How to Aid People With Depression in the Developing World

Depression is one of the most common conditions affecting Americans each year. In a country as developed as the U.S., health professionals can readily provide high-quality care to patients struggling with depression. Prescription medications have proven successful in treating and helping patients manage their depression, as have therapy and counselling programs. This is unfortunately not the reality for people affected by the same mental illness in the developing world.

It is estimated that 350 million people suffer from depression worldwide, yet less than 10 percent of people in developing countries have access to adequate treatment and care options. A study conducted in rural India found that just under 40 percent of the entire population suffered from some form of mild to moderate depression. Another study conducted in Pakistan found that 50 percent of all women living in rural areas suffered from some form of depression or anxiety. A study published in the Journal of the American Medical Association found that patients who had previously endured a traumatic event – such as conflict or fleeing their countries as refugees – had a significantly increased risk of experiencing recurring depression.

The World Health Organization (WHO) has recognized the severity of depression and its nature as a global health crisis. Conditions which commonly exist in developing countries, such as social and political instability, armed conflict, refugee crises, economic instability and food instability are all extremely high risk triggers for anxiety and depression disorders. According to the WHO, a disproportionate number of the world’s medical professionals practice in developed countries. There is a far greater availability of healthcare in places where it is least needed.

Depression is a disease which can limit a patient’s functioning and cause them a great deal of discomfort and suffering. The WHO has listed depression on their Mental Health Gap Action Program, and as a result, they aim to curb the rising number of individuals suffering from depression in the developing world. The plan is to provide adequate training and assistance to people who might not have extensive healthcare backgrounds, so that they can better assist people suffering from depression in developing nations.

There is a real and dire need to determine ways in which to combat depression in the developing world. With the support of the international aid community, organizations such as WHO can implement aid strategies to hopefully bring an end to the disproportionately high number of untreated depression patients living in the developing world.

– Tyler Troped

Photo: Flickr

The Severity of Depression in India

According to the American Psychiatric Association, depression is defined as “a common and serious medical illness that negatively affects how you feel, the way you think and how you act.” Depression is not just about someone being sad, but rather about an individual lacking the motivation to do anything, from their favorite activities to simply eating. With the disorder affecting 322 million people worldwide, it is a major health concern on a global level. Depression in India is, according to recent reports, at a severe level.

While depression has no limitations as to whom it affects, there are certain areas that have an exceptionally high number of people suffering from the disorder. India is one nation that has been proven to have high rates of depression. In 2016, the World Health Organization (WHO) ranked India as the most depressed country on the planet. The WHO also reported that more than 4.5 percent of the Indian population suffers from the mental illness. While 4.5 percent may not seem like a significant amount, it is actually equivalent to 56 million individuals.

Depression can be treated with several methods such as medication and therapy. However, Indians who suffer from the disorder lack the resources that they need, due to the fact that only .06 percent of India’s health budget is used for mental health purposes. This number is shockingly low in light of the fact that well-developed countries usually utilize at least four percent of their health budgets for mental health.

As recent studies have shown, there are only 0.301 psychiatrists per 100,000 individuals in India. With not enough psychologists, nurses and social workers, many who suffer from depression in India are not given the opportunity to receive professional help.

With depression rates in India on the rise, the government is making an effort to decrease depression rates. In March, Parliament passed the Mental Health Care Bill. This bill offers all Indians mental health care, prohibits electroconvulsive therapy on minors and decriminalizes suicide.

Despite advancements, depression still remains a serious issue in the country. However, with new policies constantly being devised, depression in India, as well as throughout the world, will hopefully decrease over time.

– Raven Rentas

Photo: Pixabay

Syrian Mental Health

During a 2015 study, the German Federal Chamber of Psychotherapists found that half of Syrian refugees had mental issues, while nearly three-quarters of those affected have witnessed violence and 50 percent have been subjected to violence themselves. The United Nations High Commissioner for Refugees (UNHCR) cites that the most common clinical disorders regarding Syrian mental health are “depression, prolonged grief disorder, posttraumatic stress disorder and various forms of anxiety disorders.”

A Chinese study found that children who experience the deprivation of parental care are at higher risk of intellectual and emotional struggles. Larger volumes of gray matter, which indicates “insufficient pruning and maturity of the brain,” appeared in children subjected to substantial parental absence.

Essential rights including education and access to health services are often absent among displaced refugees and children are more likely to be exposed to human trafficking. According to the United Nations High Commissioner for Refugees, Syrian refugees total 4.8 million and almost half of that number are children.

The International Medical Corps (IMC) found that Syrian refugees and internally displaced persons (IDP) have extremely limited access to mental health facilities and 54 percent suffer from severe emotional disorders like depression and anxiety.

Refugee policies in Syria’s neighboring countries such as in Lebanon are also harmful to fostering Syrian mental health for refugees, such as the inability for the establishment of permanent refugee camps and forbiddance of Syrians to work in the country. The United Nations Population Fund (UNFPA) found that 41 percent of Syrian youth in Lebanon have experienced suicidal compulsions.

However, during the Obama administration in the summer of 2016, Secretary Kerry announced a rise of an additional $439 million in humanitarian assistance for Syrians including increased access to mental health services. Emergency relief funding aims to support non-governmental organizations (NGOs), international organizations and United Nations operations, especially those addressed in the eight billion dollars U.N. appeal of 2016 for Syrian aid. Included in the funding is $130 million to the UNHCR to provide mental health support and child protection for IDPs and refugees, while an additional $36 million to Turkey also provides mental health support through the International Organization for Migration (IOM).

– Amber Bailey

Photo: Flickr

Poverty and Depression in the Developing World

In 2003, psychiatrists Vikram Patel and Arthur Kleinman suggested that there is a correlation between poverty and depression, as well as other common mental illness, in developing countries. They argued that the “experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health” explain why impoverished people are so vulnerable to mental illnesses such as depression.

In the United States, as of 2011, 30.9 percent of people in poverty are depressed. While this isn’t a global statistic, it does illuminate the relationship between the global depression phenomenon and global stressors, such as insecurity, violence, etc. These external factors are crucial to the development of depression, but so are internal or hereditary ones; a combination of the two is what neuroscientists now believe causes the neurological disorder.

Studies of the neurology of depression center around the neurotransmitter serotonin, a chemical messenger found in the brain associated with feelings of well-being, mood regulation, memory and cognition. Neurons release serotonin into the synaptic cleft, the space in-between neurons, and receptors on adjacent neurons receive it.

Different receptors have specialized effects. The two most important serotonin receptors in depression research are 5-hydroxytryptamine receptor 1A (5HT1A) and 2A (5HT2A.) The former is associated with increased activity, while the latter is associated with decreased activity.

One theory is that depression is caused by an uneven ratio of 5HT1A to 5HT2A receptors, with an excess of 5HT2A. This is an hereditary occurrence that leaves one more prone to depression, though not necessarily depressed. If there is insecurity, violence, etc. in this person’s environment, however, he or she is likely to develop symptoms of depression.

Another theory suggests that people suffering from depression naturally produce less serotonin than those who do not. This is, again, genetic and will only ever make one vulnerable to depression; it’s most likely a combination of genetic predisposition and external influences from one’s environment that cause this mental illness.

To counteract genetic predispositions to depression, neurologists, commonly use an antidepressant medication called selective serotonin re-uptake inhibitor (SSRI) drugs. They block what is called re-uptake, a process during which neurotransmitter transporters limit the amount of a neurotransmitter – in this case serotonin – in the synaptic cleft by taking it from receptors and driving it to other areas of the brain. Blocking re-uptake increases one’s serotonin levels where it counts, in the synaptic cleft where neurons communicate.

The effects of this medication may seem counter intuitive.

“Regardless of the emotion being happy or sad it would seem SSRI drugs dampens the experienced intensity of the emotion,” said Albert Gjedde, a neuroscientist who studies antidepressant SSRI drugs. “People in treatment with SSRI dugs describe it as if the peak of their emotions are cut away.”

Drugs such as SSRIs can help people with innate biases toward depression, but until poverty and its consequences are reduced, there will always be those at risk. Neuroscientists and philanthropists must work in tandem to mitigate the effects of depression and, eventually, to annihilate it.

– Adam Kaminski

Sources: The Atlantic, ScienceNordic
Photo: Salon