Young people are the biggest victims of depression! Experts call for global action

Written by: Wang Haha

Layout: Li Xuewei

It is estimated that 5% of adults worldwide suffer from depression each year. Insufficient knowledge about the disease and a lack of support from psychological and social resources have resulted in poor prevention, diagnosis, and treatment of depression.

The world is failing to address the ongoing and growing global depression crisis it faces, the Lancet World Psychiatric Association's Commission on Depression says. Depression has become an overlooked global health crisis, with the highest incidence among young people.

(Source: Pixabay)

In high-income countries, about half of people with depression are not diagnosed or treated, while in low- and middle-income countries, the proportion is about 80-90%. The COVID-19 pandemic has brought additional challenges. Social isolation, bereavement, uncertainty, hardship and difficulty in accessing medical care have had a serious impact on the mental health of millions of people.

Against this backdrop, 25 experts from 11 countries, covering disciplines ranging from neuroscience to global health, on the Lancet World Psychiatric Association Commission called on governments, healthcare providers, researchers, people with depression and their families to work together to improve the prevention and care of depression, fill knowledge gaps and raise public awareness, so as to address the suffering and premature death caused by this avoidable disease worldwide.

(Source: The Lancet)

"We know that most people with depression at all stages of life recover if they get adequate support and treatment," said co-author Dr. Charles Reynolds from the University of Pittsburgh. "With sound science, commitment, and shared responsibility, we can prevent and treat depression, thereby avoiding its potentially disabling and lethal consequences."

“We must engage people living with depression, together with families, practitioners, policymakers and civil society, to reduce the burden by sharing their experiences, providing others with information about the condition and where to get help, and advocating for more resources for evidence-based prevention and treatment approaches.”

A disease that is difficult to identify and understand

Depression is a common disorder worldwide, yet many misconceptions still surround it. These include the common misconception that depression is simply sadness, a sign of weakness, or confined to certain cultural groups.

But in reality, depression can affect anyone, regardless of gender, background, social class or age, and the symptoms and prevalence of depression vary across cultures and populations. The risk of depression increases in adverse environments such as poverty, violence, displacement, and gender, racial and other forms of discrimination.

Experts also emphasize that depression is a specific health condition characterized by its persistence, severe impact on daily functioning, and long-term consequences for health. Depression is associated with a wide variety of chronic physical illnesses, and a person's physical health can affect his or her mental health and vice versa. In the worst case, depression can lead to suicide.

(Source: Pixabay)

Studies show that 70%-80% of suicides in high-income countries and about half of suicides in low- and middle-income countries are caused by mental illness, with depression being the most common cause. Depression also takes a huge social and economic toll on individuals, families, communities and countries, yet our society still has a poor understanding of depression.

"Arguably, no health condition is more common, more debilitating, more prevalent or more treatable than depression, yet it receives barely enough attention and resources," said Christian Kieling, co-chair of the commission and associate professor at the Federal University of Sul in Brazil.

"Effective psychosocial treatments and medical care are difficult to access, and high levels of stigma still prevent many people, including adolescents and young adults at risk for or experiencing depression, from seeking the help they need to lead healthy and productive lives."

It can be prevented and treated

The Lancet World Psychiatric Association Commission made ambitious recommendations to address inequalities and widespread neglect in the diagnosis, treatment and prevention of depression, including prioritizing innovative step-by-step care and early intervention approaches, and delivering collaborative care in resource-limited and other settings.

Experts are calling for society to take steps to prevent depression, giving it similar attention and support as other areas such as heart disease and cancer.

For example, reducing adverse experiences in childhood (including neglect and trauma) and throughout the life cycle to reduce the prevalence of depression; another example is interventions at the individual level that focus on lifestyle factors (such as smoking, drinking, lack of physical activity) and other risk factors such as intimate partner violence and stressful life events such as bereavement or financial pressures.

“Prevention is the most neglected aspect of depression. This is partly because most interventions are outside the health sector,” said Dr Lakshmi Vijayakumar from the Centre for Suicide Prevention and Voluntary Health Services in Chennai, India. “Given the lifelong impacts of depression in adolescents, from difficulties in school and future relationships to risk of substance abuse, self-harm and suicide, investing in its prevention is well worthwhile.”

Experts also say that the current classification of people with depressive symptoms into two categories — either they are clinically depressed or not — is overly simplistic. They argue that depression is a complex condition with a wide variety of signs and symptoms, severity, and duration across cultures and over the life course.

Figure | Clinical stages of depression (Source: The Lancet)

As a result, they support a personalized, staged approach to depression and recommend interventions tailored to the individual's specific needs and the severity of the condition, ranging from self-help and lifestyle changes, to psychotherapy and antidepressants, to more intensive and specialized treatments such as electroconvulsive therapy (ECT) for severe, refractory disease.

Committee co-chair Professor Vikram Patel of Harvard Medical School, USA, explained: "No two people have exactly the same life experiences and constitutions, which ultimately leads to unique experiences of depression and different needs for help, support and treatment. Similar to cancer treatment, a phased approach views depression as a continuum - from wellness, to temporary distress, to actual depressive disorder. And, it recommends that interventions be initiated early in the course of the disease."

Figure | Reducing the harm caused by depression requires joint action from all parties (Source: The Lancet)

Most importantly, more attention and resources are needed to ensure people get the care they need, when and where they need it. As the Commission highlights, global action is needed to reduce the damaging impact of poverty, gender inequality and other social inequalities on mental health.

“Depression is a global health crisis that requires a response at multiple levels. This Commission provides an important opportunity for joint action to transform approaches to mental health care and prevention worldwide. Policies that reduce racial or ethnic inequalities, systemic disadvantages suffered by women, and support equitable income distribution through universal health coverage and expanded access to education are potentially powerful prevention strategies. Investing in reducing the burden of depression will give millions of people the opportunity to become healthier, happier and more productive members of society, help strengthen national economies, and advance the United Nations 2030 Sustainable Development Goals,” said Professor Helen Herrman, University of Melbourne, Australia.

References:

https://www.eurekalert.org/news-releases/943069

https://www.who.int/news-room/fact-sheets/detail/depression

https://www.thelancet.com/commissions/united-action-on-depression

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