DALY  And  Burden  Of  Disease

But let us get on with the other recent findings on suicide.

Over the last ten years, W.H.O., with the World Bank and Harvard Medical School, has developed DALY (Disability Adjusted Life Years), which is a measure of the burden that a disease entails (Murray and Lopez, 1996). This was a multicentric study involving both developed and developing countries. Its findings in 1990 and projection for 2020 are real eye-openers. While in 1990 malaria and T.B. were prominent, mental illness ranked very high. Unipolar Major Depression (3.7%) ranked fourth after Lower Respiratory Tract Infection (8.2%), Diarrhoeal  disease (7.2%) and Prenatal conditions (6.7%). It must be noted that two of the above conditions are infectious diseases and one involves childbirth, all of which are recognized major physiopathological stressors. None of these are the so-called ‘Life-Style’ diseases. Amongst those, Depression (3.7%) was rated above Ischemic Heart Disease (3.4%) in the global burden. This effectively dispelled the common man’s notion that Depression is a major problem only in the developed world. Moreover, as of now, Mental disorders (9.7%) rank just below Cardiovascular Disorders (10.5%) in the total burden.

The projections for 2020 are equally revealing. Depressive disorders are expected to be the second highest cause of disease burden worldwide (Brown, 2001). The global burden of Unipolar Major Depression (5.7%) will be a close second to Ischemic Heart Disease (5.9%), followed by Traffic Accidents (5.1%), Cerebrovascular Accidents (4.4%) and Chronic Obstructive Pulmonary Disease (4.2%). Malaria, T.B. and Prenatal conditions would become less important. Compared to the sophisticated Heart Institutes and other places to treat Ischemic Heart disease of which every city boasts, what should be the increase in the member of sophisticated Centers to treat Depression, where public awareness and governmental thrust is abysmally small ? How much greater is the need for public and private funding, the general awareness, the will and programmes to combat it ?

“Unfortunately, only about one third of individuals with depression are in treatment, not only because of underrecognition by health care providers but also because individuals often conceive of their depression as a type of moral deficiency, which is shameful and should be hidden . Individual often feel as if they could get better if they just ‘pulled themselves up by the bootstraps’ and tried harder. The reality is that depression is an illness, not a choice, and is just as socially debilitating as coronary artery disease and more debilitating than diabetes mellitus or arthritis. Furthermore, upto 15% of severely depressed patients will ultimately commit suicide. Suicide attempts are upto ten per hundred subjects depressed for a year, with one successful suicide per hundred subjects depressed a year. In the United States for example, there are approximately 300,000 suicide attempts and 30,000 suicides per year, most, but not all, associated with depression... mood disorders are common, debilitating, life -threatening illnesses, which can be successfully treated  but commonly are not treated . Public education efforts are ongoing to identify cases and provide effective treatment” (Stahl, 2003).

i) One out of seven with recurrent depressive illness commits suicide.

ii) 70% of suicides have depressive illness.

iii) 70% of suicides see their primary care physician within six weeks of their suicide.*

iv) Suicide is the seventh leading cause of death in the United States.

The hidden cost of depression as a considerable burden on society and the individual, especially in terms of incapacity to work, has been noted in the UK (Thomas and Morris, 2003). The hidden cost of not treating depression is 30,000 to 35,000 suicides per year in the United States alone (Stahl, 2003). The figures are equally applicable to the other countries, including India. The role of care-providers, governmental bodies and enlightened citizens is clearly cutout and needs to be focussed in the direction of suicide prevention. What more need be said?

The projection in 2020 for all mental disorders is 15% i.e. from 9.7% in 1990, the global burden of mental disorders will rise to 15%, a rise of more than 50%, of which one third will be due to Unipolar Major Depression.

Why are we looking at these statistics here ? Because the major cause of premature mortality in Unipolar Major Depression is suicide. In fact the major cause of premature mortality in psychiatric conditions taken as a whole is also suicide. Thus, study of the various dimensions of suicide is so very important. And treatment of mental disorders can be one sure way of reducing the rising suicide rates the world over.

The Global Burden of Disease Study has been an eye-opener for public health programmes.

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