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Editor’s note
Mental health is an integral part of overall health, but mental health issues are often ignored or even misunderstood. About 1 in 8 people worldwide suffer from mental illness, among which depression is one of the most common mental illnesses. October 10 is World Mental Health Day , focusing on mental health and related high-incidence diseases. We share with readers the major report on depression published by the authoritative medical journal "The Lancet" this year.
responds to the call of WHO ,
WHO data shows that about 280 million depressed patients worldwide, and 25.0% of adults suffer from depression . However, the health crisis of has not been paid enough attention to it and has not been fully recognized and understood by the public. In high-income countries, nearly half of the patients with depression have not been diagnosed or treated, and in low- and middle-income countries, this proportion is as high as 80% to 90%.
In order to reduce the burden of depression, more attention is paid to millions of depression patients around the world, "The Lancet) published "The Lancetml-The World Psychiatric Association Major Report on Depression: The time has come to take joint action on depression" . The report was co-written by 25 experts from 11 countries and multiple disciplines, and is advised by people who have experienced depression. The report provides evidence and suggestions from the meaning of depression, disease burden, root causes, public understanding, and intervention measures.
Screenshot Source: The Lancet
Depression is a common disease that can affect anyone
"Why is depression not considered a common disease?"
-Depression patient Vidushi Karnatic, 20 years old
There are many misunderstandings about depression. For example, some people think that depression is just a manifestation of sadness, weakness, or limited to groups of specific backgrounds. "High stigma has prevented many from seeking help and living a healthy life." said Associate Professor Christian Kieling, co-chair of the report and Universidade Federal do Rio Grande do Sul, Brazil.
In the recent cognitive survey conducted by WuXi AppTec content team to more than 260 universities and research institutions in China and nearly 1,500 students, although 74% of the people participating in the survey believed that "mental health" is equally important as "physical health", more than 76% of the people said that they did not understand their definition, intervention and treatment methods, etc. .
Report first pointed out that depression is a common disease. It is different from the sad experiences of most people, and from the pain or despair that people experience in adversity. Depression is a unique health problem characterized by persistence and significant impact on daily functioning and long-term health consequences.
Depression can affect anyone, regardless of gender, age or social class or background, despite the increased risk of depression in adversity (such as poverty, violence, displacement environments, and gender, race and other forms of discrimination). is by no means a personal "fault" or a manifestation of psychological weakness.
Generally speaking, depression , loss of interest and fatigue are common characteristics of patients with depression.But we must also realize that depression is a syndrome that covers various signs and symptoms, different severity and different disease trajectories. is different for each individual patient.
Depression is also related to a variety of chronic physical diseases, includes arthritis, asthma , cancer, cardiovascular disease, diabetes , obesity, hypertension , cognitive impairment , chronic respiratory diseases, various chronic pain and dementia, etc. In the worst case, depression can lead to suicide. study shows that 70% to 80% of high-income areas die from suicide, and about half of middle- and low-income areas die from mental illness, among which depression is the most common cause.
has a high incidence rate, and the course of the disease is diverse.
"Depression will not notify you of 'attack' in advance."
--Ishita Mehra, a patient with depression, 22 years old,
About 4.7% of the world's population has had depression attacks in any 12 months, with an average duration of attacks of about 6 months. At the same time, up to 20-33% of depression attacks are related to the history of bipolar disorder . Although the lifetime prevalence of bipolar disorder is much lower than depression, depression episodes in patients with bipolar disorder are more persistent and more likely to recur.
According to the results of the World Mental Health Survey, the average of the lifetime prevalence of depression is 10.6% in countries (based on the community epidemiological survey conducted in 28 countries) .
From the perspective of onset age, young people are the peak of the disease. median age of onset of depression in high-income areas and middle- and low-income areas are 26-year-old and 24-year-old , respectively. Another secondary peak in is senile , and many elderly patients with depression will suffer from multiple mental disorders.
In addition, based on this calculation, the average risk of depression at the age of 75 is expected to be 19.6% . In other words, almost one in five people in the world who live to the age of 75 will experience depression in their lifetime. This number is twice the lifelong prevalence rate in the survey, partly due to the age of the survey respondents, who may not have reached the peak of "olderness".
▲At different ages before the age of 75, the estimated population proportion of depression (Picture source: Reference [1])
The natural course of depression is diverse.
- From the perspective of the duration of the attack, most depression attacks in can be relieved within 1 year. In the community survey, persistent depression (i.e., the onset lasts for more than 12 months) accounted for about 12% of people who met the diagnostic criteria for depression; but in primary and secondary medical institutions, the proportion of persistent depression may be as high as 61%.
- Depression usually also intermittently relapses in . In primary or secondary health care institutions, follow-up studies over ≥5 years have shown that the recurrence rate can be as high as 71% to 85%. However, the recurrence rate among patients with depression in the community sample was relatively low, with 27% to 45% reporting recurrences within 20 years.
focuses on the urgent needs and innovative solutions for mental health problems. At 10 a.m. on Saturday, October 15, WuXi AppTec will hold a special session on the "Let Science Lead" series of forums in the field of mental health.
▲Long press and hold to identify the QR code above, register for free, make an appointment to watch
There is no single factor that can fully explain the cause of the disease
report pointed out that three key observations shape our understanding of the root causes of depression.
First of all, depression has family factors .Parents suffer from depression or bipolar disorder, and the child is at increased risk of depression even if he is not raised by his biological parents. However, most people with depression are not affected by their parents.
Secondly, in most cases, teenagers and adults who are suffering from depression usually have childhood diseases such as attention deficit hyperactivity disorder (ADHD) and anxiety disorders. However, most children with ADHD or anxiety disorder do not suffer from depression as adults.
, Most depressions start with stressful events, especially those who lose people or things that are important to you, experience disappointing events, or experience humiliation. Depression is more likely to occur among people who experience these events earlier or are neglected and traumatized. However, the vast majority of people face stressful events and most people will not suffer from depression afterwards.
The above results suggest the inheritance, development and environmental origin of of depression , but also show that there is no single factor that can fully explain why depression occurs. The interaction of these factors in , the influence of different stages of the life course, together constitutes the root cause of depression.
Image source: 123RF
Prevention is crucial to reduce the burden of disease
report stressed that the burden of depression has not been reduced over the past three decades. Therefore, we need to develop a society-wide strategy to reduce adverse experiences in childhood (including neglect and trauma) and throughout the life cycle, thereby reducing the prevalence of depression.
- From the perspective of social environment : promote equality, fairness, and reduce discrimination.
- From the perspective of individual environment : in the family support parenting, prevent perinatal depression, and reduce intimate partner violence ; in schools, improve the school atmosphere and reduce campus bullying ; in the workplace, pay attention to employees mental health and promote physical activities; in the community, promote social support, reduce loneliness in the elderly ; in the field of health care, timely discover and support individuals at risk of depression, and patients with chronic diseases have a high prevalence of depression, and especially pay attention to . In addition, it is necessary to focus on lifestyle factors (such as smoking, drinking, lack of physical activity) .
- In addition, for all ages, genders, and cultural backgrounds, psychological and social intervention is required if risk factors (selective prevention) or existing related symptoms (indicated prevention).
" prevention is the most overlooked aspect of depression. " Dr. Lakshmi Vijayakumar of the Suicide Prevention Centre for Chennai and Volunteer Health Services SNEHA pointed out.
Individualized and staged care
Since depression is a complex disease, different patients have different symptoms and different courses of onset. The report also emphasizes individualized and staged depression care methods: formulate intervention measures based on the chronological order and severity of symptoms. ranges from self-help, lifestyle changes, to psychological treatment and antidepressant treatment, to more intensive and professional treatment, such as electroconvulsive therapy for severe and refractory depression (ECT).
"Everyone's life story and situation are different, and everyone has a unique experience of depression and recovery needs." The report co-chairman and Professor Vikram Patel of Harvard Medical School said, "(This requires) regards depression as a process with continuous changes and different stages. It recommends corresponding interventions from the earliest stages of the disease."
report also recommends the use of collaborative care strategy as a supplement to conventional evidence-based interventions. For example, recruits locally and widely available non-professional personnel, such as community health workers and non-professional consultants.Because there are currently no adequate resources for depression care anywhere in the world, and the widespread inclusion of non-professionals can also help reduce stigma and cultural barriers.
Finally, the report also called on to make more investments to ensure that people can get the mental health care they need at the time and place they need .
It is worth noting that although has multiple treatment options, the field of mental health is still generally facing severe unmet treatment needs. Take depression as an example, nearly 2/3 of the patients cannot obtain sufficient relief from existing therapies. In response to the call of the World Health Organization (WHO) - to make "Mental Health and Well-being for All" a global priority, at 10 a.m. on Saturday, html, WuXi AppTec will hold a special session on the "Let Science Lead" series of forums in the field of mental health. At that time, more than a dozen important guests from the global medical community, academic institutions and industry will discuss the urgent needs of mental health issues, the progress of treatment research and development and innovative blueprints.
We look forward to working with colleagues from all over the world to pay attention to the research and development progress in the field of mental health, with the power of science, cooperation and platform, and bring transformative drugs to patients faster and let more people enjoy mental health!
Due to limited space, this article only introduces some of the key points of the Lancet report.
Reference
[1] Depression. Retrieved September 27, 2022 from https://www.who.int/zh/news-room/fact-sheets/detail/depression
[2] Helen Herrman, et al., (2022). Time for united action on depression: a Lancet–World Psychiatric Association Commission. The Lancet, DOI:https://doi.org/10.1016/S0140-6736(21)02141-3
[3] THE LANCET: Overlooked and underfunded—experts call for united action to reduce the global burden of depression. Retrieved September 27, 2022 from https://www.eurekalert.org/news-releases/943069
Disclaimer: WuXi AppTec content team focuses on introducing the progress of global biomedical health research. This article is for information exchange only. The views in the article do not represent the position of WuXi AppTec, nor does it represent that WuXi AppTec supports or opposes the views in the article. This article is not a recommendation for treatment. If you need treatment plan guidance, please go to a regular hospital for treatment.
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