Depression a Big Factor in Poor Health

Sept. 6, 2007 -- Depression has a greater impact on overall health than arthritis, diabetes, angina, and asthma, but it all too often goes unrecognized and untreated, a report from the World Health Organization (WHO) suggests.

Based on interviews with almost 250,000 people living in 60 countries, WHO researchers found depression to be a greater predictor of poor health in patients with these chronic conditions than having one or more chronic medical conditions without depression.

People who had arthritis, diabetes, angina, or asthma were more likely to suffer from depression than people without these conditions.

And consistent across different countries and cultures, people with depression plus one or more of the chronic diseases included in the study had the worst overall health scores.

The findings, which appear in the Sept. 8 issue of The Lancet, illustrate the urgency of identifying and treating depression in patients with other chronic health problems and in the population as a whole, the WHO researchers conclude.

"We have to recognize that mental health is not a luxury. It is a necessity for good overall health," researcher Somnath Chatterji, MD, tells WebMD.

"Health care providers are so focused on the physical health of their patients that they often miss the signs of depression. But treating depression can have a big impact on overall health."

Depression Screening in New York City

Lloyd I. Sederer, MD, knows all too well the importance of identifying and treating depression in patients who see doctors for other health issues. When he was mental health commissioner in New York City, Sederer implemented a routine depression screening program now used in the city's municipal hospitals.

Prior to seeing their doctor, patients fill out a nine-question mental health survey. Their answers are scored numerically, with a high score suggestive of depression.

"When you go to the doctor they weigh you, take your blood pressure, and you get other tests that result in numbers," Sederer tells WebMD. "Patients and doctors understand numbers, so being able to talk about depression in numbers is important."

Sederer says as few as one in eight depressed people receive care for their condition that is considered minimally adequate.

"If this was cancer or tuberculosis or diabetes and one in eight people were getting minimally adequate care, the public wouldn't stand for it," says Sederer, who now serves as medical director for the New York State Office of Mental Health.

The hope, he adds, is that routine depression screening will become the norm in New York City and across the country once doctors become convinced that the self-reported test has value.

"Twenty one million adults in the United States suffer from depression and half a million depressed people between the ages of 18 to 55 kill themselves every year," he says. "This is a big problem."

Depression and Disease Connected

Mental health researcher Gavin Andrews, MD, says doctors must recognize the integral nature of mental and physical ailments in their patients.

"They should put as much energy into screening and treating depression as they put into treating angina, diabetes, arthritis, or any other chronic condition," he tells WebMD.

Andrews is a professor of psychiatry at the University of New South Wales in Sydney, Australia.

In an editorial accompanying the WHO report, he noted that less than 30% of patients in Australia receive adequate treatment for depression, compared to 90% of patients with asthma and 80% of patients with arthritis.

"Treatment for depression should at least be on a par with that for other chronic diseases," he wrote.

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