Depression in General Medicine

Depression is not only a medical, but also a social problem of our time. The subjective severity of the manifestations of depression, the tendency to frequent relapses of this condition, the relatively high cost of treatment is a great mental, physical and economic misfortune for the patient, his relatives and society as a whole.

On the economic side, timely prevention and adequate treatment of depression, which is considered the “most expensive disease” of modern times, pays for itself. The direct and indirect economic losses from major depressive disorder in the United States are $ 43.7 billion annually. At the same time, direct costs, including the cost of medicines, treatment in medical institutions, reach $ 12 billion; indirect costs – 31 billion, of which 8 billion are associated with premature death, 23 billion – with a decrease in labor productivity, quality of life of the patient and his family members; indirect losses from disability correspond to 16 billion dollars.

Since depression is one of the five most famous disorders encountered in medical practice, patients suffering from this disease often turn for help not to psychiatrists, but to ordinary medical institutions. The total cost of treatment in this case increases significantly. With a combination of somatic illness and depression, the length of stay of elderly people in general type hospitals and the frequency of visits to the territorial polyclinic is much higher than in patients with the same somatic pathology, but without signs of affective disorders.

Depression affects the adaptive capacity of a person, reduces his life expectancy to a much greater extent than chronic diseases such as diabetes, bronchial asthma or hypertension. Disability rates for depression are more than two times higher than the common causes of disability, such as iron deficiency anemia, chronic lung disease, and diseases of the joints. If depression persists for a year, it leads to greater physical, social and occupational restriction, as well as to a longer inpatient treatment than the above-mentioned diseases.

The effect of depression on the degree of disability is clearly manifested when comparing the indicators of disability. Of interest are the materials obtained as a result of a special study to the clinical and epidemiological characteristics of patients suffering from depression in general medical practice (a large multidisciplinary hospital, a territorial polyclinic). They indicate that the proportion of hospital patients with concomitant depression in somatic disease among persons with disabilities I and II groups statistically significantly exceeds the same indicators of the studied sample as a whole. Thus, during the examination of patients with manifestations of depression, the disabled group I accounted for 2.1% and 0.9%, and the disabled group II – 32.3% and 20.4%, respectively. Similar ratios are detected in patients of the territorial polyclinic with a disability of groups II and III. Among patients with symptoms of depression, group II persons with disabilities made up 26.2% and 22.1%, group III persons with disabilities – 4.6% and 1.5%, respectively.

It is generally accepted that depression complicates the course of other diseases and contributes to disability. Disability due to depression is comparable to disability with coronary heart disease.

The value of depression is particularly increasing given the high risk of suicide in this condition. Among mental disorders, depression is the most common cause of suicide. Thoughts of suicide are characteristic of 60-80% of patients with depression, 15% of whom may attempt suicide. During a depressive episode, the risk of suicide in this group of patients is 30 times higher than that of the general population. Especially great is the risk of suicide with a prolonged course of depression, often recurring exacerbations of the disease, as well as with a combination of depression and chronic somatic illness.

local_offerevent_note January 28, 2019

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