Public health implications of depressive disorder

U svijetu više od 450 milijuna ljudi pati od psihičkih poremećaja, a puno veći broj ima psihičke probleme . Procjenjuje se da u svijetu oko 151 milijun ljudi pati od depresije. Na stanje mentalnog zdravlja utječu socio-ekonomski, biološki te čimbenici okoline. Dobro je poznato da nema zdravlja bez mentalnog zdravlja, a ono je temelj za osobnu dobrobit kao i djelotvorno funkcioniranje zajednice. Depresija je čest poremećaj raspoloženja koji dovodi do smanjenja sposobnosti bolesnika da se brine o sebi i izvršava svakodnevne obaveze. U najtežem obliku, depresija može dovesti do samoubojstva. Gotovo milijun ljudi godišnje počini suicid, odnosno oko 3000 smrtnih slučajeva događa se svaki dan. Računa se da na svaku osobu koja je izvršila samoubojstvo oko 20 ili više osoba pokuša suicid. Nije u potpunosti razjašnjen uzrok nastanka depresivnog poremećaja mada se smatra kako dugotrajnija kronična stresna zbivanja postupno uzrokuju promjene u sustavu prijenosa neurotransmitera i doprinose razvoju depresije. Uočeno je da introvertne i pasivno ovisne osobe sa smanjenom sposobnošću adaptacije promjenama češće obolijevaju od rekurentnog unipolarnog poremećaja. Općenito, tijek unipolarnog poremećaja karakteriziran je asimptomatskim fazama s fazama relapsa no poznato je da se u oko trećine bolesnika može javiti i kao jedna epizoda, a najčešće nastupa iznad 50 godina. Postoje i lakši slučajevi depresije gdje uglavnom prevladava povlačenje u sebe, izbjegavanje socijalnih kontakata, plačljivost bez prisutnosti vegetativnih tegoba. Takav oblik depresije nazivamo distimija (dysthymia). Najveći postotak, oko 70%, psihijatrijskih dijagnoza u ambulantama obiteljske medicine odnosi se upravo na depresiju. Vrlo je važno prepoznati intenzitet poremećaja o čemu ovisi terapijski pristup i trajanje liječenja.Worldwide, there are more than 450 million people suffering from mental disorders and a significantly larger number have psychological problems. It is estimated that globaly about 151 million people suffer from depression. Socio - economic, biological and environmental factors have implications on mental health condition. It is well known that there is no health without mental health, and that state of mental healh is precondition for personal well-being as well as the owerall functioning of the community. Depression is a common mood disorder that leads to a reduction in the ability of patients to take care of themselves and perform their everyday duties . In the most severe forms, depression can lead to suicide. Nearly one million people a year commit suicide, meaning that nearly 3,000 deaths occur every day. It is calculated that for every person who has committed suicide about 20 or more people attempt suicide. The cause of depressive disorders is not fully understood yet, although it is observed that chronic stressful events cause gradual changes in the transmission of neurotransmitters and contribute to the development of depression. Furthermore, it was noted that the introverted and passivly dependent people with reduced ability to adapt to changing environment more frequently often from recurrent unipolar disorder. In general, the course of unipolar disorder is characterized by the phases of the asymptomatic periods with periods of relapses but it is known that approximately one third of patients can experience only a single episode, occuring usually above age of 50. There are also milder cases of depression, called dysthymia, characterized by symptoms of depression such as withdrawal, social distancing, tearfulness but without the presence of vegetative symptoms. The largest percentage, about 70% of psychiatric diagnoses in outpatient family medicine, concerns some of the forms of depression. The type of therapy and duration of the treatment depends on the intensity of the disorder