Depression made it to the top. Dr Shekhar Saxena (WHO)

Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO. 
Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO.

A 2012 report of the World heath organisation claimed that “unipolar depressive disorders, ranked as the third leading cause of the global burden of disease in 2004, will move into the first place by 2030”. As of 30 March 2017, 13 years earlier than predicted, depression is officially the leading cause of ill-health and disability worldwide.

What are the reasons behind the epidemic boom of depression, why is it coming 13 years earlier than predicted and what should be done on a personal, local and governmental level –  I have reached out to Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at the World Health Organisation (WHO).

Here is some more trivia:

  • Depression and another common mental disorder, anxiety, result in a global economic loss of a trillion US dollars every year;
  • 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;
  • 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;
  • Even in high-income countries, nearly 50% of people with depression do not get treatment.

Dr Saxena, depression is already the leading cause of ill-health and disability worldwide. What does it mean for a psychological condition to be disabling on a global scale?

All health conditions cause some kind of disabilities, and many of them also cause death. We have a way to calculate the amount of disability that every health condition causes based on how severe the disability is and how long does it last. Using this calculation we have found out that depression overall is the most significant cause of disability all over the world. It is responsible for about 7.5% of all disabilities caused by a health condition. That is a huge amount.

Some time ago the predictions were that Depression will be the #1 disabling disease by 2030.   However, here we are – 2017, and depression already is on top of the charts. Having the current figures of depression, what are the predictions now for 2030?

Depression is likely to remain at the top. It is not only prevalent but it is also increasing and has been increasing over the past 15 years. The world is ageing and depressing is more common amongst people who are older. It is quite likely that depression will keep increasing.

I must add that depression doesn’t only cause a great amount of disability, it also causes deaths. And the deaths are because of suicide. Not all suicides are because of depression but a significant proportion is and that is another reason why depression is such a large cause for public concern.

What brought this rapid development?

Depression has various causes. It is not caused by a single factor. There are a few genetic causes, also biological causes – something goes wrong in the brain, which leads to depression. The most important cause for depression, however, are various sorts of stresses and factors in the social-economic environment that we live in. For example, people who are under severe stress, either because of severe poverty, or are faced with difficulties within the family or with their job, or displacement – being a migrant, a refugee, being unemployed – these are all possible causes of depression. We should also remember that other physical illnesses, like chronic disabling illnesses or life-threatening illnesses, are also a huge factor for depression. And lastly, excessive use of alcohol and drugs is also an important cause of depression.

In a particular person, it has to be assessed as to what the exact causes are, but for a population, these are the most significant causes.

Which countries are most affected by mental health issues and depression in particular, and is there a certain predisposition that would explain that?

We published a couple of months back a booklet on depression (WHO-MSD-MER-2017.2-eng) and other common mental disorders that gives the latest figures on the prevalence of depression. Overall, it is between 4 to 6% of a countries population that suffers from depression. I would say that every country, whether it is small or large, whether it’s poor or rich, whether it’s an island or a continental country – they all have depression. Depression is common in both genders and in all ages, except very young kids. It is something that is universal and there is no predisposition in any nation or culture. The only exception are countries that are going through severe conflicts, wars and migration and also countries that suffer from natural disasters such as earthquakes, floods, tsunamis.  These countries have a higher prevalence of depression.

What should be done on a personal, local and governmental level to take control over the epidemic spread of depression worldwide? 

There are several things that need to be done. One of WHO’s main messages is “Depression – let’s talk”, because talking is the beginning of seeking help and receiving help. Talking can be with a family member, could be with a friend, a colleague and also talking to a healthcare provider, be is a doctor or a nurse or a specialist. People should be able to talk about their depression. That often is the beginning of the help that should be received.

At a personal level, we need to recognise the signs of depression within ourselves. The depression that I am talking about is the illness of depression and not the day-to-day sadness, which all of us can have. Depression as an illness is characterised by at least two weeks of sustained sadness and lack of interest in activities. The is what need to watch out for in ourselves, but also amongst out family members, friends and colleagues so that we can start talking and either solve the problem or seek further help.

At a governmental level, the services for mental health in general and more specifically for depression, need to be increased massively. Even in high-income countries, more than 50% of people with depression are not receiving help, and in low-income countries that percentage is much higher. Governments need to provide treatment for depression and this can be provided with the help of specialists, but also we strongly recommend that general doctors, nurses and other healthcare providers need to be trained in identifying and treating depression at an early stage. Also, the stigma against depression should be reduced. People are hesitant to go to a psychiatrist or a psychologist, they often go to a general practitioner, who should be able to identify the issue.

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