Mental illness is a group of disorders characterized by abnormal mood, thought, and behavior. The Centers for Disease Control (CDC) has reported that only 17% Americans are in optimal mental health, which means that 83% or 265 million Americans suffer from some sort of mental disorder! Judging by some of the events, incidents, words, actions, and behaviors that the world has been privy to in this great country, that may make some sense. But jokes apart, that is a shockingly huge number. How do we continue to function as a nation with these terrible illnesses affecting so many people? Let us look at the numbers first.
The most common mental illness globally is major depression. Over 350 million people across the world suffer from it as reported by the World Health Organization. This may well be an underestimation as mild to moderate depression may remain undiagnosed due to lack of care seeking. Overall it affects approximately one-third of adult Americans. This means that more than 82 million adults in the United States alone are inflicted with depression. The mind boggles at this statistic – one out of every four Americans is depressed.
It has been estimated that by the year 2020, depression will be the second leading cause of disability worldwide after heart disease. Women are twice as likely to suffer from it than men and men, historically, are less inclined to seek care or even report symptoms of depression. Teenagers and elderly people commonly have undiagnosed depression, a very worrisome trend in two vulnerable cohorts of the population, since mental illness frequently presents during teens and the elderly are at elevated risk of disability and death due to it. In children, symptoms like social withdrawal, mood swings, substance use, and poor school performance, are subtle red flags and must be evaluated by a physician or psychiatrist for early diagnosis and treatment. Similarly, in the elderly, poor appetite, weight loss, and emotional lability may be clues to the diagnosis.
There is emerging evidence that depression is related to worse health outcomes due to chronic diseases like diabetes, cancer, obesity, asthma and risky lifestyle patterns including smoking, alcoholism, poor sleep hygiene, and physical inactivity. It also results in high incidents of suicide, which is the cause of more lives lost than the combination of murder, war and natural disasters! In the last decade, the suicide rate among Americans between 45-64 years has increased by 30% overall and by 50% in white middle-aged men, the majority of which are preceded by depression.
The problem is compounded by the fact that it is often undiagnosed and under-treated due in part to the stigma associated with it. The common symptoms of depression include irritable mood, persistent sadness for two or more weeks, low energy, hopelessness, poor self-worth, loss or gain of appetite, poor concentration, anxiety, lack of enjoyment in activities that were previously enjoyable, and thoughts of suicide. There may be symptoms of back pain, headache, joint pain, and other non-specific complaints that have no explanation. Fibromyalgia often has underlying depression. Other warning signs may indicate suicidality, for example sudden social withdrawal, unkempt look, drug or alcohol abuse, and drastic changes in behavior.
Depression screening tools are available to the primary care physicians for easy diagnosis and it is critical that they screen all their patients routinely during office visits as recommended by the US Preventive Task Force since there is evidence that treating depression decreases overall morbidity. Treatment for depression includes structured psychotherapy for mild cases, anti-depressant medications with psychotherapy for moderate to severe depression, and social support measures from family and the community. Exercise programs are vital for preventing depression in the elderly. The recent death of Robin Williams will hopefully bring more attention to this stigmatized disease that has remained unrecognized as the silent killer for a very long time. Patients who suspect they may have some of these symptoms must be proactive in discussing it with their doctors.
Special request from Dr. Pandey: If you are willing to share your story about mental illness to help other people you are more than welcome to do so. Peer experiences remind people that they are not alone.
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