A walk in the Park

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This blog is dedicated to everyone who has struggled with Community Medicine. Through my posts I hope to simplify and demystify community medicine. The emphasis will be on clarifying concepts rather than providing ready-made answers to exam questions.

Feedback is crucial for the success of this endeavour, so you are encouraged to comment and criticize if you cannot understand something.

If you want a topic to be discussed sooner rather than later, please let me know via

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A single example may not be able to explain 100% of a given topic, so multiple examples may be provided to explain different parts of a single concept.

If something doesn’t seem right:

a. Write to me about it (at communitymedicine4asses@yahoo.com), and

b. Cross check with another source (textbook, expert, etc.)

I hope that my exertions will make your experience with community medicine seem like a “Walk in the Park”

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Note 2. Please understand that this blog (and the corresponding facebook page/ group) is maintained in my spare time. I have a full time job, and am available to pursue these activities only after regular working hours (after 5 pm Indian Standard Time). However urgently you may wish to receive a response from me, I will be able to respond only upon returning home from work (I am offline the rest of the time).

Note 3. Please mind your language when interacting with me/ in the group linked to this blog. Rude/ offensive language will result in expulsion from both my friends list and the said group.

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WHO updates fact sheet on Depression (23 February 2017)

The World Health Day theme this year is ‘Depression: Let’s Talk’. In the run-up to the World Health Day 2017, the World Health Organization (WHO) has updated its fact sheet on depression, as well as released Global Health Estimates on ‘Depression and Other Common Mental Disorders’.

Key Messages:

Depression is a common mental disorder. Globally, more than 300 million people of all ages suffer from depression.

Depression results from a complex interaction of social, psychological and biological factors.

People who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression. Depression can, in turn, lead to more stress and dysfunction and worsen the affected person’s life situation and depression itself.

There are interrelationships between depression and physical health. For example, cardiovascular disease can lead to depression and vice versa.

Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.

More women are affected by depression than men.

At its worst, depression can lead to suicide.

Close to 800 000 people die due to suicide every year. Suicide is the second leading cause of death in 15-29 year old persons.

Types and Symptoms

Recurrent depressive disorder: this disorder involves repeated depressive episodes.

During these episodes, the person experiences depressed mood, loss of interest and enjoyment, and reduced energy leading to diminished activity for at least two weeks.

Many people with depression also suffer from

  • anxiety symptoms,
  • disturbed sleep and appetite and
  • may have feelings of guilt or low self-worth,
  • poor concentration and even
  • medically unexplained symptoms.

Depending on the number and severity of symptoms, a depressive episode can be categorized as mild, moderate, or severe.

An individual with a mild depressive episode will have some difficulty in continuing with ordinary work and social activities, but will probably not cease to function completely.

During a severe depressive episode, it is very unlikely that the sufferer will be able to continue with social, work, or domestic activities, except to a very limited extent.

Bipolar affective disorder: this type of depression typically consists of both manic and depressive episodes separated by periods of normal mood.

Manic episodes involve elevated or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need for sleep.

Treatment

There are effective treatments for depression:

  • behavioural activation,
  • cognitive behavioural therapy [CBT], 
  • interpersonal psychotherapy [IPT]),
  • antidepressant medication (such as selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]).

Fewer than half of those affected in the world (in many countries, fewer than 10%) receive such treatments.

Antidepressants can be an effective form of treatment for moderate-severe depression but are not the first line of treatment for cases of mild depression. They should not be used for treating depression in children and are not the first line of treatment in adolescents, among whom they should be used with caution.

Barriers to effective care include

  • lack of resources,
  • lack of trained health-care providers,
  • social stigma associated with mental disorders,
  • inaccurate assessment.

In countries of all income levels, people who are depressed are often not correctly diagnosed, and others who do not have the disorder are too often misdiagnosed and prescribed antidepressants.

Useful Links:

Link to the updated fact sheet:

http://www.who.int/mediacentre/factsheets/fs369/en/

Link to WHO Report: Depression and Other Common Mental Disorders- Global Health Estimates (English)[PDF]:

http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf

Link to WHO page containing handouts on depression:

http://www.who.int/campaigns/world-health-day/2017/handouts-depression/en/