| ashu |
Posted
on 18-Jun-03 06:07 PM
Black people are 40 percent less likely to experience
depression than Hispanic or white people, the survey said.
On the other hand, blacks who develop the disorder are 30
percent more likely to suffer lasting or recurring
depression.
People living in poverty are nearly four times as likely to
suffer chronic depression as affluent people, the survey
reported.
Younger people are also at risk. Among those experiencing
depression in a one-year period, three times as many people
were from 18 to 29 as were 60 and older.
That depression strikes so early in life is an important
reason why it is such a significant health problem
worldwide, Dr. Kessler said.
"Hypertension and arthritis start at age 55," he said.
"Depression starts at 15 or 25. So the number of years of
suffering in a person's life is much higher."
A third paper in the journal focuses on the high rate of
doctors' suicides. Although no recent studies of suicide
among doctors in the United States have been conducted,
doctors in international studies have been found to be
significantly more likely to commit suicide than other
people of their sex and age.
Although in the general population men are more likely than
women to commit suicide, among doctors, women and men are
equally at risk.
Because so many American doctors have quit smoking, their
health is generally better than that of other people their
age.
"Doctors have lower heart disease rates and lower cancer
rates," said Dr. Daniel E. Ford, of the Johns Hopkins
University Medical Center, an author of the study. "The
suicide rate really sticks out there as the one rate that's
different."
The numbers suggest that doctors are not as adept as they
should be at recognizing and treating depression and mood
disorders, said Dr. J. John Mann of the Columbia University
Medical Center, president of the American Foundation for
Suicide Prevention and another author of the study.
"Physicians need to take better care of themselves and
translate that into the way they care for their patients."
Dr. Insel, an author of an editorial in the journal on
depression, noted that doctors were better at treating the
disorder than at understanding it.
"We don't understand the pathophysiology," he said. "And
there is no biomarker. We don't have a P.S.A. test for
depression."
That was a reference to the blood test used to help
diagnose prostate cancer.
A better understanding is crucial, Dr. Insel said, because
depression affects the entire body.
"It's not just people feeling lousy," he said. "Depression
affects the cardiovascular system, the endocrine system,
even bone growth leading to osteoporosis."
Depression develops in one in four people who have had
heart attacks. When it strikes, the risk of dying is three
and a half times greater than if the victims were not
depressed, studies show, making it as great a risk factor
as smoking.
A study of nearly 2,500 people, also in the journal, looked
at whether treating for depression after a heart attack
would improve survival. Treatment, with antidepressants or
counseling, was found to reduce depression and improve
social functioning, but it did not influence survival.
Dr. Susan M. Czajkowski, a research psychologist at the
National Heart, Lung and Blood Institute who is an author
of the study, said future studies might find that stronger
treatments or therapy at a different time, perhaps before
the first heart attack, might make a difference in
survival.
"We need another trial," Dr. Insel said. "We need a really
serious large-scale study to see whether you're going to
save lives in people who've had a heart attack by treating
their depression."
http://www.nytimes.com/2003/06/18/health/18DEPR.html?ex=1056940388&ei=1&en=2e639b2d298e8b73
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| ashu |
Posted
on 18-Jun-03 06:07 PM
More Americans Seeking Help for Depression
June 18, 2003
By MARY DUENWALD
More than half of the Americans who suffer from depression
now seek treatment, up from one-third 10 years ago, a new
survey says. Yet nearly 60 percent of the people in
treatment do not receive adequate care, the researchers
found.
More than 16 percent of Americans - as many as 35 million
people - suffer from depression severe enough to warrant
treatment at some time in their lives, according to the
National Comorbidity Study, sponsored by the National
Institutes of Health and published today in a special issue
on depression of The Journal of the American Medical
Association. In any given one-year period, 13 million to 14
million people, about 6.6 percent of the nation, experience
the illness.
The numbers are similar to those found in the first survey
10 years ago. At that time, the lifetime prevalence of
depression was measured at nearly 15 percent and the
one-year figure at 8.6 percent.
Depression costs employers $44 billion a year in lost
productive time, according to a second survey reported in
the same issue of the journal. That figure is $31 billion
more than the amount lost because of illnesses in people
who do not have depression. The participants were asked
about their wages and lost hours.
Most of the lost time occurs while people are at work, said
the lead researcher, Dr. Walter F. Stewart, an
epidemiologist now at Geisinger Health Care Systems in
Danville, Pa.
"People are making it to work," Dr. Stewart said. "They're
just not engaged in work. They're getting to the door, but
then closing it and just not functioning. People have
called this `presenteeism,' and it is often invisible to
employers."
An important reason that people with depression fail to
receive proper care, said Dr. Ronald Kessler, the leader of
the N.I.H. survey who is a professor of health care policy
at Harvard, is that many people seek help from family
doctors, who often do not treat depression aggressively.
"Family doctors are apparently not yet up to speed enough
to give good quality care," Dr. Kessler said.
In the survey, which included interviews with more than
9,000 people, treatment was considered adequate if it
consisted of at least eight half-hour sessions of
counseling with a mental health professional or treatment
with antidepressant drugs for at least 30 days, combined
with four visits to a doctor.
In some cases, the researchers found, patients with
depression were given just 5 milligrams of antidepressant,
one-fourth the standard dose.
Dr. Kessler said family practitioners could easily learn to
improve their treatments.
"The bigger nut to crack," he said, "has been getting
people to come into treatment. And in that area, we've made
significant progress."
The director of the National Institute of Mental Health,
Dr. Thomas R. Insel, said depressed people often
discontinued their treatments.
"Depression," Dr. Insel said, "brings a tremendous sense of
hopelessness. When you're in the middle of it, you can't
remember that things were ever any better."
The illness displays sadness, hopelessness and difficulty
concentrating.
The survey found that women continued to have a higher risk
for depression than men, though the gap is narrowing. Women
who have had at least one episode of depression outnumbered
men 1.7 to 1. Forty to 50 years ago, the ratio was three to
one, Dr. Kessler said, and 10 years ago, it was two to one.
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