Do you often feel very tired, pessimist and hopeless? Have you lost interest in activities and interests you previously enjoyed? Do feelings of guilt and compunction keep you occupied? Are you insomniac? Do you often suffer from digestive disorders? Are you losing weight? Do you get exhausted and fatigued? Do you feel remorse and contrition? Do relationships not attract you anymore? Do you remain persistently sad, anxious or vacuous? Do you find yourself irritated and restless? Do you face difficulties in concentrating, remembering details and making decisions? Do thoughts of suicide come to your mind? Have you ever attempted a suicide? If your answers to four or more of these questions is ‘yes’ for two or more weeks consistently, beware, you are most probably suffering from depression – though you might think it’s due to your exhausting daily routine.
Mental disorder, generally, is not taken as a disease rather it is considered insanity or lunacy or an impact of black magic or some mischief of evil spirits. But, modern science has evidently proved that just like physical ailments, mental disorders do also exist and that they are absolutely curable. One such disease or disorder is depression i.e. dysthymia, to highlight the menace of which World Health Day is being celebrated on April 07, 2017 under the theme: “Depression: Let’s Talk.”
A person gets depressed when he finds himself mired in issues like poverty, unemployment and is faced with adverse life events like death of a close person, physical disorders and alcoholism, as well as drug addiction. Moreover, changes in a person’s brain chemistry, genetic effects, human behaviours, emotional bonds and psychological factors do also throw a person under the claws of depression. Although any person belonging to any field of life and falling in any age group can become its victim, yet most commonly it attacks adults and adolescents. Under extreme effects of this disorder, a person secludes and sequesters himself and from society and shuns his normal-life activities, causing thereby a decline in his income, ergo standard of life. And, above all, such a person is often considered and disparagingly called lunatic or insane. Experts opine that this disease is fundamentally a hereditary and genetic disorder that is intensified by social, economic and political deprivations.
Depression is slowly, yet gradually, making its presence felt around the world. A report by World Health Organization, titled ‘Depression and Other Common Disorders, Global Health Estimates’ says that “the total estimated number of people living with depression increased by 18.4 percent in the 2005-2015 decade” and that “[t]he total number of people living with depression in the world is 322 million … Globally, it is estimated that 4.4% of the global population suffer from depressive disorder …”
An analysis of the report suggests that the largest number of those suffering from depression is living in India with an estimated 56675,969 people are suffering from depressive disorders. The next on this list are China (2nd) and the United States (3rd) with the numbers of such people reaching 54,815,739 and 17,491,047, respectively. Pakistan is at 7th position on this list with 7,436,224 reported cases.
A common misconception about mental disorders is that they are the problems of well-off people only. It is an absolutely unfounded and baseless conception because it attacks people belonging in developing and underdeveloped countries with same ferocity as it attacks their counterparts in the developed world. The veracity of this notion can be adjudged from the fact that among top ten countries, where depression is endemic, eight fall in the category of developing and underdeveloped countries – India, China, Brazil, Indonesia, Russia, Pakistan, Nigeria and Bangladesh.
Among developed countries, on the other hand, the United States and Japan are among top 10 countries. If we analyze the permeation of depression disorders in terms of population, we find that among 183 countries for which data were available, Ukraine was at the top of the list where 6.3 percent of country’s population suffered from depression disorders. Australia, Estonia and the United States closely followed with an approximate ratio of 5.9 percent. Pakistan is at 116th place on this ranking with 4.2 percent of country’s population suffering from depression disorders; women being more prone to depression than men. At global level, 5.1 percent of females and 3.6 percent of males are facing the menace of depression. Health experts believe that a big cause of depression among women is the hormonal changes under the effects of which one in every 100 women becomes a victim of depression during or after pregnancy.
According to the National Institute of Mental Health (NIMH), symptoms of depression in women may include persistent feelings of sadness or anxiety, worthlessness and helplessness, as well as a feeling of remorse. Common symptoms in men include fatigue and decreased energy, irritability and restlessness, loss of interest in favourite activities or hobbies, and insomnia and other sleep-related disorders. A depressed child may pretend to be sick, refuse to go to school, cling to a parent, or worry that the parent may die. Older children may sulk, get into trouble at school, be negative, grouchy, and feel that they are misunderstood.
In aged people, the most common symptoms include fatigue or being slowed down, restiveness, irritability, indecisiveness or difficulty in decision-making, longing for someone’s attention and Parkinson’s disease.
Mental stress may also lead to contracting other diseases including diabetes, cancer, cardiovascular problems and spasm and sometimes these ailments also cause depression. In addition, side-effects of drugs may also cause depression. An acute depression may spur a person to commit suicide which was the 20th biggest cause of deaths around the world in 2015. The WHO estimates that during 2015, as many as 788,000 people took their own life by committing suicide — nearly 1.5% of all deaths worldwide — bringing it into the top 20 leading causes of death. Furthermore, suicide was the second leading cause of death among 15-29 year olds globally, in 2015.
As per WHO’s Global Health Estimates 2016, most suicides were committed in India, where nearly 206,000 people took their own lives. India was closely followed by China and the United States at second and third place with the number of suicides recorded at 186,000 and 45,900, respectively. And, it is due to this fact that these three countries have the largest number of peoples suffering from depression. Pakistan was ranked 33rd in the world with as many as 3,913 suicides reported in 2015. When seen on a broader level, 29 percent of deaths caused by self-harm worldwide were reported in the South Asia.
High suicide rates – a suicide is committed every 40 seconds — as well as a huge number of cases of attempted suicide worldwide not only highlight the gravity of the situation regarding depression but also underscore the need for patients to undergo proper treatment. The principal cause behind a high ratio of 1:60 of suicide and attempted suicide cases, as reported by the WHO, is depression. It is also to be noted that a depressed person may become suspicious about near and dear ones and may even commit a homicide.
But, still, in many countries proper treatment of patients with depression unfortunately, is not given due importance. According to a report titled “Depression: A Global Crisis,” published by World Federation for Mental Health, fewer than 25 percent of people across the world have access to treatments for depression. And, it is because, in most countries, mental health is still a neglected domain. According to WHO, in 2014, nearly 45 percent of world’s population was living in the countries — 60 countries, in fact — where less than one psychiatrist was available for a population of 100,000 people; whereas the ratio of psychiatric nurses for the same was only 7.7.
Dr Ghulam Rasool, Professor of Psychiatry at Quetta’s Bolan Medical College and Executive Director Balochistan Institute of Psychiatry and Behavioural Sciences, asserts that among the biggest reasons why people hesitate on getting treatment for mentally-ill patients include insufficient awareness, lack of knowledge of its symptoms, failure to have proper treatment, non-recognition of mental disorders as an ailment and limited availability of proper treatment facilities — if some are available those are limited to big cities only. Another big problem is that a doctor cannot give proper time to a patient due to high rate of visiting patients. He opines that due to these factors only 2 percent patients pay a visit to a medical professional while 98 percent prefer to avail other sources including other doctors, paramedics, herbalists, midwives and/or a faith-healer. Dr Ghulam Rasool further says that under depression 70-80 percent patients may resort to using narcotics. He asserts that amidst the growing number of patient with depression disorders, the existing strength of 300 working psychiatrists in Pakistan is insufficient and there should be at least 9,000 of them to cope with the situation. As regards the matter of an ideal psychiatry team, he thinks that a professional psychiatrist must have a team comprising 4 nurses, 6 social workers and 4 psychologists to assist him.
If we look into the facts and figures on the availability of medical facilities in Pakistan, we find that as per WHO estimates, the ratio of psychiatrists per 100,000 population in the country is only 0.31 while that of psychiatric nurses and social workers is also meager i.e. 15.43 and 2.32, respectively. Hence, in terms of psychiatrists per 100,000 population, Pakistan ranks 89th in the world while in terms of nurses and social workers, the country is at 29th and 17th position, respectively. Moreover, the picture of mental healthcare facilities in Pakistan as presented by WHO’s Mental Health Atlas 2011 is that, in 2010, the number of beds for patients with mental disorders was only 3,231 which, in effect, means that there were 17.4 beds available for 100,000 people. Furthermore, there were 5 mental hospitals in the country having a capacity of only 1,825 beds which turns out to be only 0.98 for the abovementioned set of population.
Although this state of affairs regarding mental health is somewhat similar to that of the world in general, yet it calls for immediate attention of the policymakers. It is especially important because the circumstances we are faced with do make us feel depressed but one can avoid the repercussions with a little care and by staying more informed on its symptoms, preventive measures, as well as by getting proper medical treatment. But, unfortunately, owing to the taboos attached with this disorder, people hesitate to consult a professional doctor and undergo proper treatment.