UNIPOLARMAJORDEPRESSION

SIR MICHAEL MARMOT GROUP

1

GROUP CONTRIBUTIONS

SHIRISH TIWARISlide Preparation and

Presentation

DR NEYANG NITIK

Data Collection from Books

DR MEENAKSHI MALIK

Data collection for Global Burden

DR ISHA SHARMA

Data Collection for NMHP

MRS SHALINI KUMARI

Data Compilation for NMHP

HEEYA MAITYWHO and Data

Compilation

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ABRAHAM LINCOLN

SIR MICHAEL MARMOT GROUP 3

WHAT IS UNIPOLAR MAJOR DEPRESSION ?

Unipolar Major Depression is a mentaldisorder characterized by pervasiveand persistent low mood that isaccompanied by low self esteem and bya loss of interest of pleasure inenjoyable activities. (3)

MANIFESTATIONS

Affects daily life for weeks or longer Interferes with social life

- Family and relationships- work and school life- Sleeping and eating habits

Implications on general health

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HISTORY

• Hippocrates – described Melancholia with mental and physical symptoms. (3)

• Sigmund Freud – Mourning and Melancholy

CLASSIFICATION

• DSM-I, 1952 AND DSM-II, 1968. (3)

• ICD – 10 By WHO

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RISK FACTORS

• Anemia, Epilepsy• Metabolic• Neurological and Metabolic

PHYSIOLOGICAL FACTORS

• Anxiety• Poverty• Family Pressure

SOCIAL FACTORS

SYMPTOMS

Restlessness and Irritation

Loss of Interest

Abnormal Appetite

Insomnia and Hypersomnia

EP

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Approx. 298 MN people affected as of 2010 (4.3%) of global population. (3)

Lifetime Incidence – 3% in Japan to 17% in USA.

Population Studies – UMD twice in women compared to men. (3)

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More common in urban than rural population. (3)

8.2% - global YLDs in 2010, making it the 2nd leading cause of global disability.

11th leading cause of global burden (or DALYs) in 2010. (6)

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GOLBAL BURDEN OF UNIPOLAR DEPRESSION

Global Rank of MDD (Acc. To WHO) (5)

Year Rank Cause DALYs (000s)

% DALYs DALYs per 100,000

population

2000 11 Unipolar depressive disorders64,300 2.2 1050

2010 9 Unipolar depressive disorders 76,500 2.8 1081

GHE Estimates 2014 : DALYs by Age and Sex (Acc. To WHO) (5)

Age group Sex

0-27 days

1-59 months 5-14 years 15-29 years

30-49 years

50-59 years

60-69 years 70+ years Total

Male 0 1,731 3,084,015 8,598,453 10,379,302 3,783,804 2,012,581 1,288,466 29,148,352

Female 0 2,759 4,796,559 13,222,569 16,511,919 6,321,185 3,600,032 2,896,867 47,351,890

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COMPARISON OF DALYs

Globally, Prevalence of MDD more in women than men (2012)

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

40,000,000

45,000,000

50,000,000

0-27 days 1-59months

5-14 years 15-29years

30-49years

50-59years

60-69years

70+ years Total

Male

Female

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Unipolar Depressive Disorders World Map(6)

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GBD OF DEPRESSION IN INDIA

Global Health Estimates – DALYs – By sex and age groups (2012).(5)

0

1000

2000

3000

4000

5000

6000

7000

8000

DALYs 0-4years

DALYs 5-14years

DALYs 15-29years

DALYs 30-59years

DALYs 60-69years

DALYs 70+years

All Ages

MALE 0.3 587.6 1543.5 2282.9 267 134 4815.3

FEMALE 0.4 876.9 2288.9 3474.2 458.1 269.2 7367.7

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GBD OF DEPRESSION IN INDIA

Global Health Estimates – DALYs in year 2000 and 2012. (5)

18% increase from year 2000 to 2012 of depressive disorder.

YEAR AGEGROUP

DALYs 0-4years

DALYs 5-14years

DALYs 15-29years

DALYs 30-59years

DALYs 60-69years

DALYs 70+years

All Ages

2000 2000 0.7 1400.8 3278.7 4393.1 547.7 271.6 9892

2012 2012 0.7 1464.5 3832.4 5757 725.1 403.3 12183

0

2000

4000

6000

8000

10000

12000

14000

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('0

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)

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WORLD HEALTH ORGANISATION

mhGAP – Mental Health Gap Action Plan.(8)

-“Scaling up care for mental, neurological and substance disorder”

- It was endorsed by 55th World Health Assembly in 2002.

- Mental Health : Evidence and Research Team (MER)

- Mental Health Atlas

- WHO-AIMS (Assessment Instrument for Mental Health Systems)

- WHO-MIND (Mental Health in Development)

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Objectives

Ensure Care for All

Stimulate Self Help

Promote Communication

Encourage Awareness

NATIONAL MENTAL HEALTH PROGRAMME

Started in 1982

Re -Strategized in

2003

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NATIONAL MENTAL HEALTH PROGRAMME

HOSPITAL BASED APPROACH

COMMUNITY BASED

APPROACH

10th 5 Year plan(2002-07)

DMHP-Country wise

Strengthening Central & State Mental Health Authorities

Increased Psychiatry content in Medical curriculum

Research & Training

11th 5 Year plan(2007-12)

DMHP with added components

Modernization of state run hospitals

Up gradation of psychiatric wing

IEC Man power

development

12th 5 Year plan(2012-17)

Integration of different components of NMHP to that of NRHM

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• 0.05% of total Health Budget – For Mental Health

• The 11th FYP of 2005 had an allocation of Rs.1000 crore for the NMHP

• Sum of 70 crore has been made available for 2008-09 for the further implementation of NMHP but this only constitutes 2.5% of the total health budget.

BUDGET ALLOCATION

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S. No. Resources Present Status (2011) Required Status

1 Psychiatrist 3000 11,500

2 Clinical Psychologist 500 17,250

3 Psychiatrist Social Workers

400 23,000

4 Psychiatrist Nurses 900 9,000

5 Number of Beds 300 30,000

• 7% of population suffers from mental disorders

• Point Prevalence - 10 to 20 per 1000 of the population

• <1 Psychiatrist for every FOUR lakh population.

MANPOWER RESOURCE IN INDIA

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SHORTCOMINGS OF NMHP

• Lack of manpower resources

• Lack of proper and effective monitoring and guidelines.

• Inadequate data about Health Status

• Poor feasibility of policies and implementation.

• No indicators to assess mental health

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RECOMMENDATIONS FOR NMHP

• Strengthening manpower

• Proactive role of State Government in the implementation of programmes.

• Preventive measures should be taken

• Manpower should be trained with Public Mental Health.

• Integrated with NRHM

• NGO works should be encouraged.

• Social Initiatives should be given preference

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Psychotherapy – Effective at preventing new onset of depression.

- Interpersonal Therapy

- Cognitive Behavioral Therapy

- Significant in severe cases of disorders.

- Mostly given with psychotherapy.

- E.g.:- SSRIs, Bupropion, Venlafaxine, etc.

- Significant decline in suicide rates.(3)

TREATMENT

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S. No. Low Resourced Setting High Resourced Setting

1 Routine screening for detection High-risk or routine screening with confirmation of diagnosis by skilled clinician

2 Psycho-education Psycho-education

3 Generic antidepressants Choice of antidepressants

4 Problem-solving treatment Choice of brief psychological treatments

CONCLUSION

• Mass awareness through education and promotion.

• Removal of Social taboos and stigmas (FAITH-HEALERS)

• People with illness should be joined to mainstream.

PACKAGE CARE FOR DEPRESSION.

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Sir Isaac Newton John Stuart Mill Abraham Lincoln

Robin Williams Mike Tyson

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IMPORTANT FACTS

World Mental Health Day – 10th October

Theme for 2014 – “Living with Schizophrenia”

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REFERENCES

1) The Hindu Newspaper - http://tinyurl.com/pzby9ow

2) National Crime Records Bureau – Suicides in India, 2013

3) Wikipedia - http://tinyurl.com/lealaug

4) http://obad.ca/information_depression#criteria

5) WHO Data on Global Health Estimates.

6) GBD Data on Depressive Disorder

7) Medscape - http://www.medscape.com/viewarticle/813896

8) WHO - http://www.who.int/mental_health/mhgap/en/

9) WHO - http://www.who.int/mental_health/maternal-child/en/

10)MOHFW - http://tinyurl.com/qgvu6ev

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“Depression begins with disappointment. When disappointment festers in our soul, it leads to discouragement.”- Joyce Meyer