Under the system formulated by Chris Murray for the Global Burden of Disease to measure global health, depression is shown to be a shockingly burdensome condition. Major depressive disorder was assigned a Disability Adjusted Life Year (or DALY) value of 0.6, meaning that for every year one has the condition, it is the equivalent of three-fifths of a year’s healthy life lost. According to Global Burden, as stated in Epic Measures, rates of major depressive disorder worldwide increased 37 percent between 1990 and 2010. In the initial Global Burden report in 1992, depression was shown to be the fifth highest cause of health loss as measured by DALYs in young adult women. In 2010, major depressive disorder was ranked the eleventh highest in global burden caused by disease and the second highest cause of years lived with disability. And in that year, major depressive disorder caused more loss of health in DALYs worldwide than tuberculosis.
For a long time, major depressive disorder was not seen as a global health concern. Those studying global health were far more concerned with diseases that cause early mortality, especially among children. Chris Murray’s innovation with the DALY allowed people to see that illnesses that may not be a direct cause of death may still be a burden because it quantifies suffering over time. Although the measure by which it does so is imperfect, it does show the importance of addressing conditions such as depression, and that the effects that depression has on one’s life can be as negative as that of many physical illnesses.
So what are the obstacles to addressing depression?
One major problem faced by those battling depression, as well as many other mental health issues, is stigma. The stigmatization of depression makes it hard for people to seek treatment even when it is available. One example of this is very close to home for I and my fellow Smithies, as well as college students across the United States. Many college students with mental illnesses fear disclosing their status and seeking help through the health and counseling services provided to them. This is because they face discrimination when they disclose certain concerns that make colleges worry about liability. Students with certain mental health issues have been forced on medical leave by their colleges, who have then made it nearly impossible to return by placing insurmountable obstacles to their readmission. They also worry about a lack of privacy due to differences between how health records are handled in educational institutions compared with outside of them; the former are covered under the Family Educational Rights and Privacy Act (FERPA), while the latter fall under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. These problems mean that many students don’t seek help for mental illness when they need it out of fear of the possible consequences.
Stigma against mental illness doesn’t just affect people in colleges, of course. It has wide-ranging ramifications across society, negatively affecting people’s ability to access treatment. Many people cannot afford mental health care because it is not covered by insurance to the same extent as many physical ailments. Mental health research may not be funded as much as other forms of research. Mentally ill people, particularly people of color, face increased danger to their lives in encounters with the police. And the mental health care system in the United States as a whole is fundamentally broken, with psychiatric hospitals being closed due to lack of funding and Medicare and Medicaid providing little to no coverage, which particularly affects low-income people. Internalized prejudice, as well, can prevent people from seeking out support because they have absorbed the messages that depression and other forms of mental illness are something to be ashamed of, or they may be afraid of what their family and peers might think of them. The issues on college campuses are just a microcosm of larger issues with how society handles mental health.
So how can these issues be addressed?
Some measures are already in place that could be expanded upon. The Affordable Care Act requires coverage of mental illness, including an expansion of Medicaid for this purpose. The Americans With Disabilities Act includes mental illness as a covered category, meaning that certain legal protections exist for the mentally ill in the workplace, for example. To return to the example of college campuses, using ADA to more clearly and consistently protect mentally ill college students would benefit them greatly. More dramatic interventions should also be considered; as stated in Epic Measures, for example, Australia made short-term therapy for depression free following a national burden analysis. Government funding for mental health should not be cut needlessly, and should be directed toward more effectively providing services for treatment and prevention of mental illness. This includes research into new treatments for depression. Additionally, the provisions in FERPA that create privacy concerns for students related to health should be revised. And increased education about depression and other mental illnesses should be prioritized among the general population in order to reduce stigma, whether in school, in the workplace, the government, the police force, or elsewhere. Over the long term, greater knowledge about depression would both empower people to be able to seek help for their own mental health issues and make it safer to discuss it openly with those around them without as much fear of the possible consequences. Addressing both the social and legal effects of stigma against depression is vital to ensuring that people can get access to the treatments they need to maintain their mental health and that they feel comfortable doing so.