Sunday, October 21, 2007


The mental, physical, and financial cost of depression

Peter Singer
(The writer is professor of bioethics at Princeton University. Courtesy: Project Syndicate)

Depression is, according to a World Health Organisation study, the world’s fourth worst health problem, measured by how many years of good health it takes away. By 2020, it is likely to rank second, behind heart disease. Yet not enough is being done to treat or prevent it.

The study, led by Saba Moussavi and published last month in The Lancet, also revealed that depression has more impact on the physical health of those who suffer from it than major chronic diseases like angina, diabetes, arthritis, and asthma. Yet in the same issue of The Lancet, Gavin Andrews and Nickolai Titov, researchers at the University of New South Wales, reported that Australians with depression are far less likely to receive an acceptable level of care than patients with arthritis or asthma. This pattern is consistent with reports from other developed nations.

Treating depression is often, if not always, effective. Even in narrow cost-benefit terms, it makes sense to spend more on treating depression. A study of 28 European countries found that depression cost them 118 billion euros in 2004, or 1 per cent of their combined GDP. The cost of treating depression accounted for only 9 per cent of this sum. Richard Layard, of the Centre for Economic Performance at the London School of Economics, has said that mental illness is Britain’s biggest social problem, costing 1.5 per cent of GDP. He estimates that while treatment may cost £750 per patient over two years, the result is likely to be an extra month of work, worth £1880. Layard advocates more psychotherapy rather than drug treatment.

In the US, a research team headed by Philip Wang of the National Institute of Mental Health in Rockville, Maryland, reported similar results last month in the Journal of the American Medical Asso-ciation. Wang’s team conducted a randomised controlled trial that showed that depression screening to find workers who could benefit from treatment would help reduce health insurance costs to employers, decrease absence due to sickness and increase job retention and productivity.

Depression is also costly in developing countries. In China, according to a recent article by Teh-wei Hu and colleagues in Social Psychiatry and Psychiatric Epidemiology, depression costs 51 billion renminbi, or more than $6 billion per year at 2002 prices. A few years ago, a research team led by Vikram Patel reported in the British Medical Journal that depression is common in Zimbabwe, where it was often known by a Shona word that means “thinking too much”.

Around the world, many primary care physicians lack the training to recognise mental illness and may not be up to date with treatment options. Patients, too, may fail to seek treatment, because mental illness still carries a stigma that can make it harder to acknowledge than a physical illness.

The problem has been aggravated, in the US at least, by the refusal of some health insurance policies to cover mental illness. Thus, the US Senate’s recent approval of the Mental Health Parity Act is a significant step forward. The legislation, which still has to pass through the House of Representatives, would require health insurance plans provided by employers to cover treatment for mental illness at a level similar to coverage for general health care.

Unfortunately, the legislation will do nothing for the 47 million Americans who have no health insurance at all. Can we prevent depression? Some depression appears to be genetic, in which case genetic therapy may offer a solution. But much of it appears to depend on environmental factors. Perhaps we need to focus on aspects of living that have a positive effect on mental health.

Recent studies show that spending time relaxing with family and friends contributes to how happy people are with their lives, while long working hours, and especially long commuting times, contribute to stress and unhappiness.

Relaxed, happy people can still become depressed and stressed and unhappy people may not be depressed, but it is a reasonable hypothesis that happier people are less likely to become depressed.

See: Alternative medicine for treating depression

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