About World Health Day
On April 7th last year the theme of World Health Day was Diabetes. This year’s theme was one to which diabetes is linked because this disorder can affect decision-making abilities, memory and self-management. This disease can make persons unable to function effectively or to participate in family or community life. Indeed, depression can also contribute to diabetes and the presence of one disease requires screening for the other. The disease burden of both conditions is higher for persons in low and middle income countries and the prevalence of these diseases continues to increase annually at an alarming rate; over 300 million persons are estimated to have depression globally whereas 415 million persons are estimated to have diabetes.
Depression is a mood disorder that, for at least two weeks, includes loss of interest or pleasure in usual activities or depressed mood and four of the following:
• suicidal thoughts,
• loss of energy or fatigue,
• weight change,
• unintentional purposeless movement/ slow movement,
• feelings of worthlessness,
• poor concentration or indecision,
• insomnia or hypersomnia.
There is often not just one cause of depression. Stressors triggered by adverse life events may cause an unchecked downward spiral due to isolation, negative self-criticism and poor coping choices. Abused substances such as narcotics and alcohol can increase the risk of a depressive disorder. Depression may also be genetic, especially among first degree relatives. In fact, research is ongoing about genes related to the serotonin system linked to depression.
The World Health Organisation’s recent campaign for World Mental Health is entitled “Depression: Let’s talk”. This slogan underscores a few truths, one of which is that not many persons really talk about depression, that the stigma of mental health issues extends to this condition in spite of the statistics that one in six persons are affected in U.S. and that clinical depression may be the largest contributor to disability worldwide.
The symptoms or signs may be difficult to discern and may be attributed to moodiness, something a person can “snap out of”, or weakness. Persons with depression may subsequently be exposed to greater cruelty due to pervasive misunderstandings. Furthermore, seeking help is a difficult step for persons who suffer from depression, who may be faced with disinterest, absence of true empathy or compassion or incorrectly applied resources. Is medication needed? A psychiatrist? A psychologist? A counsellor? A support group?
The World Health Organisation describes depression as a black dog. While we may not appreciate this characterisation of our favourite colour or pet, the metaphor is effective. Depression can be aggressive and hijack a person’s life or can be made to “heel” and taught new tricks. Caregivers should understand their own boundaries, offer support and introduce their loved one to someone who has the training or the expanse of compassion or life experience to be helpful. While cognitive behavioural therapy and mindful meditation can help to change patterns of negative thought, most of all persons with depression should hold on to hope and look forward to no more black dog days.