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David Baxter

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Worldwide Depression Is Physically Destructive and Undertreated
Friday, September 07, 2007

In a development that will hopefully silence those who repudiate the classification of depression as a disease, concurrent studies from the World Health Organisation and the National Institute of Mental Health report that clinical depression, which remains almost exclusively untreated despite affecting hundreds of millions worldwide, inflicts more long-term damage on a patient's overall state of health than many other chronic physical illnesses.

Comparing the effects of depression to those of four more rigorously studied medical conditions among nearly 250,000 subjects in 60 different countries, researchers determined that depression carries more severe health consequences than angina, asthma, arthritis and diabetes and that more aggressive advanced treatment would very obviously improve health quotients worldwide. Working from a series of questions about variables such as sleep, physical pain and cognitive fitness while controlling for poverty, age and independent medical conditions, researchers determined that depression has the largest measurable influence on declining health, especially when combined with comorbid diseases. Individuals with depression and arthritis, for example, scored far worse on health assessments than those with arthritis and diabetes. The report's most striking implication is that, upon diagnosing a given physical illness, doctors often fail to explore other reasons for exacerbated declines in a patient's overall health. Even if medicine manages to counter other chronic conditions, a patient's profile is far less likely to improve if he or she does not receive treatment specifically designed for depression. Unfortunately, those with simple ashtma and arthritis receive much better treatment than their depressed counterparts in every corner of the world.

An independent study by the World Health Organisation reports that the vast majority of individuals suffering from depression around the world do not get the medical help they need. Unsurprisingly, the study found a close correlation between treatment rates for mental illness and the percentage of a nation's gross domestic product which is dedicated to healthcare: those living in countries with the fewest economic resources are also least likely to receive treatment. Despite numerous reports of substandard mental health programs, the United States towers above nearly every other country in terms of research and treatment rates with nearly 200 times as many psychiatrists, psychologists, psychiatric nurses and social workers as countries on the opposite end of the economic spectrum. The equation remains devastating even when stated in the most objective light: only one half of the most severely affected individuals living in the world's wealthiest developed nations receive treatment for their conditions. The greater instance of depression in the U.S. has nothing to do with a weak national character. We simply devote more time and money to the issue, and it's still not nearly enough. One can only imagine how many hundreds of millions suffer in silence or seek treatment that simply isn't there to be had.

Some of the WHO's statistics serve as sufficient cause for outrage on their own: Though an estimated 20% of the world's children and adolescents suffer from diagnosable mental illness, even middle-income countries have only one child psychiatrist for every 1 to 4 million citizens. Further negating the chances of successful treatment are the cultural and universal prejudices that remain firmly in place: a South African poll revealed that a considerable majority of the countrys' citizens view depression as a case of stress overload or personal weakness rather than a classifiable disease. While the treatment of depressive individuals has unquestionably improved in the recent past, numerous reports of human rights violations relating to the mentally ill continue to crop up in every single country, and the total number of cases that go unreported almost certainly dwarfs that sum. Very few countries have specific legal guidelines to accomodate the mentally ill.

Some seem to think that efforts to counter epidemic depression would be far too costly, but the WHO firmly disagrees: As little as $2-4 per person per year could lead to vastly improved mental health service systems in lower and middle-income countries. Arguments as to whether depression is "over-diagnosed" will undoubtedly persist, and those who make that point have legitimate concerns about the dangers of "pathologizing" lesser mood problems. But the supposedly contentious issue of depression as a deadly disease to be aggressively pursued in every corner of the world needs no further consideration.
 

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