CG123 Common mental health disorders - National Institute for ...

Common mental health disordersof these individuals recover without treatment in the following years, with a steepdecline in PTSD rates occurring in the first year (for example, Breslau et al., 1991;Kessler et al., 1995). On the other hand, at least one third of people who initiallydevelop PTSD remain symptomatic for 3 years or longer and are at risk of secondaryproblems such as substance misuse (for example, Kessler et al., 1995). In the 2007ONS (McManus et al., 2009) survey, screening positive for current PTSD declinedwith age, from 4.7% of 16- to 24-year-olds to 0.6% of adults aged 75 years or over.2.2.5 Impairment, disability, secondary problemsDepressionApart from the subjective suffering experienced by people who are depressed, theimpact on social and occupational functioning, physical health and mortality issubstantial. In fact, depressive illness causes a greater decrement in health state thanmajor chronic physical illnesses such as angina, arthritis, asthma and diabetes(Moussavi et al., 2007).Depression is a major cause of disability across the world. In 1990 it was thefourth most common cause of loss of disability-adjusted life years (DALYs) in theworld and by 2020 it is projected to become the second most common cause (WorldBank, 1993). In 1994 it was estimated that about 1.5 million DALYs were lost eachyear in the West as a result of depression (Murray et al., 1994). Depressive disordersaccount for 4.4% of the global disease burden or the equivalent of 65 million DALYs(Murray & Lopez, 1997; WHO, 2002).Emotional, motivational and cognitive effects substantially reduce a person’s abilityto work effectively, with losses in personal and family income as well as lostcontribution to society in tax revenues and employment skills. Wider social effectsinclude: greater dependence upon welfare and benefits with loss of self-esteem andself-confidence; social impairments, including reduced ability to communicate andsustain relationships during the illness with knock-on effects after an episode; andlonger-term impairment in social functioning, especially for those who have chronicor recurrent disorders. Some of the features of depression (such as lethargy) mayimpede access to appropriate healthcare.Depression can also exacerbate the pain, distress and disability associated withphysical health problems, and can adversely affect outcomes. Depression combinedwith chronic physical health problems incrementally worsens health compared with aphysical health problem alone or even combinations of physical health problems(Moussavi et al., 2007). In addition, for a range of physical health problems findingssuggest an increased risk of death when comorbid depression is present (Cassano &Fava, 2002). In coronary heart disease, for example, depressive disorders are associatedwith an 80% increased risk both for its development and of subsequent mortalityin people with established disease, at least partly because of common contributoryfactors (Nicholson et al., 2006).Suicide accounts for nearly 1% of all deaths and nearly two thirds are people withdepression (Sartorius, 2001); putting it in another way, having depression leads to25