Chapter One

Introduction

1.1    Background of the Study

Depression is a major cause of the global disease burden, affecting an estimated 350-400 million persons worldwide. This makes depression the largest contributor to years lived with disability globally (Marcus et al.2012). Depressive disorders are the second leading cause of years lived with disability (YLDs) and Major Depressive Disorder accounts for 8.2% (5.9%–10.8%) of global YLDs in 2010 and dysthymia for 1.4% (0.9%–2.0%)(Murray et al. 2013, WHO, 2001).Furthermore, in 2010, depression was estimated to cost at least US$ 800 billion in lost economic output and this sum is expected to more than double by 2030 (WHO, 2008). A research carried out by the World Health Organization (WHO) in 2012 in 17 countries revealed that one in 20 people reported depression (Marcus et al. 2012). At its worst, depression can lead to suicide and about 800,000 to 1 million people commit suicide annually (Marcus et al. 2012). Major Depressive Disorder explained 16 million suicide Disability Adjusted Life Years (DALYs) (Murray et al. 2013). Among patients with chronic physical illnesses like, Human Immuno-deficiency Virus/ Acquired Immuno-deficiency Syndrome (HIV/AIDS), hypertension, diabetes, cancers and tuberculosis (TB) the prevalence of depression is between 10-20%(Katon et al.2007).

Depression is a serious public health problem, as it is the third leading burden of disease worldwide and the first in middle-and high-income countries (1). Studies from Western countries (United States and Europe) show that the lifetime prevalence of depression is around 13-16% (2, 3). Depression is a recurrent disorder in a majority of the cases (4).

Major depressive disorder is a mental disorder belonging to the group of mood disorders in the Diagnostic and Statistical Manual IV (DSM-IV-TR) (5). According to the definition it includes depressed or irritable mood, decreased interest or pleasure, change in weight or appetite, change in sleep patterns, change in activity, fatigue or loss of energy, guild/worthlessness, lack of concentration and suicidality. At least five out of nine symptoms need to be present nearly every day for a diagnosis of major depressive disorder. Furthermore the social, occupational or educational function of the patient needs to be impaired. Cut-offs are given for defining mild, moderate or severe depression. The Diagnostic and Statistical Manual V (DSM-V) uses a very similar definition of major depression as the previous version, though here the chapter on depressive disorder is separate from bipolar and related disorders (6).

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