World Health Day: open dialogue about depression is needed to raise awareness, build understanding and reduce stigma

World Health Day 2017 focuses on depression – a leading cause of disability globally and a leading underlying cause for the 128 000 suicide deaths that occur each year in the WHO European Region. Despite being very common and affecting anyone at any stage of life, depression is still vastly under-recognized and undertreated; there is, consequently, a need to open up dialogue and tackle the stigma associated with this highly disabling condition.

“Although depression can be treated and prevented, at least 75% of all people suffering from major depression do not receive adequate treatment,” said WHO Regional Director for Europe Dr Zsuzsanna Jakab. “However, it is not enough to simply scale up services – it is equally important to raise awareness, build understanding and reduce stigma.”

Huge gaps in diagnosis and treatment

The number of people with depressive disorders in the Region amounts to 40 million, with prevalence in countries ranging from 3.8% to 6.3% of the total population, according to newly released WHO global health estimates for 2015. The WHO campaign “Depression: let’s talk” aims to inform the general public about the consequences and management of depression, and how to provide support to people living with depression.

“You may not be able to talk yourself out of a depression, but talking about depression is an important first step,” said Dr Jakab.

This was the case for Annika*, a teacher in Finland, who used internet-based cognitive behavioural therapy – also called talking therapy – to address her depression. “My automatic thoughts were negative and critical, so I needed to change my internal dialogue,” Annika said. “I realized I was demanding more and more of myself because I wanted everything to be perfect. Of course everything can’t be perfect all the time ... You have to be your own best friend and start treating yourself that way.”

Even when services are available, many people suffering from depression avoid or delay treatment due to fear of prejudice and discrimination. This, together with low governmental spending, has led to huge gaps in diagnosis and treatment and has resulted in 3 out of 4 people suffering from major depression failing to receive the appropriate help they need.

Cost-effective treatment

A recent WHO-led study estimated that the global costs of depression and anxiety disorders exceed US$ 1 trillion each year. “Not taking action is expensive as the economic costs of depression and other common mental disorders are enormous, mainly due to productivity losses caused by absenteeism and lower work productivity,” said Dr Dan Chisholm, Programme Manager for Mental Health at WHO/Europe.

Treating depression with therapy or antidepressants, or a combination of both, is cost-effective and even cost-saving: every US$ 1 invested leads to a return of US$ 4 in better health outcomes and work ability. Despite cost-effective treatments, governmental spending on mental health services is extremely low; according to WHO’s “Mental health atlas 2011” survey, an average of only 3% of health budgets is spent on mental health, ranging from less than 1% in low-income countries to 5% in high-income countries.

Depression often occurs with other conditions and can lead to suicide

Depression increases the risk of anxiety disorders, substance abuse disorders and other noncommunicable diseases, such as diabetes and heart disease. The opposite is also true, meaning that people with these other conditions have a higher risk of depression. At worst, depression leads to suicide, which is the second-leading cause of death among 15–29 year-olds, after road traffic accidents. The low- and middle-income countries in the Region have the highest suicide rates in the world.

Efforts to address depression linked to achieving Sustainable Development Goals

More effective prevention and treatment of depression, combined with greater awareness of the disease, will be a vital part of countries’ efforts to move towards universal health coverage and social inclusion. Such efforts will help countries to achieve target 3.4 of the Sustainable Development Goals – by 2030, to reduce by one-third premature mortality from noncommunicable diseases through prevention and treatment and to promote mental health and well-being.

*A pseudonym has been used.