls for six-month jail term to anyone found violating such norms in fact seems to accord dignity to mentally-ill patients allowing their families to make well-informed choices.
Despite the known effectiveness of treatment for depression majoirty of people in need do not receive it. Barriers to effective care include lack of trained providers and social stigma associated with the disease.
Prevention of depression is a key area that deserves attention. Many preventive programmes have provided evidence on the reduction of elevated levels of depressive symptoms.
While global burden of depression poses a substantial public health challenge there are a number of strategies that can effectively address the burden. For common mental disorders like depression being managed in primary care settings, key interventions are treatment with generic anti-depressant drugs and brief psychotherapy. Results indicate the feasibility, affordability and cost effectiveness of such treatments. To drive home the point that mental illness can be treated, education and communication plays a crucial role. Besides proper institutional care and awareness drives, community and family support is a must.
Depression is a mental disorder that is pervasive in the world and effects us all . Fortunately, a solution is at hand. Also, efficacious and cost effective treatment are available to improve health and lives of millions. It is time to educate ourselves about the disease and help those who are suffering from this disorder. It is also time to make mental illness a far more normal and openly discussed malady so that it does not carry a stigma.
By Sunita Vakil