This week, we take a look at some recent news about depression. The findings were published last month in a special issue of the Journal of the American Medical Association.
A new study found that more than half of Americans with major depression sought treatment. Ten years ago, only one in three did so. However, many people who go for treatment do not receive adequate or appropriate care. In fact, the study found that only 21 per cent of Americans with major depression receive the level of care recommended by the government. The researchers questioned over 9,000 people aged eighteen and over. The year-long study began in February 2001.
Kathleen Merikangas is with the National Institute of Mental Health. She was one of the lead researchers of the study of depression in the United States. Ms Merikangas says that major depression is now the leading cause of disability worldwide. She notes that, as recently as 1996, heart disease was the leading cause of disability. Ms Merikangas says that approximately 16 percent of Americans will suffer from major depression at some point in their lives. That equates to more than 30 million people. Around 13 million of those people experienced depression last year. These figures are similar to those from 10 years ago.
The study found that women are 56 percent more likely than men to become depressed at some point in their lives. However, this gender difference has decreased over the years. The study also found that people with a low income or education have some of the highest rates of depression. Researchers say that depression is more common in people aged 18 to 44 than in those over 60. Dr Merikangas suggests this may be because older people have learned to accept their situation and cope better with the realities of life. Most people who reported experiencing depression in a given year said it had a significant impact on their lives. Ms Merikangas says it can affect jobs, marriages and parenting. Those with severe depression in the past year reported being unable to work or carry out other normal activities for an average of 35 days.
Ronald Kessler of Harvard Medical School led the study. He says that many doctors may not be aware of the latest treatments for depression. Professor Kessler says that research has shown the most effective treatment to be a combination of medication and psychological counselling. He adds that treatment should be tailored to the individual. This is because no treatment works for everyone. For the purposes of the study, patients were considered to have received adequate treatment if they met either of two requirements. If they received medication, they took it for at least a month and attended four appointments with a doctor. If they did not receive medication, they met with a mental health expert for 30 minutes at least eight times.
Another study in the Journal of the American Medical Association examined the cost of depression in the workplace. The researchers estimated that lost productive time due to depression incurs costs of at least $31 billion for employers each year. Over a two-month period last year, the researchers questioned more than 1,000 American workers by telephone. The study found that workers without depression reported an average of one-and-a-half hours of lost productivity per week. However, those with depression reported more than five-and-a-half hours of lost productivity per week. According to the researchers, most of this time is lost through reduced performance while employees are at work. The study was led by researchers from the AdvancePCS Center for Work and Health in Maryland. Eli Lilly, the company that manufactures the antidepressant Prozac, funded the research.
Many people with depression continue to go to work. However, the researchers say that these individuals do not perform at their normal level. Many are unable to think clearly or get along well with others in the workplace. Yet many people still avoid treatment because they do not want others to know they are depressed. Some people who do seek treatment stop taking their medication early. Others do not receive an adequate supply of medication. Furthermore, there are generally more doctors and other resources available to help people living in cities than those in less populated areas.
Depression is often difficult to recognise. This means that it often goes untreated. Experts say that many employers do not take the disorder as seriously as other illnesses. They recommend interventions such as employee assistance programmes and support groups to help people deal with depression. Depression affects not just the mind, but the body too. Symptoms include feelings of sadness and hopelessness, loss of appetite and sleep disturbances. Depression has also been linked to other disorders, including heart disease. Researchers now say that the risk of death is three times greater for people who have heart attacks and subsequently develop depression. This is compared to those who have heart attacks but do not develop depression. This level of risk is similar to that associated with smoking.
Depression can also run in families. Health experts say it is the main reason people kill themselves. It can be difficult to tell if someone is depressed. Doctors do not always ask patients who exhibit possible symptoms. Researchers say that doctors without special training in mental health may not recognise the signs or treat them properly. Additionally, some health plans may restrict patients’ access to expert care.
Another report in the Journal of the American Medical Association addresses depression among doctors. It states that doctors often fail to recognise depression in themselves and seek treatment. Studies have found that doctors are at greater risk of suicide than the general population. However, fewer doctors die from cancer and heart disease than the general population. Experts say this is because cigarette use dropped among doctors once they recognised the dangers of smoking. Researchers say that all of these findings show that depression must be taken more seriously. Dr Thomas Insel is the director of the National Institute of Mental Health. He notes that approximately thirty thousand people in the United States kill themselves every year. This is almost twice the number of people killed by others. Dr Insel says there is no scientific reason to treat mental disorders differently to physical disorders.
There are drugs that doctors use to treat depression. However, in developing countries, many people are unable to access these antidepressants. Paul Bolton is a professor at the Johns Hopkins University School of Public Health in Baltimore, Maryland. Professor Bolton says these drugs are too costly, have many side effects, and must be taken for months or even years. He suggests that in developing countries, the most effective treatment may simply be to encourage people to talk about their problems.
Professor Bolton led a study on depression in Uganda. Last month, the results were included in a special issue of the Journal of the American Medical Association on depression. His team studied 225 Ugandan men and women. The participants underwent four months of treatment. Each week, they met in groups led by the researchers. The researchers found that 86% of the participants showed signs of major depression. After the therapy, however, only seven percent still exhibited these symptoms. Paul Bolton describes the initial results as very promising. However, he and his team still do not know what it was about this intervention that worked. Perhaps the important part was meeting in groups and talking. Bolton says he feels this study has demonstrated that it is possible to be effective with few resources.
