World Health Day | Depression has gone up 18-20% over the past decade: Dr Henk Bekedam

On World Health Day, WHO Representative to India talks about their campaign to get more people with depression to seek treatment.

The theme for World Health Organisation’s World Health Day on April 7 2017 is “Depression: let’s talk”. According to the latest WHO’s estimates, 322 million people are living with depression worldwide, with the numbers increasing from by more than 18% between 2005 and 2015. Close to one in 20 people (4.4%) are affected, with depression being more common among women (5.1%) than men (3.6%).

About 322 million people are living with depression worldwide.(Representative image)

WHO Representative to India Dr Henk Bekedam tells HT about WHO’s campaign to get more people with depression seeking help and get treated.

Why was depression been chosen as the theme?

Depression is something that’s there. It affects 4-5% of the people, globally, including in India. It’s not a rare disease, it is everywhere. In that sense, depression is far more close to communities than it is acknowledged. It is also one of those things you don’t like to talk about. People with depression often find it difficult to come forward, and people around them sometimes find it difficult to recognize it and to reach out.

On World Health Day, WHO wants to create awareness about depression. For those with depression, that they are not alone, that is actually something many others are struggling with; but also for all of us that we have a role in this.

Read | The great depression: Understanding the cause of suicides in India

I was very impressed that the Prime Minister (in Mann Bi baat) emphasized that depression is both preventable and it’s curable. That people (with depression) should be ready to confront it and others around them must reach out and support.

Why is it still so under-diagnosed?

When you are depressed, it’s very difficult to confront it because you’re still struggling with the depression itself. You don’t have the confidence to say something, you doubt yourself. And many people don’t know how to respond. People in the direct environment need to pay more attention (to signs).

Will India’s new Mental Healthcare Bill help destigmatise mental health disorders?

What’s very important is that it has decriminalised suicide. I don’t know if you or anybody close to you has dealt with suicide, but I have, and people are never the same again. They struggle because they have questions that never will be answered. Depression in its lethal form can lead to suicide and in that context the bill is very important.

The human rights approach in mental healthcare bill is also very progressive. It gives more power to the patient to decide about their own well-being, so I think we see a lot of positive things in the bill.

It’s very well to ask people to talk about depression, but India doesn’t have enough psychiatrists to treat them. How can India deal with the shortage?

There is a shortage and we need to be working on this part, but there is a plan under the mental health policy in 2014 that is being implemented in 339 districts in India, which is very encouraging.

In general we have shortages in India, but these are even more in rural areas. India’s mental health programme may not change the availability of services overnight, but it at least recognizes it. Healthcare workers are being made more aware about mental health issues so they become the first point of contact. This is a very realistic plan. India cannot start aiming to have psychiatrists in every district overnight, but it has very realistic plan on how to move forward.

Does urbanisation contribute to depression?

Socio-economic factors can be causes or challenges. One of the more dramatic things in life is movement – especially when people move from a rural setting to an urban one and things change. The family and community structure is very different. Some people cope every well with it but some struggle.

Urbanisation -- which is a part of economic growth and India is in a very fortunate phase of economic growth -- is expected and will continue. With economic growth, many people go to the cities because they think the jobs are in the city. It also makes people less active. The first thing people do when they move to urban areas is put their bicycles under a tree and then they are either waiting for a bus or using some other form of rapid transport.

Lifestyles have also changed. When I was a young boy, I was climbing trees and playing football. My daughters are attached to the electronic device and while they enjoy most parts of it, it lowers physical activity. But you can also use mobile devices for the better, such as using them to track physical activity. I compare notes with some of the people in my office – by the way, I’m mostly beaten, I’m not walking enough but I’m very happy others are – and this helps create awareness. I think we can use new devices and tools both ways.

Is depression actually going up or is it just linked to population growth?

Depression has gone up as a percentage, it’s not just population growth – the rates have come up by 18-20%. Urbanisation is definitely an issue and the modern way of living and communication. Some of my colleagues only communicate by email, and I say, your colleague is sitting just 20 metres away, why don’t you enter the room and start talking?

There’s also the pressure. I’ve been in Asia for 20 years and in countries like China and Korea, people have fewer children and the pressure on children to do well is enormous. My girls who grew up in Asia and my seven year-old daughter could play with a friend he had only on Saturday between 1 pm and 3 pm and between 4 pm and 6 pm because in the morning she had piano lessons, math lessons, extra lessons for English etc. And that was a seven year old! I didn’t do any homework till I was 12!

How important is physical activity?

Being physically active helps you in many ways to deal with challenges. In Asia, including India, physical activity gets less compulsory when children are 16-17 (years old) and have sit for Board exams. I’d like to urge schools encourage physical activity because it helps children physically and mentally. Replacing physical activity classes by math and physics is something I really hope the ministry of education will come down strongly on. Physical activity must remain compulsory throughout studies.