The issue no. 9590 of The Lancet (September 9, 2007) contains several articles about mental health. As usual for the journal, a global perspective is given and social aspects of the problem are particularly addressed. S. Moussavi et al (1), analysing data from the World Health Survey of WHO, aimed at comparing the impairment in health state induced by depression with that due to four common chronic diseases: angina, arthritis, asthma, and diabetes.
Participants to the study (almost 250000 adults from 60 countries in all regions of the world) were asked to self-evaluate their health status, answering questions about the occurrence of disability in their daily life activities. Authors found that depression causes a health state impairment greater than the four physical conditions considered. The effect was much larger when depression was associated with one or more of the other diseases. In a comment (2), G. Andrews and N. Titov note that the finding is consistent with previous observations performed with different methods. They also remark that nowadays depression is treated in a small percentage of cases, although effective treatment is available.
A possible explanation for the frequent occurrence of clinical inertia in this field is that, as physicians, we are used to sharply separate what is “physical” from what is “mental” in our patients: may be we don’t take in mind enough that we have “whole” persons in front of us. This way, we risk to damage our patients seriously, not only because we leave untreated serious diseases, but also because many conditions, e.g. cardiovascular diseases, are worsened by depression.
It is also noteworthy, in the same issue of The Lancet, the comment by N. Sartorius (3) about social stigma that patients with mental problems have often to face.
Teodoro Marotta, Napoli,
Moussavi S et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 2007; 370: 851-858.
(2) Andrews G, Titov N. Depression is very disabling. Lancet 2007; 370: 808-809.