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What is depression?
Contents:


  1. Symptoms of depression
  2. Depression: Facts, Statistics, and You
  3. INTRODUCTION
  4. What is depression and why is it rising?
  5. The epidemiology of depression across cultures

Despite the number of sufferers globally, there is still a lot of stigma attached to discussing mental health in the workplace. In the US, the Americans with Disabilities Act prohibits discrimination against individuals with disabilities and mental health issues in all areas of public life, including jobs and education.


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In the UK, the Equality Act performs much the same function, but the efficacy of such rules is questionable. The report, commissioned by Prime Minister Theresa May , recommended that businesses produce, implement and communicate a mental health at work plan, encourage open conversations about the topic and provide support when employees are struggling. In a move that will chime with respondents to the US MHA survey, the UK report also says companies should provide good working conditions, effective line management and ensure staff have a healthy work-life balance as well as opportunities for development.

Adam Jezard , Formative Content. The views expressed in this article are those of the author alone and not the World Economic Forum. Adam Jezard Formative Content. In this Tokyo cafe, the waiters are robots operated remotely by people with disabilities Sean Fleming 17 Dec Other commonly agreed causes or triggers are past trauma or abuse; a genetic predisposition to depression, which may or may not be the same as a family history; life stresses, including financial problems or bereavement; chronic pain or illness; and taking drugs, including cannabis, ecstasy and heroin.

The subject of much debate, there is a school of thought that severe stress or certain illnesses can trigger an excessive response from the immune system, causing inflammation in the brain, which in turn causes depression. The WHO estimates that fewer than half of people with depression are receiving treatment. Many more will be getting inadequate help, often focused on medication, with too little investment in talking therapies, which are regarded as a crucial ally. Among pharmacological treatments for depression, the most commonly prescribed antidepressants are selective serotonin re-uptake inhibitors SSRIs which reduce the absorption of serotonin, increasing overall levels.

Symptoms of depression

Another popular class of drugs is serotonin norepinephrine re-uptake inhibitor SNRIs , which work on both serotonin and noradrenaline. The most common talking therapy is cognitive behavioural therapy, which breaks down overwhelming problems into situations, thoughts, emotions, physical feelings and actions to try to break a cycle of negative thoughts. Other types are interpersonal therapy, behavioural activation, psychodynamic psychotherapy and couples therapy. All talking therapies can be used on their own, or with medication.

From , cases of depressive illness increased by nearly a fifth. People born after are 10 times more likely to have depression.

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Depression: Facts, Statistics, and You

This reflects both population growth and a proportional increase in the rate of depression among the most at-risk ages, the WHO said. Suicide rates, however, have declined globally, by about a quarter. In , the rate was Other reasons given for the continuing rise in depressive illness include an ageing population to year-olds are more likely to suffer than other age groups , and rising stress and isolation.

No new antidepressant drugs have been developed in the last 25 years, forcing psychiatrists to look elsewhere for help.

World Depression Begins! (Bo Polny)

There have been positive experiments with both ketamine and psilocybin , the active ingredient in magic mushrooms. A recent analysis from the WMH surveys documented the latter association by showing that history of mental disorders as of the age of completing schooling predicted current at the time of interview unemployment and work disability However, these associations were only significant in high income countries, raising the possibility that MDD becomes more detrimental to work performance as the substantive complexity of work increases.

A great deal of research has been carried out on the associations of mental disorders with various aspects of role performance, with a special focus on marital quality, work performance, and financial success. It has long been known that marital dissatisfaction and discord are strongly related to depressive symptoms e.

Longitudinal studies show that the association is bidirectional 75 , , but with a stronger time-lagged association of marital discord predicting depressive symptoms than vice versa Fewer studies have considered the effects of clinical depression on marital functioning 27 , 67 , 99 , but those studies consistently document significant adverse effects. Considerable research documents that both perpetration of and victimization by physical violence in marital relationships are significantly associated with depression While these studies have generally focused on presumed mental health consequences of relationship violence 1 , 64 , , a growing body of research has more recently suggested that marital violence is partly a consequence of pre-existing mental disorders 58 , 73 , 93 , Indeed, longitudinal studies consistently find that pre-marital history of mental disorders, including depression, predict subsequent marital violence perpetration 34 , 73 and victimization 69 , 93 , , However, few of these studies adjusted for comorbidity.

A recent study in the WMH surveys 84 found that the association between premarital history of MDD and subsequent marital violence disappears after controls are introduced for disruptive behavioral disorders and substance use disorders, suggesting that depression might be a risk marker rather than a causal risk factor.

A number of studies have documented significant associations of both maternal 74 and paternal depression with negative parenting behaviors. These associations are found throughout the age range of children, but most pronounced for the parents of young children. Although only an incomplete understanding exists of pathways, both laboratory and naturalistic studies of parent-infant micro-interactions have documented subtle ways in which parent depression leads to maladaptive interactions that impede infant affect regulation and later child development Considerable research has examined days out of role associated with various physical and mental disorders in an effort to produce data on comparative disease burden for health policy planning purposes 2 , These studies typically find that MDD is associated with among the highest number of days out of role at the societal level of any physical or mental disorder due to its combination of comparatively high prevalence and comparatively strong individual-level association 26 , 88 , In the WMH surveys, for example, 62, respondents across 24 countries were assessed for a wide range of common physical and mental disorders as well as for days out of role in the 30 days before interview 4.

MDD was associated with 5. A number of epidemiological surveys in the US have estimated the workplace costs of either MDE or MDD on absenteeism and low work performance often referred to as presenteeism 39 , 50 , , Several studies attempted to estimate the annual salary-equivalent human capital value of these losses. One of most striking aspects of the impairment associated with MDD is that the personal earnings and household income of people with MDD are substantially lower than those of people without depression 35 , 45 , 56 , 72 , 78 , However, it is unclear whether depression is primariry a cause, consequence, or both in these associations due to the possibility of reciprocal causation between income-earnings and MDD Causal effects of low income on depression have been documented in quasi-experimental studies of job loss Time series analyses have also documented aggregate associations between unemployment rates and suicide rates Previous studies of the effects of mental disorders on reductions in income have not controlled for these reciprocal effects, making the size of the adverse effects of depression on income-earnings uncertain.

One way to sort out this temporal order would be to take advantage of the fact that depression often starts in childhood or adolescence and use prospective epidemiological data to study long-term associations between early-onset disorders and subsequent income-earnings.

INTRODUCTION

Several such studies exist, all of them suggesting that depression in childhood-adolescence predicts reduced income-earnings in adulthood 38 , A number of community surveys, most of them carried out in the US, have examined the comparative effects of diverse diseases on various aspects of role functioning 55 , 70 , 82 , , , MDE was included in a number of these studies and the results typically showed that musculoskeletal disorders and MDE were associated with the highest levels of disability at the individual level among all commonly occurring disorders assessed.

The most compelling study of this sort outside the US was based on fifteen national surveys carried out as part of the WMH surveys Disorder-specific disability scores were compared across people who experienced each of ten chronic physical disorders and ten mental disorders in the year before interview. MDD and bipolar disorder BPD were the mental disorders most often rated severely impairing in both developed and developing countries.

None of the physical disorders considered had impairment levels as high as those for MDD or BPD despite the fact that the physical disorders included such severe conditions as cancer, diabetes, and heart disease. Nearly all the higher mental-than-physical ratings were statistically significant at the. Comparable results were obtained when analyses focused exclusively on sub-samples of cases in treatment and when comparisons were restricted to respondents who had both disorders in a given pair e.

Another set of surveys examined comparative decrements in perceived health associated with a wide range of disorders 3 , 77 , MDD was the focus of two such studies. The first study was part of the WHO World Health Surveys of nearly one-quarter of a million respondents across 60 countries A consistent pattern was found in these surveys across countries and socio-demographic subgroups within countries for MDD to be associated with a larger decrement in perceived health than any of the four physical disorders compared with it angina, arthritis, asthma, diabetes.

It is now well established that MDD is significantly associated with a wide variety of chronic physical disorders, including arthritis, asthma, cancer, cardiovascular disease, diabetes, hypertension, chronic respiratory disorders, and a variety of chronic pain conditions 6 , 18 , 22 , 31 , 32 , 81 , 92 , 96 , Although most of the data documenting these associations comes from clinical samples in the US, similar data also exist from community epidemiological surveys carried out throughout the world , These associations have considerable individual and public health significance and can be thoughts of as representing costs of depression in at least two ways.

First, to the extent that MDD is a causal risk factor, it leads to an increased prevalence of these physical disorders, with all their associated financial costs, impairments, and increased mortality risk. Evidence about MDD as a cause of these physical disorders is spotty, though, although we know from meta-analyses of longitudinal studies that MDD is a consistent predictor of the subsequent first onset of coronary artery disease , , stroke 94 , diabetes 20 , heart attacks , and certain types of cancer A number of biologically plausible mechanisms have been proposed to explain the prospective associations of MDD with these disorders 21 , 25 , 28 , 47 , These include a variety of poor health behaviors known to be linked to MDD, such as elevated rates of smoking and drinking 30 , obesity 23 , low compliance with treatment regimens , , and a variety of biological dysregulations, such as hypothalamic-pituitary-adrenal hyperactivity and impaired immune function Based on these observations, there is good reason to believe that MDD might be a causal risk factor for at least some chronic physical disorders.

Second, even if depression is more a consequence than a cause of chronic physical disorders, as it appears to be for some disorders based on stronger prospective associations of depression onset subsequent to, rather than before, onset of the physical disorder, comorbid depression is often associated with a worse course of the physical disorder 37 , 76 , A number of reasons could be involved here, but one of the most consistently documented is that depression is often associated with non-adherence to treatment regimens 12 , 24 , Based on these considerations, it should not be surprising that MDD is associated with significantly elevated risk of early death 21 , 28 , This is true not only because people with MDD have high suicide risk 11 , 86 , , but also because depression is associated with elevated risk of onset, persistence, and severity of a wide range of physical disorders.

Indeed, a number of interventions have been developed to detect and treat depression among people with CVD in an effort to prolong their lives, although the results of these studies have so far been mixed 9. The data reviewed here show clearly that major depression is a commonly occurring and burdensome disorder.

Types of depression

Methodological studies reviewed here find no evidence that the substantial cross-national variation in prevalence estimates reviewed here, with the highest prevalence estimates found in some of the wealthiest countries in the world, is due as methodological factors, adding indirect support to a substantive interpretation of observed cross-national differences in MDE prevalence estimates.

Why these differences exist is less clear, as on one level it seems counter-intuitive that people in high income countries would experience more stress than those in low-middle income countries. However, it has been suggested that depression is to some extent an illness of affluence A related argument is that income inequality, which is for the most part greater in high than low-middle income countries, promotes a wide variety of chronic conditions that includes depression It is hoped that future epidemiological research sheds light on these perspectives.

In considering a substantive interpretation of the international data on prevalence of major depression, it is noteworthy that while lifetime prevalence estimates were higher in high than low-middle income countries overall, no significant difference was found in month prevalence, which means that the ratio of month to lifetime prevalence estimates was higher in low-middle than high income countries. It might be that these results reflect genuinely lower lifetime prevalence but higher persistence of depression in low-middle than high income countries, but another plausible and more parsimonious explanation is that error in recall of prior lifetime episodes in epidemiological surveys carried out in higher in low-middle than high income countries.

Longitudinal data collection would be required to document such a difference rigorously 97 , Although such data do not currently exist, it is important to recognize this possibility of cross-national variation in recall error before launching an extensive investigation of substantive explanations. Another implication of the methodological limitation of existing cross-national epidemiological surveys of major depression is that the cross-sectional nature of these surveys makes it impossible to determine the temporal direction of associations between depression and socio-demographic variables.

This means that even though variables such as education and marital status are typically considered predictors of depression, they might actually be consequences or involved in reciprocal causal relationships with depression. A final noteworthy limitation of existing epidemiological studies is that the assessments of major depression were almost certainly suboptimal, although interview translation, back-translation, and harmonization procedures have improved in recent cross-national surveys 43 and that blinded clinical reappraisal interviews in a number of recent surveys document good concordance between survey diagnoses of major depression and independent clinical diagnoses Despite these limitations, existing epidemiological data show clearly that major depression is a commonly occurring and seriously impairing disorder.

The high prevalence and persistence of major depression in the many different countries where epidemiological surveys have been administered confirm the worldwide importance of this disorder. Although evidence is not definitive that major depression plays a causal role in its associations with the many adverse outcomes reviewed here, the indirect evidence is sufficiently strong to argue for the likely cost-effectiveness of expanded depression treatment from a societal perspective Two separate large-scale randomized workplace depression treatment effectiveness trials have been carried out in the US to evaluate the cost-effectiveness of expanded treatment from an employer perspective , Both trials had positive returns-on-investment to employers.

A substantial expansion of worksite depression care management programs has occurred in the US subsequent to the publication of these trials Yet the proportion of people with depression who receive treatment remains low in much of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines Although the treatment rate was higher for more severe cases, even those with severe MDD often failed to receive treatment The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value Randomized controlled trials are needed to increase our understanding of the effects of detection and treatment of major depression among people in treatment for chronic physical disorders.

In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early detection and treatment on changes in life course role trajectories, role performance, and onset of secondary disorders. We thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. A complete list of WMH publications can be found at http: The funding organizations had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

The costs of depression.


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  6. Both used with permission. Kessler has had research support for his epidemiological studies from Analysis Group Inc. Bromet reports no competing interests.

    What is depression and why is it rising?

    National Center for Biotechnology Information , U. Annu Rev Public Health. Author manuscript; available in PMC Jul Kessler 1 and Evelyn J. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Annu Rev Public Health. See other articles in PMC that cite the published article.

    The epidemiology of depression across cultures

    Abstract Epidemiological data are reviewed on the prevalence, course, socio-demographic correlates, and societal costs of major depression throughout the world. Burden of illness, depression, epidemiology. Open in a separate window. ILLNESS COURSE Few large-scale longitudinal general population studies of major depression exist, but clinical studies show that a substantial proportion of people who seek treatment for major depression have a chronic-recurrent course of illness 42 , Education Several studies show early-onset mental disorders associated termination of education 13 , 15 , 54 , 68 , 79 , , , Marital timing and stability Several studies have examined associations of pre-marital mental disorders with subsequent marriage 14 , 36 , Teen childbearing We are aware of only one study that examined the association between child-adolescent mental disorder and subsequent teen child bearing Employment status Although depression is known to be associated with unemployment, most research on this association has emphasized the impact of job loss on depression rather than depression as a risk factor for job loss Role performance A great deal of research has been carried out on the associations of mental disorders with various aspects of role performance, with a special focus on marital quality, work performance, and financial success.

    Marital functioning It has long been known that marital dissatisfaction and discord are strongly related to depressive symptoms e. Parental functioning A number of studies have documented significant associations of both maternal 74 and paternal depression with negative parenting behaviors. Days out of role Considerable research has examined days out of role associated with various physical and mental disorders in an effort to produce data on comparative disease burden for health policy planning purposes 2 , Financial success One of most striking aspects of the impairment associated with MDD is that the personal earnings and household income of people with MDD are substantially lower than those of people without depression 35 , 45 , 56 , 72 , 78 , Comparative impairments A number of community surveys, most of them carried out in the US, have examined the comparative effects of diverse diseases on various aspects of role functioning 55 , 70 , 82 , , , Morbidity and mortality It is now well established that MDD is significantly associated with a wide variety of chronic physical disorders, including arthritis, asthma, cancer, cardiovascular disease, diabetes, hypertension, chronic respiratory disorders, and a variety of chronic pain conditions 6 , 18 , 22 , 31 , 32 , 81 , 92 , 96 , Major depression is a commonly occurring disorder in all countries where epidemiological surveys have been carried out.

    However, lifetime prevalence estimates of major depression vary widely across countries, with prevalence generally higher in high income versus low-middle income countries. Age-of-onset AOO distributions show consistent evidence for a wide age range of risk with median AOO typically in early adulthood. Women consistently across countries have lifetime risk of major depression roughly twice that of men.

    Major depression is associated with a wide range of indicators of impairment and secondary morbidity, although some of these individual-level associations are stronger in high income than low-middle income countries. Mental health correlates of intimate partner violence in marital relationships in a nationally representative sample of males and females. Disability and quality of life impact of mental disorders in Europe: Health-related quality of life associated with chronic conditions in eight countries: Days out of role due to common physical and mental conditions: