Article by: Chaitra Jawalkoti MPH, B.Sc. Microbiology
WHO defined “Depression is a common mental disorder, characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks”
Depression is most common illness affecting people of all ages, genders, socioeconomic groups and religions all over the world. Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Today, 350 million people are affected by depression. In 2011 the World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression. In 2015 estimated 322 million people were affected by depression globally and the proportion of the global population with depression is estimated to be 4.4%. Depression is more common among females (5.1%) than males (3.6%) (4). Globally, depression is ranked as the largest single contributor to non- fatal health loss, accounting 7.5% of global years lived with disability (YLDs) and 2.0% of global disability adjusted life years (DALYs).
All over world depression is most common illness affecting people of all ages, gender, socioeconomic group and religions . 322 million people in 2015 were affected by depression globally and 4.4% proportion of global population is estimated to be with depression.
The lifetime rates of uni-polar depression (i.e., major depressive disorder and dysthymia) are approximately 20%. Among adolescents with uni-polar depression approximately 80% experience major depressive disorder (MDD) by itself or in conjunction with a non-affective disorder, 10% experience dysthymia without MDD and 10% experience “double depression” i.e. dysthymia with MDD . 8.2% was lifetime prevalence of alcohol use and 9.4% of substance abuse.
The developmental effects of mental health symptoms on substance use has two competing hypothesis:
1) distal mental health problems will be more associated with substance use, that represent early emerging mental health problems which are more severe and associated with difficulties, or
2) mental health problems occur closer in time to substance use and have stronger effect than distal occurring as proximal predictors are stronger than distal predictors .
Depressive symptoms and conduct problems are the most strongly associated categories of mental health with substance use during adolescence. Depression is highly comorbid with anxiety, delinquency and aggression in predicting substance use and typically depression presents with the context of a multi-symptom profile. Current and lifetime major depressive disorder are significantly associated with substance dependence, panic and generalized anxiety disorders and several personal disorders.
The factors associated with depressive and substance use disorders are severe mood symptoms, longer duration of illness and either disorder of isolation. Positive association have been derived between heavy alcohol use and later depression symptoms among adolescents. It also includes genetic predisposition, exposure to prenatal environmental factors, biologic environmental risk or non-biologic environmental risk like disruptive family. Phobias preceded development of alcohol use as self-medication for symptoms of negative affect. Personality traits also play an important role in developing additive behavior like alcohol dependence and associated disorders. The co-occurrence of transience and depression are associated with other mental health disorders.
Binge drinking is also associated with depression. Sexual assault, physical injuries, hangover symptoms and academic compromise are associated with binge drinking. In a study done by, Nourse R et al. titled as, “College binge drinking and its association with depression and anxiety: a prospective observational study”, 29.4% reported they experienced depression before they started drinking, 14.9% reported depressed feelings after drinking, 8.4% reported that drinking made their feelings of depression worse and 15.9% reported drinking lessened their feelings of depression.
Depressive symptoms differ with age, gender, socioeconomic status, ethnicity, life stress, social support and coping. Symptoms like stress experiences, stress reactivity and anxiety are associated with alcohol use in girls at higher rates and men have alcohol use disorder without depression. Family conflict and peer deviance are among reasons that result in depression and alcohol use but in males depression and alcohol use appeared to be independent variables while for females depression and alcohol use were associated with each other through risks such as peer deviance. Women with comorbid condition believe that drinking can provide relief from depressive symptoms and dysphoric states. Adolescents who reported increase depression and conduct disorder symptoms in 6th to 9th grade reported substance use related impairment in 12th grade.
Impact of depression lead to occurrence of suicidal ideas and suicide attempts. For incidence of disability major depression and alcohol use disorders are the risk factors. This study derived that magnitude of co-morbidity with psychiatric disorders was greater for drug disorders than alcohol disorders.
Depression is a disorder that can be easily diagnosed and treated. The intervention of case management and psycho-social interventions led by trained health counselor and supervision of mental health specialist and medication was found effective. Group cognitive behavioral therapy for depression may also improve outcomes by reducing association between depression and substance use.
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