НОВОСТИ УКРАИНСКОЙ ПСИХИАТРИИ
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Журнал «Медицинские исследования»
Том 1, выпуск 1, 2001

THE PUBLIC HEALTH IMPORTANCE OF DEPRESSIVE DISORDERS

N. Sartorius

H.U.G., Department of Psychiatry
Geneva, Switzerland

* Published by:
Sartorius N. The public health importance of depressive disorders // Медицинские исследования. — 2001. — Т. 1, вып. 1. — С. 20–21.

[Sartorius, N. (2001). The public health importance of depressive disorders. Medical Researches (Kharkiv), 1, 1, 20–21.]

The decision whether a problem is of public health importance is usually based on the examination of five groups of facts:

  1. The frequency of the problem.
  2. The severity of the problem expressed in terms of suffering and disruption of life routines.
  3. The socioeconomic consequences of the problem.
  4. The feasibility of interventions that will remove or alleviate the problem.
  5. The temporal tendencies of the problem, e.g., the likelihood that the problem will spontaneously diminish or disappear.

In the instance of depressive disorders it is now possible to say that all the criteria for declaring that these disorders are a major public health problem have been satisfied and that, therefore, public health authorities should give priority to programs that will improve the treatment of depressive disorders and their prevention. Depressive disorders are frequent. Epidemiological studies earned out in different countries (and even in the same countries at different points in time) show differences in the prevalence of depression. These have various reasons ranging from differences in the methods of sampling and assessment to differences in ways in which various cultural groups express distress. On the whole, however, it can be estimated that 2–5% of the general population have depressive disorders of sufficient severity to require qualified help (Marsella et al, 1985). There are also variations in the numbers of people with depressive disorders contacting health services in different countries. On the whole, however, studies carried out in general health services have demonstrated that, on average, 10% of all contacts with general health care services occur because of the presence of a depressive disorder. These findings have been replicated a number of times and in different parts of the world (Ustun and Sartorius, 1995) (see Table 1). Depressive disorders are thus frequent and their management uses up a significant proportion of health care resources. Depressive disorders are also a severe problem. They lead to a variety of disruptions of normal life routines — ranging from family discord to incompetent parenting and lessened work performance. They produce much suffering and can lead to suicide. Approximately 15% of people with depressive disorders kill themselves. Many of the depressive disorders tend to last long if not appropriately treated. The presence of depressive disorders increases the likelihood of physical illness and prolongs the duration of its treatment. Depressive disorders are often expressed in terms of physical symptoms of a severely disturbing type.

Table 1

Prevalence of people with depressive disorders among people contacting general health services

Centre Prevalence (%)
Santiago (Chile) 29.5
Manchester 16.9
Groningen (Neth) 15.9
Rio de Janeiro (Brazil) 15.8
Paris (France) 13.7
Ankara (Turkey) 11.6
Mainz (Germany) 11.2
Bangalore (India) 9.1
Athens (Greece) 6.4
Seattle (USA) 6.3
Berlin (Germany) 6.1
Verona (Italy) 4.7
Ibadan (Nigeria) 4.2
Shanghai (China) 4.0
Nagasaki (Japan) 2.6

The socioeconomic consequences of depressive disorders are grave. The recent reports of the World Bank and of the World Health Organization (Murray and Lopez, 1996) indicate that depressive disorders cause a significant proportion of all disability produced by mental disorders. Projections of these figures also demonstrate that, in twenty years from now, depressive disorders will be the most important cause of disability and that the presence of depressive disorders will be responsible for a major part of years of life lost because of diseases.

Possibilities for effective treatment of depressive disorders have significantly increased in recent years. A number of new medicaments have become available making the treatment of depression by pharmacological means not only more effective but also safer. Research on other methods of treatment — for example cognitive therapy — has also resulted in evidence about the efficacy of these methods of treatment. Patients, on the whole, do accept treatment for depressive disorder. Certain features of new medication — fewer and less disturbing side-effects and ease of administration, for example, have increased the probability that patients will follow the prescribed treatments. While primary prevention of depressive disorders is not yet possible we can reduce the probability of further episodes of illness and diminish the impact of the now well researched risk factors.

Operational research has also demonstrated that «well trained general practitioners and other health personnel can adequately treat depressive disorders thus reducing the problem of lack of highly trained staff in many settings. This is an important finding because, at present, only a small proportion of people with depressive disorders contacting general health services receive adequate treatment.

Finally, it does seem that depressive disorders will increase in numbers in the years to come. This prediction relies on a number of facts. The extension of life expectancy brings more people in the age of higher risk for depressive disorders. The expectancy of life of people with depressive disorder has also increased which contributes to an increase in their prevalence. The number of people who suffer for a long time from various chronic disorders (e.g., gastrointestinal disorders) known to increase the risk for the appearance of depressive disorders is also on the rise. The widespread use of medicaments known to marginally increase the risk for depression (e.g., hormonal preparations, antihypertensive medication) may contribute to the frequency of iatrogenic depressive disorders. Finally, there are also indications that the incidence of depressive disorders might be on the rise. Reports of a decrease in the age of first appearance of depressive disorders over the past several decades would support this possibility.

In summary, depressive disorders have to be considered as a major public health problem deserving priority in public health action. There arc numerous possibilities for effective therapeutic interventions that can decrease suffering and disability produced by depressive disorders. Action now is important because there are indications that available treatment technology is not well used and that depressive disorders are on the increase.

References

  1. Marsella A. et al. Crosscultural studies of depressive disorders. An overview // Kleinman A., Good В. Culture and depression. — Berkley University of California Press, 1985.
  2. Murray C. J. L., Lopez A. D. (eds.) The global burden of disease. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. — Boston: Harvard University Press, 1996.
  3. Ustun Т. В., Sartorius N. (eds.) Mental illness in general health care. An international study. — Chichester: John Wiley & Sons Ltd, 1995.

© «Новости украинской психиатрии», 2005
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