20 years on; Mental Illness Awareness Week, October 2012

Dr. Mona Nongmeikapam *

WHO Definition of Health emphasises that: "it is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, hereby highlighting the importance of mental health". In this context, World Mental Health Day (10 October) is celebrated as a day for global mental health education, awareness and advocacy. It was first celebrated in 1992 under the initiative of Richard Hunter, the Deputy Secretary General of the World Federation for Mental Health, a global mental health organisation with members and contacts in more than 150 countries. Since then this day, each October thousands of supporters come to celebrate this annual awareness program to bring attention to Mental Illness and its major effects on peoples' life worldwide. In some countries this day is part of the larger Mental Illness Awareness Week.

WORLD MENTAL HEALTH DAY 2012

World Mental Health Day aims at raising public awareness about mental health issues. The day promotes open discussion of mental disorders, and investments in prevention, promotion and treatment services. On its 20th anniversary this year, the theme for the day was "Depression: A Global Crisis".

The topic is particularly apt and in keeping with the need of the hour. Depression affects more than 350 million people of all ages, in all communities, and is a significant contributor to the global burden of disease. Although there are known effective treatments for depression, access to treatment is a problem in most countries and in some countries fewer than 10% of those who need it receive such treatment.

Depression can affect anyone and it is one of the most widespread illnesses, often co-existing with other serious illnesses. According to the World Health Organization, unipolar depressive disorders were ranked as the third leading cause of the global burden of disease in 2004 and will move into the first place by 2030. This year aimed at providing information about depression as a treatable illness, and to spread the message that recovery is possible and achievable. This would prove universally beneficial, as among the developed countries, the current economic downturn has resulted in increased unemployment, increased debts and increased insecurity resulting also in an increasing incidence of depression among the population. And as for middle- to low-income ­­­countries, public education on mental health is often inadequate due to limited resources.

The World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression in the previous year. Depressive disorders often start at a young age; they reduce people's functioning and often are recurring. For these reasons, depression is the leading cause of disability worldwide in terms of total years lost due to disability. The demand for curbing depression and other mental health conditions is on the rise globally and a recent World Health Assembly drew attention to the same.

What is depression?

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, and poor concentration. There may be often symptoms of anxiety. These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities.

At its worst, depression can lead to suicide. Almost 1 million lives are lost yearly due to suicide, which translates to 3000 suicide deaths every day. For every person who completes a suicide, 20 or more may attempt to end his or her life (WHO, 2012).

Some variations of depression:

o Depressive episode involves symptoms such as depressed mood, loss of interest and enjoyment, and increased fatigability (maybe mild, moderate, or severe). An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely. During a severe depressive episode, on the other hand, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.

o Bipolar affective disorder typically consists of both manic and depressive episodes separated by periods of normal mood. Manic episodes involve elevated mood and increased energy, over-activity, pressure of speech and decreased need for sleep.

Who gets depression?

It varies considerably across the populations of the world. Lifetime prevalence rates range between 8 to 12 percent. The lack of standard diagnostic screening criteria makes it difficult to compare depression rates cross-nationally.

Risk factors:

o Gender. Depression is two to three times more common in women
o Economic disadvantages, that is, poverty.
o Social disadvantages, such as low education.
o Genetics. If you have someone in your immediate family with the disorder, you are two to three times more likely to develop depression at some point in your life.
o Exposure to violence.
o Being separated or divorced, in most countries, especially for men.
o Other chronic illness.

Managing depression

Depression is a disorder that can be reliably diagnosed and treated in primary care. Preferable treatment options consist of basic psychosocial support combined with antidepressant medication or psychotherapy, such as cognitive behavior therapy, interpersonal psychotherapy or problem-solving treatment. As an adjunct to care by specialists or in primary health care, self-help is an important approach to help people with depression. Innovative approaches include self-help books or internet-based self-help programs!

Reducing the burden of depression

There are a number of well-defined and evidence-based strategies that can effectively address or combat this burden. The key interventions are treatment with generic antidepressant drugs and brief psychotherapy. Economic analysis has indicated that treating depression in primary care is feasible, affordable and cost-effective.

While depression is the leading cause of disability for both males and females, the burden of depression is 50% higher for females than males (WHO, 2008). In fact, depression is the leading cause of disease burden for women in both high-income and low- and middle-income countries (WHO, 2008).

Research in developing countries suggests that maternal depression may be a risk factor for poor growth in young children. This risk factor could mean that maternal mental health in low-income countries may have a substantial influence on growth during childhood, with the effects of depression affecting not only this generation but also the next.

Effective community approaches to prevent depression focus on several actions surrounding the strengthening of protective factors and the reduction of risk factors. Examples of strengthening protective factors include school-based programs targeting cognitive, problem-solving and social skills of children and adolescents as well as exercise programs for the elderly. Interventions for parents of children with conduct problems aimed at improving parental psychosocial well-being by information provision and by training in behavioral childrearing strategies may reduce parental depressive symptoms, with improvements in children's outcomes.

Living with depression, especially if it is chronic or recurring, can make you feel exhausted, overwhelmed and helpless. These feelings can often make you want to give up. Recognizing that these negative thoughts are part of your depression is one step toward recovery. It is important to take good care of yourself throughout your treatment. This can be hardest in the beginning, especially before your treatment begins to work.

Taking Care of Yourself

Depression is real. It is an illness of the brain that usually requires some form of treatment. It is important for you to recognize this, to take the illness seriously, and to take good care of yourself.

Depression can make even the simplest parts of daily living very difficult.

o Consider some form of exercise daily. Exercise is good for both physical and mental health.
Establishing a regular exercise routine will help maintain a healthy weight and reduce stress levels, important for someone with depression.

o Try to eat a healthy balanced diet every day. A healthy diet, which includes whole grains, fresh fruits and vegetables, protein, and is low in fat, will help keep your body healthy.
o There are many relaxation techniques to lower your stress, including meditation and deep breathing, which can help with depression.
These techniques, widely used around the world, are a low-cost way to lower stress.
o Maintain healthy sleep habits, as much as possible. Set up a regular routine for bedtime and morning to be sure you are getting enough sleep, but not too much sleep.
o Avoid and reduce stress. Stress, both at work and home, can increase your feelings of depression.
It is important to avoid stress in your daily life.
o Keep your working hours predictable and manageable. Openly communicate with family members and loved ones about what is going on in your life to foster better relationships and elicit their support.
o Limit or curtail alcohol or substance use or abuse. Use of these substances may worsen your symptoms of depression or interfere with your prescribed medications.
o Create a daily routine. Organizing and planning your day will help to manage the many daily life tasks that you have to do. Create and maintain a monthly calendar.
o Be patient with yourself. For someone with depression, even the smallest tasks can seem impossible. If you can't find the energy to go for a walk today, then just stand outside for a little while and get some fresh air. These things will not make your depression go away, but they may make your day feel a little bit easier.

Seeking Support

A network of family and friends can make all the difference for someone with depression. Seek out friends and family, as well as local organizations, for help in taking care of you.

Conclusion

Depression is a mental disorder that is pervasive in the world and affects us all. Unlike many large-scale international problems, a solution for depression is at hand. Efficacious and cost-effective treatments are available to improve the health and the lives of the millions of people around the world suffering from depression. On an individual, community, and national level, it is time to educate ourselves about depression and support those who are suffering from this mental disorder.

"THERE IS GROWING EMPHASIS ON A RECOVERY MODEL ACROSS THE WORLD THAT INVOLVES EMPOWERING PEOPLE WITH MENTAL ILLNESS TO TAKE CHARGE OF THEIR OWN ILLNESS, THEIR TREATMENT AND THEIR LIVES."