New Delhi: The world is facing a persisting and increasingly serious global crisis of depression, and is failing to tackle the same, according to a Lancet and World Psychiatric Association on depression, called The Lancet-WPA Commission on Depression. It calls for a whole-of-society response to reducing the global burden of depression.
It is estimated that five per cent of the adult population around the world in any year is living with depression, according to a statement issued by The Lancet. Depression remains a neglected global health crisis, despite abundant evidence that much can be done to prevent depression and aid recovery even in resource-limited settings.
About half of the people suffering from depression in high-income countries are not diagnosed or treated. In low- and middle-income countries, 80 to 90 per cent of people suffering from depression are not diagnosed or treated.
Social isolation, bereavement, uncertainty, hardship, and limited access to healthcare during the Covid-19 pandemic has created additional challenges, and is taking a serious toll on the mental health of millions.
The Commission's Call For United Action
The Lancet-WPA Commission 'Time for united action on depression' has called for concerted and collaborative efforts by governments, healthcare providers, researchers, people living with depression, and their families to improve care and prevention, fill knowledge gaps, and increase awareness to tackle one of the leading causes of avoidable suffering and premature death worldwide, the statement said. The Commission is authored by 25 experts from 11 countries spanning disciplines from neuroscience to global health, and advised by people with experience of depression.
Quoting Commision Chair Professor Helen Herrman, the statement said that depression is a global health crisis that demands response at multiple levels. Herrman is also the President of the World Psychiatric Association.
She added that the Commision offers an important opportunity for united action to transform approaches to mental health care and prevention globally. She further said that investing in reducing the burden of depression will give millions of people the chance to become healthier, happier and more productive members of society, help to strengthen national economies, and advance the 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015,
Dr Charles Reynolds from the University of Pittsburgh, co-author of the Commision, said: "We know that most individuals with depression at all stages of life will recover if they obtain adequate support and treatment. With sound science, political will, and shared responsibility, depression can be prevented and treated and potentially disabling consequences avoided. We must empower people with experience of depression together with families, practitioners, policymakers and civil society to address the tsunami of unmet need—through sharing their experiences to reduce stigma, supporting others with information about the condition and possibilities for help, and advocating for greater resources for evidence-based approaches.”
Many Myths Continue To Surround Depression
Despite the fact that depression is a common condition worldwide, many myths continue to surround it, perpetuating inaction. The myths surrounding depression include common misconceptions that depression is simply sadness, a sign of weakness, or restricted to certain cultural groups.
Depression is a distinct health condition characterised by its persistence, substantial effect on daily functioning, and long-term health consequences, the Commissioners stressed.
Depression, at its worst, can lead to suicide. According to studies, 70 to 80 per cent of people who die by suicide in high-income countries, and around half of those in low- and middle-income countries, suffer from mental illness.
Depression is the most common cause of this, and has an enormous, under-recognised social and economic toll on individuals, families, communities, and countries, the statement said.
The loss in economic productivity linked to depression cost the global economy an estimated US$1 trillion a year, even before the Covid-19 pandemic.
Commission Co-Chair Associate Professor Christian Kieling from the Universidade Federal do Rio Grande do Sul in Brazil said that there is arguably no other health condition which is as common, as burdensome, as universal, or as treatable as depression, yet it receives little policy attention and resources, according to the statement.
How To Reduce The Burden Of Depression?
In order to lower the prevalence of depression, whole-of-society strategies that reduce exposure to both adverse experiences in childhood, including neglect and trauma, and across the lifespan are needed, according to the Commission. There should be interventions at the individual level, focussing on lifestyle factors such as smoking, alcohol consumption and physical inactivity, and other risk factors such as intimate partner violence and stressful life events including bereavement or financial crisis.
Co-author Dr Lakshmi Vijayakumar from SNEHA, Suicide Prevention Centre and Voluntary Health Services, Chennai, India, said that prevention is the most neglected aspect of depression.
Importance Of A Personalised, Staged Approach To Depression Care
The current system classifies people with symptoms of depression in two categories—either they have clinical depression or not. The Commissioners stress that the system is too simplistic, and argue that depression is a complex condition with a diversity of signs and symptoms, severity levels, and duration across cultures and the life course.
A personalised, staged approach to depression care that recognises the chronology and intensity of symptoms is supported by the Commission. The approach must recommend interventions tailored to the specific needs of the individual and severity of the condition, ranging from self-help and lifestyle changes to psychological therapies and antidepressants to more intensive and specialised treatments such as electroconvulsive therapy (ECT) and brain stimulation for severe forms of the illness, the Commission stated.
Commission Co-Chair Professor Vikram Patel from Harvard Medical School in the USA explained that no two individuals share the exact life story and constitution, which ultimately leads to a unique experience of depression and different needs for help, support, and treatment.
The Commission has proposed that collaborative care strategies should be adopted to scale up evidence-based interventions in routine care. The authors argue that using locally recruited, widely available, and low-cost non-specialists such as community health workers and lay counsellors, not only addresses the acute shortage of skilled providers and financial barriers, but will also help reduce stigma and cultural barriers. At the same time, this will provide holistic care to patients and their families.
In order to ensure that people receive the care they need where and when they need it, greater investment is necessary. The Commission has underscored the importance of whole-of-government actions to reduce the damaging effects of poverty, gender inequity, and other social inequities on mental health.
Quoting Herrman, the statement said that policies that reduce racial or ethnic inequities, systematic disadvantages experienced by women and support the fair distribution of income through universal health coverage and expanding opportunities for educational attainment can be potentially powerful preventive strategies.