Depression Remains Overlooked and Underfunded; Experts Call to Reduce Global Burden 
depression homelessness
Street scene in Metro Manila, Intramurous district, Philippines. 80-90% of those with depression are left untreated or undiagnosed in low- and middle-income countries. Homelessness is one adverse experience that may cause depression.

With about half of people suffering from depression in high income countries untreated or undiagnosed, with this number rising to 80-90% in low- and middle-income countries, a Lancet and World Psychiatric Association Commission have called for a unified response against this global crisis to reduce the burden of depression.

Depression is estimated to impact 5% of adults globally, with its onset most frequent in young people. COVID-19 has caused ‘mass trauma’ worldwide and has further worsened mental health for millions, creating additional challenges with isolation, bereavement, uncertainty, hardship, and limited access to healthcare. 

To combat the crisis, the Commission’s ‘Time for united action on depression’ calls for a concerted and collaborative front from all – government, healthcare providers, researchers, and people living with depression, to improve care and prevention, fill knowledge gaps, and increase awareness for one of the leading causes of avoidable suffering and premature death worldwide. 

“Depression is a global health crisis that demands responses at multiple levels,” said Commision Chair Professor Helen Herrman.

“This Commission offers an important opportunity for united action to transform approaches to mental health care and prevention globally.”

The report is authored by 25 experts across 11 countries, from experts in neuroscience to global health. It is advised by people with experience of depression. 

Myths surrounding depression fuel inaction 

Myths surrounding mental health have fueled inaction.

While 70-80% of people who die by suicide in high income countries, and around half in LMIC, suffered from mental illness, with depression as the most common cause, myths surrounding this health condition have fueled global inaction towards depression. 

The myths include the misconception that depression is simply sadness, a sign of weakness, or restricted to certain cultural groups.

Depression also has an under-recognized social and economic toll, with the loss in economic productivity linked to depression costing the global economy an estimated $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”, said Commission Co-Chair Associate Professor Christian Kieling, of the Brazil-based Universidade Federal do Rio Grande do Sul. 

The Commission does stress that depression is distinctly a health condition that is characterized by persistence, as it inhibits daily functioning and may lead to long-term health consequences. Depression may also impact anyone, regardless of gender, background, social class, and age, though symptoms and signs of depression may vary among groups.

Society and individual strategies proposed 

Mental health services for children and adolescents have been disrupted due to COVID-19. Solutions to reduce the global burden of depression need to prevent adverse experiences in childhood.

Whole-of-society and individual level strategies have been proposed by the Commission to prevent depression, focusing on reduced exposure to adverse experiences in childhood, lifestyle factors, and other stressful events, including financial crisis or bereavement. 

“Prevention is the most neglected aspect of depression. This in part because most interventions are outside of the health sector”, said co-author Dr Lakshmi Vijayakumar from SNEHA, Suicide Prevention Centre and Voluntary Health Services of Chennai, India.

Vijayakumar further noted how crucial these prevention efforts are. 

“In the face of the lifelong effects of adolescent depression, from difficulty in school and future relationships to risk of substance abuse, self-harm, and suicide, investing in depression prevention is excellent value for money. 

It is crucial that we put into practice evidence-based interventions that support parenting, reduce violence in the family, and bullying at school, as well promoting mental health at work and addressing loneliness in older adults.”

Current classification of depression is ‘too simplistic’ 

The current classification that places people with symptoms of depression into just two categories – either they have clinical depression or not – remains too simplistic, says the Commission. 

Instead, the Commission supports a personalized, staged approach to depression care that tailors and recommends interventions to the individual and the severity of their condition. These treatments range from self-help to lifestyle changes to psychological therapies. 

“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”, explained Commission Co-Chair Professor Vikram Patel from US-based Harvard Medical School. 

In addition, the Commission also proposes collaborative care strategies that incorporate locally recruited, widely available non-specialists such as community health workers and lay counselors. 

Ultimately, they conclude that greater investment is needed on behalf of the government to reduce the damaging impact of poverty, gender inequity, and other social inequalities on mental health.

Said Patel: “Tackling the climate emergency, the COVID-19 pandemic and other global and regional emergencies that exacerbate existing inequities and threats to health, including pursuit of the UN Sustainable Development Goals, must also be vital parts of efforts to prevent depression.”

Image Credits: Wayne S. Grazio, Nenad Stojkovic/Flickr, WHO/NOOR/Sebastian Liste.

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