Globally, an estimated 1 billion people suffer from mental disorders, 81% of whom live in low- and middle-income countries. Of those 1 billion people, 5% of adults suffer from depression. In stark contrast, countries spend on mental health on an average of less than 2% of their health budgets.
"Depression is one of the most important sources of disease burden in the world, but the understanding and attention of depression in countries around the world is not enough, and the investment in depression and the burden of disease caused by it are very different." Professor Xiao Shuiyuan of the School of Public Health of Central South University said in an interview with the surging news (www.thepaper.cn) reporter. Xiao Shuiyuan mainly studies the impact of psychosocial factors and social behaviors on health, especially suicide prevention.
Recently, the top medical journal The Lancet published The Lancet– The Time for United Action on Depression: a Lancet–World Psychiatric Association Commission. The study was written by 25 experts from 11 countries and covered a wide range of disciplines, from neuroscience to global health. Among them, Xiao Shuiyuan is the only author from China.
Xiao Shuiyuan said that the report was jointly initiated by The Lancet and the World Psychiatric Society, and experts from various countries discussed the outline through online and offline meetings, wrote the first draft, and repeatedly revised it. "In this process, in addition to the members of the expert group, the opinions of other experts were consulted and interviews were conducted with some depressed patients." As a member of the expert group from China, he participated in the discussion and revision of the manuscript based on his understanding of relevant research and situation in China.
The report notes that the ongoing and growing global depression crisis remains unresolved and calls on governments, healthcare providers, researchers, people with depression and their families to make a concerted effort to improve treatment and prevention, fill knowledge gaps, raise awareness and alleviate the global burden of depression.
Professor Helen Herrman, chair of the report and from the National Centre of Excellence for Youth Mental Health in Australia and the University of Melbourne, said: "Depression is a global health crisis that needs to be addressed at multiple levels. The report calls for joint action to improve mental health services and prevention approaches globally. Reducing the burden of depression through increased investment will give millions of people the opportunity to become healthier, happier and more dynamic members of society, helping to boost national economies and advance the achievement of the United Nations 2030 Sustainable Development Goals. ”
Neurological basis of depression.
"Health systems alone can't solve it"
Depression is a common condition worldwide. But there are still many misconceptions about it that have left people with insufficient action on it for a long time. These include common misconceptions, such as equating depression with simple sadness, thinking it's a sign of weakness, or appearing only in certain cultural groups.
The report highlights that depression is a particular health problem characterized by persistence, a significant impact on daily life, and long-term health consequences. Depression can affect anyone, regardless of gender, background, social class, or age. There are differences in the symptoms of depression and the type and prevalence of manifestations across cultures and populations. The risk of depression is higher in adverse settings, including poverty, violence, displacement, and gender, ethnicity, and other forms of discrimination.
Depressive symptoms in different populations worldwide.
Surveys show that in high-income countries, about half of people with depression go undiagnosed or treated, while in low- and middle-income countries, the proportion reaches 80-90%. The COVID-19 pandemic has brought more challenges, such as social distancing, bereavement, uncertainty, hardship and limited health care, with serious impacts on the mental health of millions of people.
For the low diagnosis and treatment rates among the depressed population, Xiao Shuiyuan said that China faces similar serious problems. The results of the 2013-2015 National Epidemiological Survey of Mental Disorders in mainland China showed that only 3.6% of patients with depressive disorder in mainland China had received psychiatric treatment, and only 9.5% had received any form of treatment.
Analyzing the reasons behind it, Xiao Shuiyuan talked about the following points: First, the public's awareness and understanding of depression has a large gap. Not knowing that emotional problems with oneself, family, and friends may be a manifestation of depression, and when you suspect that you have depression, you don't know how to properly seek help; even if you go to a professional institution for diagnosis and treatment, you can't adhere to the standardized treatment well.
Second, there is a widespread social stigma of mental disorders, including stigmatization and social discrimination against depressive disorders, which prevents people with depressive disorders from seeking medical treatment and receiving treatment in professional institutions.
Third, many patients with depression are treated in grass-roots and general medical institutions because of some related physical symptoms, such as easy fatigue, poor energy, poor appetite, poor sleep, etc., and many medical staff in these institutions cannot correctly identify, diagnose and treat depression.
Fourth, there are still large gaps in the resources of mental health professionals, especially in the Midwest and rural areas.
It is important to note that depression is associated with various chronic physical ailments, and a person's physical health can affect their mental health and vice versa. In the worst case scenario, depression can lead to suicide.
Studies have shown that 70%-80% of people who die by suicide in high-income countries and about half of those who die by suicide in low- and middle-income countries suffer from mental illness, with depression being the most common cause. Depression also takes a huge, under-recognized social and economic toll on individuals, families, communities and countries.
Depending on the national income level, depression is a burden throughout life.
One of the core of the report is the call for joint action by all sectors of the country. Xiao Shuiyuan summed up the reasons for this, "I think the most important point is the prevention, diagnosis and treatment of depression, which cannot be solved by relying solely on the health system. ”
Prevention, multi-intervention and more investment
The report stresses the importance of prevention. Evidence accumulated over decades suggests that depression is one of the leading causes of avoidable suffering and premature death worldwide. However, at different levels such as the community, government, and health sectors, few people understand or acknowledge that depression is different from other problems people face. Not enough has been done to avoid and alleviate the pain and disadvantages associated with depression, and few governments acknowledge the obstacles that depression poses to social and economic development.
"It can be said that no physical illness is as common, as it causes a burden of disease, as common as depression, but it can be completely treated, but it receives little policy attention and social resources." Associate Professor Christian Kieling, co-chair of the report and from the Rio Grande Federal University del Sul in Brazil, said so.
Kieling adds, "It is difficult for people with depression to access effective psychosocial treatment and appropriate medical treatment, and the high stigma of depression continues to prevent many people from seeking the help they need to lead healthy and vibrant lives." Many of these adolescents and young adults are at risk of depression or are suffering from depression. ”
Life cycle opportunities to prevent depression.
The report mentions the need for strategy for concerted action by society as a whole to reduce adverse experiences (including neglect and trauma) during childhood and throughout life in order to reduce the incidence of depression. Interventions at the individual level are also needed, focusing on lifestyle factors (e.g., smoking, alcohol consumption, inactivity) and other risk factors such as intimate partner violence and stressful life events (e.g., bereavement or financial crisis).
The report's co-author Professor Lakshmi Vijayakumar from the Suicide Prevention Centre and voluntary health service SNEHA in Chennai, India, believes that prevention is the most overlooked point of depression.
Vijayakumar emphasizes, "Investing in depression prevention is extremely valuable in the face of the lifelong effects of depression in adolescents, from academic and future relationship difficulties to risks in substance abuse, self-harm and suicide." She also added that it is important that we put evidence-based interventions into practice to support parenting, reduce domestic violence and school bullying, promote mental health at work, and address loneliness in older adults. Having common risk factors and a higher prevalence of depression among people with chronic health problems both support common preventive measures.
The report also points out that the current systematic classification method is too simple, and only divides people with symptoms of depression into two categories: whether they have clinical depression or not. The report notes that depression is a complex disorder with a variety of signs and symptoms, severity, and duration across cultures and life courses.
The report supports an individualized, phased approach to depression care that identifies the chronological and intensity of symptoms, and recommends interventions based on an individual's specific needs and severity of the condition, from self-help and lifestyle changes to psychotherapy and antidepressants to more intense, specialized treatments such as electroconvulsive therapy (ECT) for severe, refractory depression.
"No two people have exactly the same life story and circumstances, which ultimately leads to different people suffering from depression and different needs for help, support and treatment." Professor Vikram Patel of Harvard Medical School, co-chair of the report, explains, "Similar to cancer care, the phased approach looks at depression in a continuum – from health to temporary pain to real depression – and provides a framework for recommending appropriate interventions from the very beginning of the disease. ”
The report also recommends collaborative care strategies to scale up evidence-based interventions in routine care. They argue that the use of locally recruited, widely available, low-cost lay professionals, such as community health workers and lay counsellors, not only addresses severe shortages of skilled service providers and reduces financial barriers, but also helps to reduce stigma and cultural barriers while providing holistic care for patients and their families.
Depression care services and effective coverage.
It is a matter of concern that countries around the world still need more investment to ensure that people receive the care they need, where and when they need it. The report highlights the importance of holistic government action to reduce the devastating impact of poverty, gender inequality and other social inequalities on mental health.
Xiao Shuiyuan also said in an interview with the surging news reporter that the most urgent action measures for China include: popularizing knowledge about depression; reducing stigma and social discrimination against people with mental disorders, including depressed patients; strengthening the cultivation of adolescents' psychological quality; and increasing investment in mental health.
He said that since entering the 21st century, the state has paid more and more attention to mental health work, and its investment has also increased, including the construction of social psychological systems, the capacity building of mental health services, the development of mental health in communities, and the investment in mental health research.
Despite some progress, Xiao Believes mental health still faces enormous challenges. He suggested that in terms of policies, we should support and encourage families, schools and society to further strengthen the cultivation of adolescents' psychological quality; strengthen the implementation of the Mental Health Law, take effective measures to reduce the stigma and social discrimination of patients with mental disorders; continue to increase investment in the construction of social psychological systems and mental health service systems; and support and encourage all sectors of society to promote depression prevention projects.