Depression and public health: An overview
Introduction
Depressive disorders and especially major depressive disorder (MDD) are fairly prevalent conditions in the general population. Significant suffering, high morbidity and mortality, and psychosocial functional impairment are typically associated with depressive disorders. Unfortunately, despite the availability of numerous effective treatments for depressive disorders, these latter are often underrecognized and undertreated in the community. Several factors contributing to the underrecognition of depression have been identified, ranging from the stigma of depression itself to the relative lack of systematic ascertainment of depressive symptoms by primary care physicians (PCPs). Recently, the public health significance of depression has been stressed, due to the significant impact that depression has on the course and mortality associated with other medical diseases. There is evidence that patients affected by chronic illnesses have a higher risk for depression compared to the general population. Similarly, depressed patients present substantial rates of comorbidity with chronic medical diseases.
In this review, we consider the issue of the public health relevance of depressive disorders and we focus on the recognition and management of depression, particularly in the primary care setting. Public health strategies adopted to address and prevent depressive disorders' burden to the community are also reviewed.
Section snippets
Depression: clinical features and differential diagnosis
Patients who suffer from depressive disorders typically present with a constellation of psychological, behavioral, and physical symptoms. Table 1, Table 2, Table 3 list some of the most common psychological (Table 1), behavioral (Table 2), and physical symptoms (Table 3) reported by patients with depressive disorders. However, the traditional diagnostic approach to depressive disorders has identified depressed mood and loss of interest/pleasure in most activities as key features of these
Depression and public health
Depressive disorders are quite important from a public health perspective, as they are common, they may significantly impair psychosocial functioning, and effective interventions are available [9].
Depression and primary care
As mentioned previously, only 57% of depressed patients actively seek help for their depression; interestingly, most of them consult a PCP [13]. This finding is of particular importance because it stresses the crucial role of PCPs in the recognition and treatment of depression. Clinicians, and especially PCPs, should be aware that the prevalence of depressive disorders increases from 4.9% [11] to 10.4%, when we consider patients who have been referred for any reason to their general health care
Public health policy and depression
A redefinition of depression as a frequently chronic/recurrent and disabling disorder as well as the identification of adequate and cost-effective strategies for the prevention and treatment of depression, are essential to control this major public health problem [15]. The “National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression” emphasizes three levels where relative deficiencies occur with respect to the recognition and treatment of
Conclusions
The diagnosis and treatment of depressive disorders, including major and minor depression have tremendous public health significance. Due to the relatively high prevalence [48], their management should largely take place in primary care settings, as is the case of other common chronic diseases such as diabetes and hypertension. The availability of safe, well-tolerated, and effective antidepressant treatments facilitates management of depression in primary care settings. Programs aimed at
References (96)
- et al.
Lifetime prevalence of major depression and dysthymia: results of a community survey in Sardinia
Eur Neuropsychopharmacol
(1995) - et al.
Major depression and all-cause mortality among white adults in the United States
Ann Epidemiol
(1997) - et al.
The management of treatment resistance in depressed patients with substance use disorders
Psychiatr Clin North Am
(1996 Jun) - et al.
Depression in patients with cardiac disease: a practical review
J Psychosom Res
(2000 Apr–May) - et al.
Depressive symptoms and mortality in older Mexican Americans
Ann Epidemiol
(1999 Jan) - et al.
The course of major depression in diabetes
Gen Hosp Psychiatry
(1997 Mar) - et al.
Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study
Lancet
(1997 May 24) - et al.
Major depressive disorder
Neuron
(2000) - et al.
Chronic musculoskeletal pain and depressive symptoms in the National Health and Nutrition Examination: I. Epidemiologic follow-up study
Pain
(1993) - et al.
Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs
Gen Hosp Psychiatry
(1990)
Obesity and its comorbid conditions
Clin Cornerstone
Efficacy of newer medications for treating depression in primary care patients
Am J Med
Physical activity and mental health in the United States and Canada: evidence from four population surveys
Prev Med
Patterns of antidepressant use in community practice
Gen Hosp Psychiatry
Increased platelet aggregability in major depression?
Psychiatry Res
Changes in the immune system in depression and dementia: causal or co-incidental effects?
Int J Dev Neurosci
Depression and somatization: a review
Am J Med
Depression really does hurt your heart: stress, depression, and cardiovascular disease
Prog Brain Res
Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents
Am J Med
Depression, use of medical services and cost-offset effects
J Psychosom Res
Boundaries of major depression: an evaluation of DSM-IV criteria
Am J Psychiatry
Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds
Pharmacopsychiatry
Diagnostic and statistical manual of mental disorders, 4th ed.: DSM-IV
Prominence of symptoms and level of stigma among depressed patients in Calcutta
J Indian Med Assoc
Case-finding instruments for depression: two questions are as good as many
J Gen Intern Med
Guide to clinical preventive services
Critical review of data supporting affective disorder caused by nonpsychotropic medication
Ann Clin Psychiatry
The use of public health approaches in mental health programmes
Int Clin Psychopharmacol
Affective disorders
The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey
Am J Psychiatry
Depression in the community: the first pan-European study DEPRES [Depression Research in European Society]
Int Clin Psychopharmacol
Major depression and its associated morbidity and quality of life in a random, representative Australian community sample
Aust N Z J Psychiatry
The burden of recurrent depression: causes, consequences, and future prospects
J Clin Psychiatry
The functioning and well-being of depressed patients. Results from the Medical Outcomes Study
JAMA, J Am Med Assoc
Relation between symptoms of depression and health status outcomes in acutely ill hospitalized older persons
Ann Intern Med
Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area study
Am J Psychiatry
Minor and major depression and the risk of death in older persons
Arch Gen Psychiatry
The economic and social burden of depression
J Clin Psychiatry
The epidemiology of murder–suicide
JAMA, J Am Med Assoc
The economic burden of depression in 1990
J Clin Psychiatry
Health care costs of primary care patients with recognized depression
Arch Gen Psychiatry
Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses
Arch Gen Psychiatry
The global burden of disease in 1990: summary results, sensitivity analysis and future directions
Bull World Health Organ
Evidence-based health policy—lessons from the global burden of disease study
Science
Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care
JAMA, J Am Med Assoc
Treating depressed primary care patients improves their physical, mental, and social functioning
Arch Intern Med
Randomized trial of a depression management program in high utilizers of medical care
Arch Fam Med
Cited by (412)
Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies
2024, Clinical Psychology ReviewThe mediating role of dietary inflammatory index on the association between eating breakfast and depression: Based on NHANES 2007–2018
2024, Journal of Affective DisordersPhysical activity and its fluctuations in relation to depressive symptoms: A national longitudinal study among Chinese adults
2024, Journal of Affective DisordersEviction as a community health exposure
2024, Social Science and MedicineA Latent Class Analysis: Are caregiver factors associated with U.S. adolescents' mental health?
2024, Children and Youth Services ReviewPrevalence of associated factors on depression during COVID 19 in students in a minority serving institution: A cross sectional study
2023, Journal of Affective Disorders Reports