Published on Investing in Health

On World Health Day, why I'm choosing to talk about depression

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photo: WHO

This year’s World Health Day carries a particular significance for me and for many others. The theme, “Depression: Let’s Talk,” shines a light upon a problem that oftentimes remains hidden in a dark corner of our minds, trapping us in a painful agony of sadness, loss of interest, and fear. 

While I have been blessed with good physical health, at different points in my life, I have succumbed many times to a sense of loss and detachment that has made me feel weak and incapable of facing the day, the week, or much less the future. These episodes often appeared in periods of transition, such as moving from high school to university, or times when I was separated from family, or when I experienced the loss of my father while living alone in Africa. With a telephone call, or later in life, when I was able to connect using Skype or FaceTime, I managed to reach out to loved ones, share the anguish that I felt at the moment, and little by little, with words of reassurance that everything was going to be all right and that things will get better the next day, I was able to step out of those invisible walls that were encircling me, casting a heavy shadow.  These feelings prevented me from appreciating the recharging feeling of a good walk or from marveling at the rebirth of trees and the multitude of colors that appear in the early Spring.
Let me confess: those periods were and are difficult to face.  They are not easy to handle.  When I listened to “This Depression”, a song by Bruce Springsteen, I not only learned about his long struggle with depression, but I concluded that the lyrics of the song describe with great clarity familiar feelings:

“Baby, I've been down
But never this down
I’ve been lost
But never this lost
This is my confession
I need your heart
In this depression
I need your heart
Baby, I've been low
But never this low
I’ve had my faith shaken
But never hopeless”
You may ask, why I am trying to exorcise my mental demons in a public blog?  The answer is simple.  All of us who have faced this very tangible reality know well that it is not something that people like to talk about because it is uncomfortable or because most people do not know what it’s like to experience these conditions. Unlike the manifestation of physical diseases, a depressed mood, loss of interest and enjoyment, poor concentration, constant anxiety, and reduced energy are typically not visible to others.  As a result, the easy path for the affected is to retreat, to close up, to hide the anguish of not feeling well because we do not want to be embarrassed to be seen as weak or perceived as falling apart. 
While melancholy and sadness are conveyed with dignified clarity by the guitar riffs of blues masters like the legendary B. B. King, or starkly portrayed in the paintings of Pablo Picasso’s “blue period”, for many of us, feeling down, sad, or anxious represent transitory moments that can be managed with some effort and the help of loved ones and friends, or if required, with professional advice or some form of therapy.  Unfortunately, for those without access to health services or social support, severe depression and anxiety often translates into a life of misery, compounded by alcoholism and drug dependency, living with the terror of being discovered, fearing unemployment or loss of family—a situation that puts them at the margins of society and that could tragically end in suicide.   
Indeed, as documented in a recent report by the World Health Organization (WHO), depressive and anxiety disorders are highly common across countries, impacting the mood or feelings of affected persons, with debilitating symptoms that range in severity (from mild to severe) and duration (from months to years) and that extract a terribly high social toll.  These disorders, which are diagnosable health conditions, are distinct from feelings of sadness, stress, or fear that anyone can experience from time to time in their lives.  Globally, over 300 million people are estimated to suffer from depression, equivalent to 4.3% of the world’s population. More than 80% of this non-fatal disease burden occurred in low- and middle-income countries.
None of us is immune to these conditions, as they can and do affect people of all ages, from all walks of life. However, the risk of becoming afflicted by severe depression and anxiety is increased by poverty, unemployment, death of loved ones, a relationship break-up, physical illness, conflict, forcible displacement, refugee status, social dislocation, and crime and violence.
On this World Health Day, we will do well in expressing our compassion and understanding for those affected by these mental maladies that harm the health, functioning, and well-being of people.  In the pursuit of universal health coverage and the sustainable development goals, we cannot forget that the achievement of mental health parity in health care and social services provision should be a fundamental measure of effective health and social policy, planning, organization, and financial protection arrangements for people in need across the world.
Video: “I had a black dog, his name was depression”
Video: “Making Mental Health a Global Development Priority”
Lyrics to “This Depression”, a song by Bruce Springsteen
WHO: Depression and Other Common Mental Disorders. Global Health Estimates
Blog: Mental Health Parity in the Global Health and Development Agenda

Mental health among displaced people and refugees : making the case for action at the World Bank Group

Out of the Shadows: Making Mental Health a Global Priority

Thrive: How Better Mental Health Care Transforms Lives and Saves Money

Blog: Advancing global mental health action: lessons from Canada

WHO and Mental Health

World Bank Group Mental Health site

Mental Health Innovation Network


Patricio V. Marquez

Former World Bank Group (WBG) Lead Public Health Specialist

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