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Media release: Global team of experts calls for united action to reduce the burden of depression ‑‑ an overlooked and underfunded crisis
The world is failing to tackle the persistent and deepening crisis of depression, according to a Lancet and World Psychiatric Association Commission that says a whole-of-society response is needed to reduce the global burden of the condition.
An estimated five per cent of adults are living with depression, despite abundant evidence that much can be done to prevent it and aid recovery even in resource-limited settings. In high-income countries, about half of those suffering from depression are not diagnosed or treated, and that rises to 80 to 90 per cent in low- and middle-income countries. The COVID-19 pandemic has only compounded that, with social isolation, bereavement, uncertainty and limited access to health care taking a serious toll on the mental health of millions.
Against this backdrop, the commission is calling for concerted efforts by governments, health-care providers and researchers 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. It has outlined its case in a new paper, published Tuesday in Lancet, by 25 experts from 11 countries, whose expertise spans disciplines from neuroscience to global health.
Rudolf Uher, a Canada Research Chair and professor in Dalhousie University's Department of Psychiatry, is the commission's Canadian representative and contributed to the report's examination of depression causation, which includes genetics and environment.
"The case for people living with depression has been harmed by opinions that depression is either a social phenomenon or a purely biological condition. Both are incorrect. The risk for depression is shaped by genetic disposition, physical conditions and social environment," says Dr. Uher.
"We need to address all of these aspects to help reduce the toll that depression takes on our lives.”
Depression is a common condition yet many myths continue to surround it, perpetuating inaction. The commissioners stress that depression is a distinct health condition characterised by its persistence, substantial effect on daily functioning and long-term health consequences. It can affect anyone, regardless of gender, background, social class or age.
Depression is linked to a wide variety of chronic physical illnesses, and a person’s physical health can influence their mental health. At its worst, depression can lead to suicide. Studies indicate that 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, of which depression is the most common cause. It also has an enormous social and economic toll, with the loss in economic productivity linked to depression costing an estimated US$1 trillion a year.
“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," says commission co-chair Christian Kieling, an associate professor at the Universidade Federal do Rio Grande do Sul in Brazil.
The commissioners stress that the current system of classifying people with symptoms of depression into just two categories — either they have clinical depression or not — is too simplistic. They argue that depression is a complex condition with a diversity of signs and symptoms, severity levels and duration.
The commission supports a personalised, staged approach to depression care that recognises the chronology and intensity of symptoms. It recommends interventions tailored to the specific needs of the individual, ranging from self-help and lifestyle changes to more intensive and specialised treatments, such as antidepressant medications.
“No two individuals share the exact life story and constitution, which ultimately leads to a unique experience of depression and different needs for support and treatment,” explains commission co-chair Vikram Patel, a professor at Harvard Medical School.
“Similar to cancer care, the staged approach looks at depression along a continuum — from wellness, to temporary distress, to an actual depressive disorder — and provides a framework for recommending proportional interventions from the earliest point in the illness.”
Current projects at Dalhousie and Nova Scotia Health are addressing the recommendations of the commission through the program TIDE by personalizing the initial treatment choice for depression in youth and examining who benefits from psychological treatment and who benefits from medication.
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Senior Research Reporter
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