Depression Identification, Stigma as Focus of World Health Day

Many people who are symptomatic do not realize that they have a depressive disorder.
Many people who are symptomatic do not realize that they have a depressive disorder.

Every year on April 7, the World Health Organization (WHO) celebrates the anniversary of its founding by featuring a specific health topic of international concern. The theme of the 2017 World Health Day was depression, which was also the highlight of a year-long campaign that began in October of 2016, called "Depression: Let's Talk."

To elaborate on the goals and action steps recommended by the campaign, Psychiatry Advisor spoke to Shekhar Saxena, MD, director of the Department of Mental Health and Substance Abuse at WHO.

Psychiatry Advisor: What was the motive for selecting depression as the focus of this year's World Health Day?

Dr Saxena: According to recently released figures, more than 300 million people worldwide are now living with depression, an increase of more than 18% between 2005 and 2015. These alarming figures show that depression is the leading cause of global morbidity and mortality and make it urgent for all countries to evaluate their current approaches and develop new approaches to identify and treat this condition. At present, only about 50% of people with depression receive help for it.

Psychiatry Advisor: What are the goals of the "Depression: Let's Talk" campaign?

Dr Saxena: Our basic goals for the campaign are to encourage more people with depression to seek and receive help. At this point in time, both these situations are unsatisfactory. We would like to see the general public become better informed about the causes of depression, as well as its potential consequences, such as suicide; to be aware of available help; and to enable family, friends, and colleagues of a person with depression to provide support.

Psychiatry Advisor: What prevents people with depression from seeking help?

Dr Saxena: One reason is that many people who are symptomatic do not realize they have a depressive disorder. In addition, in both developed and developing countries, there is a pervasive sense of stigma associated with depression, so people do not want to talk about it. The stigma is compounded because in many countries, help for depression is provided in settings most people find unacceptable and stigmatizing, such as inpatient psychiatric facilities. But stigma is present in all countries. It may change forms, but it remains pervasive.

Psychiatry Advisor: How does the "Depression: Let's Talk" campaign address stigma?

Dr Saxena: The campaign's main message is, "let's talk." We believe talking is the beginning of help seeking and help taking. If people start talking to family members, colleagues, friends, and healthcare providers, they will be on the path of seeking and receiving help and recovering.

Psychiatry Advisor: When you mention "healthcare providers," which specialties are you referring to?

Dr Saxena: We believe primary care providers can and should be trained to look after most cases of depression, under supervision and with specialist support. Their role as "healthcare providers" encompasses mental as well as physical health and social well-being. The WHO has many initiatives to convince policy makers to train nonspecialists in identifying and treating depression. This approach is applicable not only in developing countries but also in more developed countries. Most people seek help from general practitioners, and it is at that point of care where depression can be first identified and treated.

People who suffer from depression do not necessarily present to the general practitioner for that complaint. Depression has many comorbidities, including a higher prevalence of heart disease, blood pressure, and diabetes; cancer; disabling diseases such as rheumatoid arthritis; and even infectious diseases such as HIV. It makes sense for the healthcare professional to deal with both types of illnesses in the same setting, rather than vertically separating the system of care, with 1 setting for physical disorders and the other for mental disorders.

Psychiatry Advisor: What is the role psychiatrists play in treatment of depression?

Dr Saxena: Psychiatrists have a very large role to play. They need to train the primary care providers, support them, and supervise them, which itself is a large role. They will also, of course, treat patients whose depression cannot be managed by primary care practitioners, such as cases of complicated or treatment-resistant depression.

There is also an important role for psychologists, as current clinical guidelines specify that depression can be treated either with evidence-based psychological interventions or with medication. Primary care practitioners should have the expertise to deliver both.

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