Black dog: the future pandemic?

Sir,

Depression is sometimes referred to as the “Black Dog”. Just like a real dog, it needs to be embraced, understood, taught new tricks, and ultimately brought to heel.¹ Depression is a common illness worldwide, with more than 300 million people affected; it is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Depression is the leading cause of ill health and disability worldwide.¹ An increase of more than 18% between 2005 and 2015 makes depression a real global threat.²

Depression results from a complex interaction of social, psychological and biological factors. People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Although there are known, effective treatments for depression, fewer than half of those affected in the world receive such treatments.³ Effective community approaches to prevent depression include school-based programmes to enhance a pattern of positive thinking in children and adolescents. Exercise programmes for the elderly can also be effective in depression prevention.¹

The theme for World Heath Day 2017 was “Depression – Let’s talk” the goal of the campaign is that more people with depression, everywhere in the world, both seek and get help. Depression is one of the priority conditions covered by WHO’s mental health gap action programme.

According to WHO out of the 322 million people living with depression worldwide, nearly half of them live in South East Asian and Western Pacific region, reflecting relatively large populations of India and China. 4.5% of Indians are affected by Depression and for depressive disorders; years lived with disability (YLD) in India was 7.1% of total YLD.² A World Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated response to mental disorders at country level following which India has formulated the Mental Health Care Act, 2017 which is set to be on ground in the near future, one of the main component of the act is community based rehabilitation (CBR), which is a service delivery program to provide rehabilitation services to persons with mental illness using existing community resources with an aim to promote their reintegration in the community. The ultimate goal of rehabilitation is to make the person with mental illness independent in all aspects of their lives, financial, social, relationships building and maintaining. Such rehabilitation services shall be offered in various settings including, mental health establishments, community centres and homes.⁴

Barriers to effective care include lack of resources, dearth of trained health-care providers, and social stigma associated with mental disorders. India, for instance, has less than 4,000 psychiatrists to treat its mentally ill people. Now is the time for India and the global countries to act rightly towards preventing a possible future pandemic.

REFERENCES

1. 1. Mental Health. World Health Organ. Available at: http://www.who.int/mental_health/management/depression/en/. Accessed on 26 September 2017.
2. 2. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
3. 3. Depression. World Health Organ. Available at: http://www.who.int/mediacentre/factsheets/fs369/en/. Accessed on 26 September 2017.
4. 4. The Mental Health Care Act, 2017. Available at: http://www.prsindia.org/uploads/media/Mental%20Health/Mental%20Healthcare%20Act,%202017.pdf . Accessed on 26 September 2017.