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Making Mental Health Care a Global Health Priority

Credit: World Health Organization

Depression is the leading cause of illness and disability worldwide. According to the latest estimates from the World Health Organization (WHO), more than 300 million people are now living with depression, an increase of more than 18 percent between 2005 and 2015. Lack of support for people with mental disorders, coupled with a fear of stigma, a high burden of infectious diseases and maternal and child health challenges, as well as the growing tide of chronic non-communicable diseases, prevent many people from seeking the help they need to treat depression.

As the former director-general of WHO, Margaret Chan, MD, said in a statement earlier this year, “These figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves.”

To help raise awareness about depression, WHO launched a global campaign, called “Depression: Let’s Talk” to encourage health care providers and people who are living with mental illness to seek the treatment they need.

“The first step for anyone wishing to help someone struggling with depression is to let them know there is nothing to be ashamed of and that there are resources,” said Maria Oquendo, MD, PhD, chair of Psychiatry in the Perelman School of Medicine. “Having someone to talk to can make a world of difference.”

Depression Doesn’t Discriminate

Depression is characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks. In addition, people with depression normally have several of the following symptoms:

  • a loss of energy

  • a change in appetite

  • sleeping more or less

  • anxiety

  • reduced concentration

  • indecisiveness

  • restlessness

  • feelings of worthlessness, guilt, or hopelessness

  • thoughts of self-harm or suicide

Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living.

At worst, depression leads to suicide, which is now the second leading cause of death among 15-29-year olds.

Yet, depression can be prevented and treated.

“A better understanding of depression’s neurobiological and environmental determinants and how it can be prevented and treated will help reduce the stigma associated with the condition, and lead to more people seeking help,” Oquendo said. “And globally, we must make mental health care more accessible to the millions who need it. For example, Mozambique has a total of 13 psychiatrists for a population of 26 million, illustrating the challenges of providing people with proper care. ”

Depression and Other Diseases

Depression is also strongly linked to other serious health conditions such as heart disease, diabetes, and substance abuse, which are emerging as significant challenges in developing countries.

Mental distress can activate the body’s “flight or fight” response, the sympathetic nervous system, and boost levels of stress hormones, which in turn contributes to elevated blood pressure, high cholesterol or diabetes and prompt unhealthy behaviors like smoking or drinking or being inactive.

A recent study found that study participants who reported regularly suffering from moderate or severe psychological distress were roughly four times more likely to die of heart disease and almost three times more likely to die from any cause during the next 12 years compared to people with no depression or anxiety.

Depression and Trauma

Extreme external stressors, such as violence, war, displacement, terrorism, or natural disasters can also lead to depression. In resource-limited settings, poverty, infectious disease, gender-based violence, and other circumstances exacerbate these triggers for depression.

Yet, mental health services are often limited or even nonexistent during emergency situations as resources are focused on managing physical illnesses and injuries, and providing food and shelter.

“It’s a tragedy that we don’t view mental illness among these populations in the same way we would view physical ones,” Oquendo said.

Recently, however, the need for counseling and other mental health services has been recognized and many refugee camps and other humanitarian efforts are beginning to integrate these services into their programs to help people who have undergone a traumatic event. For example, WHO is providing materials, training and other support to mental health groups and professionals working in Syrian refugee camps in Turkey.

“Depression is something that will likely touch every single person in one way or another,” Oquendo said. “As citizens of the world, we have a responsibility to help others nations develop strategies to improve mental health services. At the same time, many of the lessons we learn in global settings are applicable right here in Philadelphia, where limited access to health care, poverty, and other social ills are sadly rampant.”  

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Views expressed are those of the author or other attributed individual and do not necessarily represent the official opinion of the related Department(s), University of Pennsylvania Health System (Penn Medicine), or the University of Pennsylvania, unless explicitly stated with the authority to do so.

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