World Health Day: It’s time to shed the stigma associated with depression

We need to talk about it

‘Depression: Let’s talk’ encapsulates the twin importance of removing stigma and lack of knowledge regarding depression and also that talking and seeking help from peers, relatives and health care professionals can lead to the path of recovery.

The theme is particularly relevant given the immense public health importance of depression. Depression can occur to anybody and causes mental anguish to the sufferer. It also prevents the sufferer from carrying out his day-to-day activities. In extreme cases, it can also lead to suicide.

As per WHO data, 300 million people all over the world today are living with Depression. Depression is also the leading cause of disability and ill health worldwide. Lack of support, awareness and stigma prevent many people from seeking treatment that they need to lead healthy, productive lives.

Where India stands

In India, the National Mental Health Survey (NMHS-3) carried out in 12 states during 2015-16 covering 10152 households and 34,802 individuals revealed that 10.6% individuals above the age of 18 years are suffering from mental illnesses and lifetime prevalence of mental disorders is 13.7%. The prevalence of mental disorders is two to three times higher in urban metros.

The survey also pointed that current and lifetime prevalence of depression is 2.7% and 5.2% respectively. In other words, it means that one in 20 people suffer from depression in India. Depression is reported to be higher in females, those in the age-group of 40-49 years, those living in urban metros and among the elderly. Experts say that 67-70% of people with major depressive disorder experience disability in work, family and social life.

Coming to some regional findings, a spokesperson of the Post Graduate Institute of Medical Education and Research (PGIMER) pointed, “As per census of 2011, population of Chandigarh is 10.55 lakh of which 97.25% lives in urban areas and rest 2.75% in rural areas. If we assume that Chandigarh has the same prevalence of mental disorders as per the national data, there are nearly 28,000 people suffering from depression currently in the city, and nearly 54000 have suffered from depression at least once in their lifetime. Treatment gap for depression is 85.2% i.e. nearly 85% of the people suffering from depression do not get treatment.”

The spokesperson further pointed that the Department of Psychiatry at PGIMER's experience also underscores the importance of recognizing and treating depression.

The number of patients approaching the department for treatment has been steadily increasing and currently the number is above 13,000 per year of which about 30% are diagnosed to be suffering from mood disorders among which depression is the most common diagnosis. In addition to these, another 30% are diagnosed as suffering from anxiety disorders in which depression or depressive symptoms are often prominent.

Dealing with suicide

A recent study by Dr Ravi Sharma, Dr Anmol Gupta and Dr Durgesh Thakur at Indira Gandhi Medical College in Shimla titled 'Prevalence and predictors of suicidal ideations among school going adolescents in a hilly state of India' has found that around 30 per cent of senior school going students had experienced suicidal ideation in the previous year.

The study found that discussing problems with parents, having good relations with teachers and helpful classmates lowered the risk of having suicidal ideations. On the contrary, adolescents having worrying issues in family, verbally or physically abused and body image conscious had increased chances of suicidal ideations.

Dr Durgesh told Catch, “Our sample size comprised 718 students from various schools in Shimla. Children who had such ideation did not have proper communication with parents, teachers and their peer group.” She disclosed that it is a medically established fact that children addicted to mobile phones, tablets and laptops often suffer from loneliness and show such tendencies.

The vulnerable years

Another study conducted at the institute by Dr Anmol Gupta, Dr Ravi Sharma and Dr Kamlesh Sharma titled 'Prevalence and risk factors for depression in elderly North Indians' shows that one tenth of the elderly residing in Shimla district are suffering from depression.

The study revealed that elderly having lower income, consuming tobacco, experiencing stressful life event in the past one year, having three or more chronic diseases and lacking positive approach toward life were found to be more depressed.

The study recommended that persons lacking positive approach toward life need to be identified by screening and should be focused on so as to reduce the probability of occurrence of depression.

In a special address on the World Health Day theme, the head of psychiatry department at PGIMER Dr Ajit Avasthi pointed that depression is a burden on the society and is something that can be recurrent and chronic. “Most of the people in the age group of 20 to 30 years are vulnerable to it and these are the most productive years. Its point prevalence at any given point of time is about 2 per cent in men and 3.5% in women while the score over 12 months is 6 per cent in case of men and 10% for women.”

He stressed on the high incidence of co-morbidity that goes along with depression and gave the examples of a high rate of diabetes and cardiovascular ailments pointing that the recovery period of a depressed person is more and hence the treatment costs are high.

The necessity of treatment

Dr Avasthi pointed that the patients of depression do not always show clear cut medical symptoms. In many cases the symptoms are vague and unexplained which need to be diagnosed with dexterity. Talking about treatments available, he underlined the need of proper communication i.e. psychotherapy in all the cases. “We are very short of psychiatrists. So we need physicians, general practitioners and even nursing staff to be trained in identifying and treating depression,” he underlined. 

He ended his speech emphasising on things that can prevent depression. He underlined them as being optimistic, reducing the stress in the lives of children by reducing adversities, indulging in more physical activity and interacting more with people.