Q & A
- Why is depression under-recognised and undertreated?
- How is depression best treated?
- What is the National Depression Initiative (NDI)?
- How much will it cost?
- Why have a National Depression Initiative?
- What audiences will the NDI campaign communicate with?
- Won’t raising awareness about depression just increase demand for services that cannot be met?
- Are there similar depression initiatives overseas?
- Links with other strategies in Mental Health and Primary Care
Everyone feels sad or depressed at some time in their lives, usually because of life circumstances such as a relationship breakdown, family, financial or work stresses, or health problems. Most people recover quickly from an episode of sadness or stress.
However, some people continue to feel extremely miserable for long periods of time, even though there may be no obvious reason to feel that way. When this kind of low mood persists for more than two weeks and other symptoms are present, it may be depression.
Common signs include:
- Persistent low mood
- Sadness or emotional ‘numbness’
- Loss of pleasure in everyday activities
- Irritability or anxiety
- Poor concentration
- Feeling guilty, or crying for no apparent reason
- Changes in eating or sleeping patterns
- Feelings of hopelessness or thoughts of death.
Te Rau Hinengaro, the NZ Mental Health Survey (MoH 2006) concludes that 5.7 percent of New Zealanders (aged 16 and over) will experience a major depressive disorder over a 12-month period. Depression is more common in women than men with 1 in 14 women experiencing major depression disorder compared to 1 in 23 men, over a 12 month period.
Mood disorders commonly co-occur with other mental health disorders (the study found that approximately half of those experiencing a mood disorder will also have an anxiety disorder, and 12.9 percent will have a co-morbid substance abuse disorder. Those aged 16 to 24 years had the highest prevalence of mood disorders, including major depressive disorders.
Te Rau Hinengaro found that only 58 percent of people classified with serious mental health disorders, and 36.5 percent of those with moderate disorders, had visited a health professional about their mental health problem in the previous 12 months. This left 42 percent of those with a serious disorder who did not receive professional help over that time.
There are social and economic costs of these people not receiving help. International reviews suggest that the direct costs and productivity driven indirect costs of depression (e.g. absenteeism) are high. In terms of average cost per patient, depression imposes a societal burden that is estimated to be larger than all other chronic conditions, and in one study depression is ranked sixth of all diseases in terms of economic burden. The London School of Economics estimated the total loss of output due to depression and chronic anxiety in the UK at some 12 billion pounds a year, and presents strong economic arguments for early intervention and effective treatment of depression.
Facts about the prevalence of depression and other mood disorders using data from the NZ Mental Health Survey can be found on this link: Facts about depression and other mood disorders (Word, 28 KB) Facts about depression and other mood disorders (PDF, 54 KB)
New Zealand research indicates that a major reason people with depression do not seek treatment is that they do not think their symptoms are severe enough to warrant visiting a doctor or other health professional for treatment. They may fear being judged as ‘just feeling sorry for themselves’ and being told that they ‘just need to snap out of it’.
However, many people with depression will often not get better on their own. Without treatment, depression may last six months or more. With treatment, 70 to 80 percent of people will recover much sooner. For most people there is complete recovery.
Different types of depression require different types of treatment, and there are effective self help strategies for mild to moderate depression, such as regular physical exercise, relaxation and problem-solving techniques and positive social activity. Information about these approaches can be found on the main NDI website on www.depression.org.nz Whatever treatment option works for a particular individual, the main point is that early intervention and treatment reduces the time and intensity of depression in many cases.
The National Depression Initiative (NDI) is a national project which is part of the Government’s commitment to addressing suicide prevention, as well as improving the mental health and wellbeing of all New Zealanders.
- To reduce the impact of depression on the lives of New Zealanders.
- Strengthen individual, family and social factors that protect against depression
- Improve community and professional responsiveness to depression
- Identify and build on opportunities to create a social and physical environment that protects people from depression.
- Encourage people to recognise and become more responsive to depression, including:
- The importance of early identification and intervention;
- Assisting people to recognise symptoms of depression in themselves and others;
- Encouraging people to seek appropriate help;
- Increasing awareness of effective interventions for depression, including self help strategies.
- Improve the capability of health professionals to respond appropriately to people seeking help with depression.
- Support co-ordination mechanisms between public health, primary health care and mental health care services, consistent with the objectives of the National Depression Initiative.
- Support the above with research, monitoring and evaluation.
$6.4 million (GST excl) was initially allocated for the National Depression Initiative public health campaign over the three years 2006 – 09. This was part of the funding package for the new suicide prevention strategy allocated as part of the Progressive Party Coalition Agreement. Additional funds have since been added to bring the 2008/09 budget to over $3.7 million.
Depression is a leading causal factor for suicide.
About two thirds of people who complete suicide are depressed at the time of their death. Some research suggests that the risk of suicide is increased 20-fold for those with major depression. About 7 out of every 100 men and 1 out of every 100 women who have been diagnosed with depression at some time in their lifetime will go on to complete suicide.
Depression is the future highest ranking burden of disease.
The World Health Organization estimates that by the year 2020, depression will be the second highest ranking cause of the burden of disease, as measured by lost disability adjusted life years (DALYs). DALYs is different to ‘incidence’. DALYs measure lost years of healthy life regardless of whether the years were lost to premature death or disability (which is weighted for severity of disability). For example, disability caused by major depression is the equivalent to blindness or paraplegia. Depression is the leading cause of disability worldwide among people aged 5 and older.
Depression is an avoidable cost for individuals and society.
People with major depression report worse health status, take more time off work, report more work performance limitations, make greater use of health services, and report poorer health-related quality of life. One UK estimate puts the cost of depression at approximately 0.6 percent of Gross Domestic Product (GDP) (about NZ$750 million). There are also significant emotional and social costs of depression for individuals, families/whänau affected, and society as a whole.
Depression is treatable, particularly if recognised early.
Depression is a significant mental health issue – but it is under-recognised and under-treated. People do not realise that early treatment is very effective. Raising public awareness about the signs of depression, encouraging early help-seeking and improving access to appropriate treatment can significantly reduce the negative impacts of depression.
What audiences will the NDI campaign communicate with?
The NDI campaign is a population health initiative for all New Zealanders, with some strategies for targeted groups, which may include:
- Groups particularly at risk of experiencing depression, (e.g. people experiencing adverse life events, people with family histories of depression, and new mothers)
- People affected by depression who would not naturally self-identify as experiencing depression, would not identify the benefits of seeking help, or would not actually seek help (e.g. adolescents, men, older people, migrants/new settlers, and people who experience addiction)
- People who may be indirectly impacted by the experience of depression (e.g. whānau/family, and workmates)
- The health sector, including primary health and mental healthcare workers, employers, and policy planners.
The planning team is aware that raising awareness about depression needs a parallel set of initiatives to ensure that health services have sufficient training, skills and resources to meet any increased demand. The 0800 helpline has been very well utilized, with nearly half of the callers being male. Initially there were up to 300 calls a day; this has leveled off to an average of 50 a day. Callers are provided with information about local services, and offered ongoing support through call-back. Feedback to date indicates that most callers are very happy with the support provided.
The experience of other countries that have had similar depression campaigns has been that demand for clinical services has not increased significantly; however the Ministry is monitoring the impact of the campaign on primary care services in particular. So far indications are that demand on primary care services for treating depression is increasing at about the same rate as it was prior to the campaign, after an initial spike in demand when the ads first went to air.
New primary mental health initiatives have been trialled by Primary Health Organisations (PHOs) around the country, and evaluated. The preliminary results have been very positive, with general practice developing innovative services to better address mental health problems, including depression. This is complementary to the NDI objectives and shows the way for future primary care services. Most PHOs are now receiving some funding for these new services, which often include access to counselling services. Green prescriptions www.sparc.org.nz , which support people to participate in physical activity can also be given by GPs. The Green Prescription programme is currently being expanded. Physical exercise in particular can be very effective in reducing the symptoms of depression.
The Ministry is also funding the research and development of new computer-based cognitive behaviour therapy (CCBT) programmes which will become widely available in the next few years. Research indicates that well-designed CCBT programmes can be very effective for managing depression.
Yes. Examples of overseas depression initiatives include:
- Defeat Depression Campaign (UK)
- NIMH Depression Awareness, Recognition and Treatment Programme (DART) (USA)
- National Depression Screening Day (USA)
- Nuremberg Alliance Against Depression (Europe)
- Beyondblue (Australia).
The NDI has been informed by the experience of various depression initiatives from overseas, in particular the Australian campaign, beyondblue, which has been in place since the late 1990’s. While the NDI may be broadly similar to beyondblue, there are also differences in the two countries’ approaches.
It is important to learn from these initiatives and to follow the results of any evaluations they have undertaken.
As well as addressing suicide prevention, the NDI is also consistent with the strategic direction and objectives of mental health and primary care strategies, for example:
- New Zealand Primary Health Care Strategy (2001)
- Te Tahuhu – Improving Mental Health 2005-2015: The Second New Zealand Mental Health and Addiction Plan (MoH 2005)
- Te Kokiri: The Mental Health and Addiction Action Plan 2006-2015
- Building on Strengths: A new approach to promoting mental health in New Zealand (2002)
- Like Minds, Like Mine National Plan 2007 – 2013 Project to Counter Stigma and Discrimination Associated with Mental Illness (2003)
The NDI will seek complementary links with existing mental health and primary health care services, to contribute to a better informed and resourced health workforce to respond to increased help-seeking for depression, particularly at the primary care level. For example, the review of the depression guidelines for general practice, being undertaken by the NZ Guidelines Group. When they are completed the guidelines will be able to be accessed electronically, and funding has been set aside for primary care training and implementation. In the meantime the NZ Guidelines Group have developed and distributed resources for both GP practices and the general public, on responding to depression in support of the public health campaign.
Under the New Zealand Primary Health Care Strategy (2001), Primary Health Organisations (PHOs) are now responsible for some aspects of mental health care, i.e. the assessment and treatment of an estimated 17 percent of the population who may experience mild to moderate mental illness (including depression).
Existing mental health services focus on the three percent of the population who are most severely affected by mental illness. The NDI will probably not work directly with the group of people experiencing clinical or severe depression who are already eligible to receive mental health services. Rather, the NDI will focus on improving access to services for people who show early signs of mild to moderate depression, for early and effective intervention.