It sucks hope and deforms perspective. Depression is not just feeling a bit "down" – at its worst, it's about being devoid of feeling altogether, as Matthew Johnstone says in his video I had a Black Dog, which has had close to 8 million views.
Friday April 7 is World Health Day and this year's theme is depression and common mental disorders with a slogan of "Let's Talk".
![A University of Queensland report estimates that rates of depression had increased 18.4 per cent in the past 10 years.](/web/20170415200650im_/http://www.canberratimes.com.au/content/dam/images/g/v/f/p/t/y/image.related.articleLeadwide.620x349.gvfntc.png/1491542752650.jpg)
Researchers from the University of Queensland have released a report for the day providing key statistics to put the prevalence of depression and mental health issues in perspective.
The report estimates that 322 million people worldwide were suffering depression in 2015 – this is about 4.4 per cent of the world's population.
"A similar number suffered from anxiety disorders," UQ's Professor Harvey Whiteford said.
"The consequences in terms of health loss are massive, with depression ranked as a leading contributor to global disability.
"Depression is also a major risk factor for suicide-related deaths."
In fact, according to the World Health Organisation, suicide as a result of depression is now the second leading cause of death among 15 to 29-year olds.
The UQ report also estimated that rates of depression had increased 18.4 per cent in the past 10 years.
"This increase is due to population growth and ageing, with more people living into the ages where depression is most common," UQ's Dr Alize Ferrari said.
Mental and physical health
As if the mental health statistics weren't enough, there are "very strong" links between our physical and mental health.
Nearly half of those with depression or anxiety have a physical illness, while having a physical illness is "one of the strongest risk factors for depression".
That includes diabetes: those with depression are more likely to develop type 2 diabetes (T2DM) and those with diabetes are two to three times more likely to develop depression than the rest of us.
Why?
Depression or emotional stress affect a number of factors including our sleep quality, immune system and are more likely to lead to unhealthy behaviours, explains Professor Jane Speight of The Australian Centre for Behavioural Research in Diabetes.
"For example, it has been shown over an 18-year study that those with higher levels of emotional stress were at 33 per cent increased risk of developing T2DM during the 18-year follow-up," Speight explains. "Analyses showed that this association might be mediated by sleep quality, low energy level and impaired health. We know that depression affects sleep quality and quantity."
She says there is less understanding about why those with diabetes are more at risk of developing depression, but says they believe it may be a combination of biological factors, stressful life circumstances, unhealthy behaviours, and also a personal or family history of depression.
"Diabetes-specific contributors may include the chronic nature of the condition and complex management regimens," Speight adds. "As various factors can contribute, the exact cause will be different for every person. "
The good news
Despite how it can feel, depression is not a life sentence.
"Depression can be prevented and treated," says WHO in a statement, noting that the purpose of the campaign is to get more people to seek and get help. "A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and lead to more people seeking help."
"It is vitally important that those people living with diabetes who experience symptoms of depression seek help," adds Diabetes Victoria CEO Craig Bennett. "Diabetes health professionals need to understand how to identify depressive symptoms and be prepared to discuss mental health issues."
Matthew Johnstone was once overwhelmed by his "black dog". Not any more. He sought help and learned to keep it in check. There is always hope and perspective can be achieved with support.
"We are not the sum of our experiences, and this is hugely important when considering mental health," he says. "There can be glitches in our lives but they can be managed; we can overcome them and become a better person if we start talking and seeking help."
First we need to talk
In a new paper, Vikram Patel – a psychiatrist, professor of International Mental Health at the London School of Hygiene & Tropical Medicine and one of Time magazine's most influential people in the world – suggests a new framework for understanding depression.
Right now, he argues that it is "binary" and either you have it or you don't. Many with "mild to moderate" symptoms fall through the cracks.
Rather, he suggests we need to look at depression as a continuum ranging from well to distress to disorder. This, he believes, can help us to see depression in its diversity and allow for an equally diverse range of treatments.
The majority of those experiencing moderate symptoms "would do just as well with low-intensity interventions such as self-care, web-based psychological therapy, and social support as with clinical interventions," he says, while clinical interventions "are mostly effective for the severe forms of depression".
Such "preemptive" care could not only improve mental health at a population level, it also enables the clinical sector to attend to those with severe disorders, Patel argues.
While the model is not bulletproof, it might just help us to recognise that depression is not one-dimensional, nor does one type of approach help everyone. But first, for anything to work, we need to talk.
"There is no doubt whatsoever that we must talk about depression more openly," Patel says, "but we must ensure that people experiencing depressive symptoms are always at the heart of the discourse."
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