October 11, 2023
Major Depressive Disorder (MDD) is a significant medical condition that profoundly influences an individual’s mood, cognitive faculties, and behavior while negatively affecting their physical health. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), the hallmark of major depressive disorder is the occurrence of depressed mood (dysphoria) and loss of interest in activities that were rather pleasurable in the past (anhedonia) for at least 2 weeks. It is imperative to distinguish MDD from transient feelings of unhappiness, part of human experience, or the profound grief that follows losing a loved one. Common emotional responses to life’s challenges often resolve naturally without medical intervention. In contrast, MDD perseveres without specialized medical treatment, and timely and appropriate intervention is essential for recovery.
Depressive disorders form a large proportion of global mental health conditions, casting shadows over countless individuals. With an estimated 121 million people affected by these disorders, they account for 5% of disability-adjusted life years (DALYs) worldwide, underscoring their profound impact on human lives. They are the leading cause of disability as measured by Years Lived with Disability (YLDs) by the World Health Organization (WHO).
Recently, the COVID-19 pandemic and subsequent restrictions, health anxieties, increased workloads, and job uncertainty have greatly exacerbated depressive disorders, especially among the younger population. While the pandemic may be behind us, other important factors continue to boost the rise in depressive disorder cases, particularly in the MENA region. Projections from the World Health Organization (WHO) foretell a future where major depressive disorder (MDD) will uphold its unenviable position as the leading cause of disability by 2030. There is an urgency to address these disorders for the sake of individual well-being and to navigate the looming public health challenges. As we delve into the complexities of these disorders and explore strategies for their prevention and management, it becomes evident that the global burden of depressive disorders is a critical issue that demands immediate attention and concerted efforts.
Epidemiological studies of Major Depressive Disorder (MDD) in the Middle East and North Africa (MENA) region from 2019 revealed that the age-standardized point prevalence of MDD stood at 3322.1 cases per 100,000 population, while the incidence rate was 4921.7 per 100,000 population.
In Saudi Arabia, the annual prevalence of MDD in the general population was 3.8 %. Women had a greater lifetime prevalence of MDD (8.9%) than men (3.1%).
Factors such as exposure to conflict, restrictions on movement, and poor living conditions contribute greatly to poor mental health. Palestine emerged as the nation with the highest burden of MDD within the region. With its ongoing war, Syria was also high on the burden spectrum. Over 35% of schoolchildren in countries such as Iraq and Afghanistan were estimated to be affected by mental disorders. Poorer countries, such as Yemen, Iraq, and Libya, were not high on the burden spectrum due to a lack of quality data or any data from these countries.
The age groups with the highest prevalence, incidence, and YLDs associated with MDD were 25–29, followed by 30–34, signaling critical ages for focusing on prevention and treatment.
Cultural sensitivities and limitations
Major Depressive Disorder (MDD) has emerged as a formidable and often misunderstood adversary in the Middle East and North Africa (MENA) region. The diagnosis and management of MDD exhibit significant variability across the region, attributed to the cultural nuances, the socio-economic factors, and the differing levels of societal unrest experienced in the countries.
In African countries, the rates of probable MDD and diagnosed MDD display a wide range, extending from 10% to nearly 30%, notably higher compared to the United States, where the prevalence of MDD stands at 6.7%. The variance is attributed to the complex interplay of socio-economic factors, healthcare infrastructure, and cultural influences on mental health.
Similarly, Middle Eastern countries, while generally exhibiting lower rates of MDD compared to certain African countries, still struggle with a substantial burden of MDD prevalence ranging from 5% to 10%. These rates underscore mental health challenges in the Middle East, where conflict, socio-political instability, and cultural nuances impact mental well-being.
As detailed, the increase in the presence of conflict in several countries within the North Africa/Middle East region, including nations like Afghanistan, Iraq, and Lebanon, has greatly contributed to a rise in the number of cases of MDD. The enduring effects of conflict, such as displacement, loss of life, economic instability, and disrupted social support systems, have left indelible marks on people’s lives, particularly adolescents.
In most of the MENA region, there is a significant disparity between the number of individuals who need treatment for depression and those who receive it. Several barriers impede access to mental healthcare in this region, including limited mental health education among primary care providers, a shortage of trained mental health specialists, resource constraints, and the deeply rooted stigma surrounding mental illness.
Insufficient education and awareness among primary care providers concerning mental illnesses hinders early detection and appropriate treatment. Moreover, the scarcity of trained mental health professionals, health infrastructure, and services exacerbates the problem, as individuals needing specialized care often struggle to find the help they require.
Stigmatization of mental illness within Middle Eastern cultures, especially in the case of women, leads to hesitation from patients in seeking help and reluctance from loved ones in finding help, further greatly contributing to the treatment gap.
Combinations of pharmacotherapy and psychotherapy may be required in most cases of MDD. Medicines that work fast, have less tolerability and safety issues, and address a broader range of symptoms result in better functional capacity and quality of life. Even though treatment guidelines recommend antidepressants as the first-line treatment for depression, physicians in the Middle East countries tend to prescribe benzodiazepines rather than antidepressants. These may result in long-term adverse effects and further worsen the condition.
The lack of trained specialists in the field and the stigma associated with mental illness means that most patients will seek treatment from a primary care provider, and many will complain of somatic symptoms such as pain, weakness, and shortness of breath rather than mood or anxiety symptoms. Almost half of the primary care patients in the United Arab Emirates who were found to have a psychiatric disorder described their symptoms as somatic instead of psychological.
The absence of precise guidelines poses several challenges, including inconsistencies in diagnosis and treatment approaches, potential mismanagement of depression cases, and an overall hindrance to effective mental healthcare delivery. The need for collaborative efforts among healthcare authorities, mental health professionals, and international organizations becomes increasingly apparent to address this shortfall.
Behavioral health interventions tailored and adapted with inputs from sub-cultural groups are essential for increased engagement and efficacy. Developing and disseminating culturally sensitive, evidence-based interventions for identifying, diagnosing, and treating depression in the Middle East should be prioritized. These interventions should account for the region’s unique cultural and societal dynamics and underscore the importance of integrating mental health awareness and care into the broader healthcare landscape.
A multifaceted approach to management is imperative. This includes enhancing education for physicians and the public, focusing on reducing the stigma associated with depression. Additionally, efforts to expand mental health services, train more mental health specialists, and promote the implementation of evidence-based guidelines are essential to improving the well-being of individuals grappling with depression.
By developing and implementing culturally sensitive guidelines, increasing awareness, and fostering a supportive environment, we can bridge the treatment gap and improve the well-being of individuals living with MDD in the MENA region. This endeavor is not only about individual health but also about preparing for future public health challenges.
Source: Delveinsight http://www.delveinsight.com/