Psychiatry Advisor: Do you see any barriers to this role for primary care practitioners, and how might these be surmounted?

Dr Saxena: One of the major barriers to the increased involvement of general practitioners in the identification and treatment of depression is the lack of financial incentives and good reimbursement. But many insurance companies are beginning to realize that it is in their interest for depression to be identified and treated as quickly as possible. And because about half of people do not follow up with a specialist when they are referred to one, the intervention for depression is best delivered in the primary care setting, as this is where the patient already is being seen.


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On a broader, systemwide level, it is important to note that depression has an enormous economic effect for the individual, family, and country. People who are depressed are unable to fulfill their regular expected roles, either in education or in employment, and have lack of interest in activities, which leads to absenteeism at work as well as presenteeism, in which the person is present at work but unable to perform to the best of his or her potential. Depression also causes family members to miss work because they often have to spend time with the person who is depressed. The global estimate is that depression and anxiety disorders, combined, are responsible for $1 trillion worldwide economic loss annually. So it makes sense for countries to invest in the treatment of depression because the rate of return is $4 to $1: for each $1 invested in treatment of depression, during the next 15 years, there will be a $4 return.

Psychiatry Advisor: What special populations may suffer from depression?

Dr Saxena: Postpartum depression is extremely common. Our figures suggest that 13% of women who have given birth to a child will suffer from depressive disorders. More often than not, these women are undiagnosed and untreated, leading not only to disability of the mother but also affecting the development of the child, which is a double disadvantage. Postpartum depression needs to be identified by mother and child health services, including family practitioners and obstetricians and gynecologists.

Geriatric depression is also a significant problem, often associated with physical illnesses and disabilities as well as dementia. By treating depression, the person’s quality of life can improve, even if the physical conditions continue. It has been shown that people who are treated for depression also become more compliant with their treatment regimens for their physical disorders. So identifying and treating depression leads to less disability and more independent living in older adults. It is also important to identify patients in nursing homes and senior facilities who might be depressed. Staff at these facilities should look out for depression and refer individuals to psychiatrists when necessary.

Psychiatry Advisor: Do you have any other suggestions for reaching individuals who are experiencing depression?

Dr Saxena: People experiencing depression sometimes talk to religious leaders and traditional healers, who can be a good entry point for depression to be identified. These spiritual leaders should be aware of where people with depression can receive treatment and make appropriate suggestions and referrals.

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Reference

World Health Organization. <a href=”http://www.who.int/campaigns/world-health-day/2017/campaign-essentials/en/”>Campaign essentials</a>. Available at: http://www.who.int/campaigns/world-health-day/2017/campaign-essentials/en/. Accessed April 12, 2017.