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Global burden of depression: The intersection of culture and medicine

The statistics about depression clearly identify it as a major public health problem (Greenberg et al, 1993). About 6% of the population meet the criteria for major depressive disorder or dysthymia at any time, and 20% of those with major depressive disorder will have symptoms that persist beyond 2 years (Keller et al, 1992). The disorder is highly recurrent; 30% of individuals experience a relapse within 3 months of recovery and (in the absence of continuation or maintenance treatment) 50% experience a further episode within 2 years. The standardised mortality ratios for unipolar depression for accidental deaths, for deaths by natural causes and for suicide were 1.4, 1.7 and 19.7, respectively (Ustun, 1999). In the National Health Service the cost of treating depression ($887 million) exceeds the cost of treating both hypertension ($439 million) and diabetes ($300 million) (Department of Health, 1996). However, the direct health care costs are dwarfed by the indirect costs (Berndt et al, 2000). Days lost from work owing to depression exceed all other disorders and the economic burden on family members and society is considerable (Broadhead et al, 1990). This may account for 60–85% of the total cost of the illness and represents a significant proportion of the gross national product (Kind & Sorensen, 1993; World Health Organization, 2001).