AN ESTIMATED 5% of people around the world experience depression every year, but it remains “a neglected global health crisis”, the Lancet has said.

A new study conducted by The Lancet along with the World Psychiatric Association Commission has found that poor understanding of depression and a lack of psychosocial and financial resources impact on prevention, diagnosis and treatment of the condition.

The study was conducted by 25 experts from 11 countries working in numerous sectors from neuroscience to global health, and was advised by people with experience of depression.

It found that about half of people suffering from depression in high-income countries are not diagnosed or treated. This rises to 80-90% in low and middle-income countries.

It also found that the Covid-19 pandemic has created additional challenges, with social isolation, bereavement, uncertainty, hardship, and limited access to healthcare taking a serious toll on the mental health of millions around the world.

Despite being a common condition, the study found that it remains poorly recognised and misunderstood.

Many misconceptions that still exist about depression, including that it is just sadness, a sign of weakness, or restricted to certain cultural groups, can lead to inaction in preventing and treating the condition.

Commission Chair Professor Helen Herrman, from the Orygen National Centre for Excellence in Youth Mental Health, said depression is a global health crisis that demands responses at multiple levels.

“This Commission offers an important opportunity for united action to transform approaches to mental health care and prevention globally,” she said.

Dr Charles Reynolds from the University of Pittsburgh, who co-authored the study, added that people with depression must be empowered to address a “tsunami of unmet need”, including by sharing their experiences to reduce stigma.

The study suggests that depression occurs most frequently in adolescents and young people, but that the symptoms they experience are thought to be common and can lead to a missed diagnoses.

It said that depression is consistently found to be more common in women than in men.

The gender difference is first apparent at about age 12 years, and has been found to peak in adolescence, at age 16 years. It is unclear whether the gender gap decreases or not during older age.

The commissioners of the study stressed that depression can affect anyone, and that regardless of gender, background, social class, or age, there is variability in types and prevalence of depressive symptoms and signs among cultures and populations.

The risk of depression rises in settings of adversity, including poverty, violence, displacement and gender, racial and other forms of discrimination.

The study said depression is also linked to a wide variety of chronic physical illnesses, and a person’s physical health can influence their mental health, and vice versa.

Studies indicate that between 70% and 80% of people who die by suicide in high-income countries, and around half of those in low and middle-income countries, suffer from mental illness, of which depression is the most common cause.

The burden of depression across the life course according to country income level. The Lancet The Lancet

The study found that even before the pandemic, the loss in economic productivity linked to depression cost the global economy an estimated $1 trillion (€860.5 billion) a year.

“There is arguably no other health condition which is as common, as burdensome, as universal, or as treatable as depression, yet it receives little policy attention and resources,” said Commission Co-Chair Associate Professor Christian Kieling from the Universidade Federal do Rio Grande do Sul in Brazil.

Effective psychosocial and medical treatments are difficult to access, while high levels of stigma still prevent many people, including the high proportion of adolescents and young people at risk for or experiencing depression, from seeking the help required to have healthy and productive lives.

Prevention and personalised care

The commission said whole-of-society strategies are needed that reduce exposure to both adverse experiences in childhood, including neglect and trauma, and across the lifespan to lower the prevalence of depression

It also said interventions are needed at the individual level, focusing on lifestyle factors and other risk factors such as intimate partner violence and stressful life events such as bereavement or financial crisis.

“Prevention is the most neglected aspect of depression,” study co-author Dr Lakshmi Vijayakumar from SNEHA, Suicide Prevention Centre and Voluntary Health Services in India said.

“In the face of the lifelong effects of adolescent depression, from difficulty in school and future relationships to risk of substance abuse, self-harm, and suicide, investing in depression prevention is excellent value for money.”

The commission also said that the current system of classifying people with symptoms of depression is too simplistic, and that a personalised, staged approach to depression care is needed that will recognise the chronology and intensity of symptoms and recommend interventions tailored to people’s specific needs.

It said that greater investment is needed to ensure that people receive the care they need for depression where and when they need it, and stressed the importance of whole-of-government actions to reduce the damaging effects of poverty, gender inequity, and other social inequities on mental health.

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