The Burden of Depression

Article excerpt

Continuing Education

Wyeth

TRENDS IN PHARMACY AND PHARMACEUTICAL CARE

When sorrows come, they come not single spies, but in battalions.

William Shakespeare, 1564-1616

The Global Burden of Disease (GBD) project began in 1992 as a collaborative effort sponsored by the World Health Organization (WHO), the World Bank, and the Harvard School of Public Health. The three initial goals of the project are: (1) to include nonfatal diseases and injuries in the analysis of international health policy, (2) to decouple epidemiological assessment from advocacy so that estimates of the mortality or disability from a condition are developed as objectively as possible, and (3) to quantify the burden of disease in a manner that allows for cost-effective analysis.

GBD researchers employed a new weighted measure for calculating disease burden, called Disability Adjusted Life Years (DALYs), which accounts for lost years of healthy life regardless of whether the years were lost to premature death or disability. For example, in the GBD, major depression has a burden equivalent to blindness or paraplegia, whereas active schizophrenic psychosis is equal in disability burden to quadriplegia. In 1996, the first results of the project were published, revealing that mental illness ranks second in the overall burden of disease. The GBD study found that in the United States, mental disorders account for more than 15% of the overall burden of disease from all causes, ranking higher than the burden associated with all forms of cancer and affecting at least one in five Americans.

The report showed that our healthcare system had greatly underestimated the burden of mental illness-the very health that is indispensable for an individual's personal well being-on family, interpersonal relationships, and community or society. Using the DALY measure, major depression ranks second only to ischemic heart disease in magnitude of total disease burden. Schizophrenia, bipolar disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder also contribute significantly to the burden represented by mental illness.

Mental health can be defined as that state of successful performance of mental function that results in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity. The term mental illness refers to all diagnosable mental disorders or those health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning. Although our understanding of mental health disorders is limited, the efficacy of mental health treatment is well documented. In the past few decades, there has been an extraordinary level of productivity in scientific research on the brain and behavior, the development of an extensive range of effective mental health treatments, and a transformation of society's attitude toward mental health care in general. In any given year today in the United States, one in six adults and one in five children obtain mental health services either from healthcare providers, the clergy, social service agencies, or schools.

Depression affects more than 18 million Americans of all ages and races. It is a mental illness that affects thoughts, moods, feelings, behavior, and physical health. Many times, stressful events can trigger a bout of depression, whereas at other times depression appears to occur spontaneously, with no identifiable specific cause. Although it is possible for depression to occur only once in a person's life, more often it occurs in repeated episodes over a lifetime. In addition, depression may occur as a chronic condition requiring chronic treatment. Depression is a systemic disease that has long been known to be a risk factor in the development of coronary disease. People with major depression are about four times more likely to die of cardiac disease. …