In spite of advances in care and public awareness, depression continues to be strongly correlated with an increased mortality risk, according to a new paper.
The Stirling County Study, an internationally-renowned longitudinal study of depression within a Nova Scotia community, began in 1952 and continues on to this day.
For this paper, an international team of researchers examined nearly 60 years of mental health data on 3,410 adults across three periods (1952-1967, 1968-1990, and 1991-2011) and linked them to the Canadian Mortality Database.
“The major finding from this study is that depression measured at any given point in time during the study carries an elevated risk of mortality that persists for as long as two decades,” say the authors.
The mortality risk for women now equals that of men
In all three study periods, men diagnosed with depression had a higher mortality risk, although the hazard ratio (HR) progressively decreased at each interval. The baseline hazard ratio compares the chances of mortality of for a depressed person versus a non-depressed person within the study period (1.00 is the baseline for non-depressed people).
The first period’s HR for men was 2.9, meaning that depressed men were nearly three times more at risk, but this has fallen to 1.52 in recent decades.
It is possible that efforts to raise awareness and the development of better treatment have helped to reduce the HR for men, according to Professor Phillip Mitchell, an Australian consultant psychiatrist who was not part of the study.
However, the opposite was seen in women: the mortality risk for women rose by 50% in the final study period, meaning that the HR for both sexes is now roughly on par. Prior to the third study period, 1992 – 2011, the HR for depressed women was extremely low, starting at 1.08 in the first period, progressing to 1.37 in the second, and finally merging with the male population at 1.51.
“During the last 20 years of the study in which women’s risk of death increased significantly, roles have changed dramatically both at home and in the workplace, and many women shoulder multiple responsibilities and expectations,” says Dr Ian Colman, Canada Research Chair in Epidemiology.
Despite speculation about the exact mechanism that dramatically raised the mortality risk for women, it is possible that the scale of the problem was hidden for some time. Depression can be hard to catch; a depressed person might seem perfectly normal on the exterior but be severely ill in reality.
As such, the authors encourage general practitioners to show extra vigilance for evidence of a depressive episode, subtle though they may be.
Depression progressively chips away at physical health
Deaths related to depression are not primarily by suicide. The World Health Organization (WHO) states the biggest killer of people with severe mental illnesses is chronic physical health conditions.
Poor diet, a lack of exercise, and drug and alcohol abuse (more common in men) are widespread in depressive populations and decrease life expectancy. There is also evidence to suggest that depression is associated with physiological changes to the cardiovascular system, increasing the risk of cardiovascular mortality.
Across the three periods in this paper, the lifespan of those diagnosed with depression at 25 was notably shorter. The first cohort (1952-1967) saw 10-12 fewer years of life, 4-7 in the second, and 7-18 in the third.
Canada lags behind other developed nations in mental health spending
The WHO reports that there are some 300 million sufferers worldwide and lists depression as the leading cause of disability. In Canada, approximately one in five Canadians experienced mental health issues in 2016, according to the Mental Health Commission of Canada’s (MHCC) 2017 report.
The same report notes that mental illness compose 38% of all illnesses for those under 65, yet in 2015, only 7.2% of total health spending ($15.8 billion) went to mental health.
This pales in comparison to major international partners such as the UK, whose National Health Service allocated 13% of total spending in the same year. The Conference Board of Canada estimates that depression tallies economic costs of $32 billion because of lost productivity alone – roughly twice that of current spending.
Bell Let’s Talk Day 2018 – How Can You Help?
Enormous challenges may exist at government level, but that doesn’t mean that you can’t make a difference. Today marks Bell Let’s Talk Day, an annual fundraiser for mental health support services which also focuses on raising awareness through education.
Simple but powerful actions include separating fact from fiction as it relates to various mental illnesses – ignorance only perpetuates destructive stereotypes and stigmatization. Changing our use of language will continue to be an important factor in driving a more progressive understanding of mental illnesses and those who suffer from them.
If you or someone you know is signed up with Bell, the company will donate 5¢ for all calls and texts made on their network, but you can also rack up donations by engaging with the social media campaign. Every tweet with the #BellLetsTalk hashtag or Bell Let’s Talk Day video view on Instagram or Snapchat nets another 5¢.
To date, Bell reports that $86.5 million has been donated to mental health initiatives, and you can call, tweet, or snap our way to $100 million and beyond.
Resources
Whether or not it’s diagnosed, constant or intermittent, or has a formal name, your suffering matters and you don’t need to suffer alone. Here are some places that will listen.
Off-campus help
Good to Talk
CAMH
Kids Help Phone (up to age 20!)
Connex Ontario
Ontario Mental Health Helpline
Alberta Mental Health Helpline
Here to Help BC
Klinic Crisis Support (Manitoba)
CHIMO Helpline (New Brunswick)
Nova Scotia Mental Health
The Island Helpline (PEI)
811 Helpline Newfoundland
On-campus help
Memorial University – Mental health services
University of PEI – Student Health Centre
Dalhousie University – Thrive
University of New Brunswick – Counselling services
McGill University – Mental Health Hub
Université de Montréal – Ressources en santé mentale
University of Toronto – Health and Wellness Centre
McMaster University – Mental Health Services
University of Waterloo – Health Services
University of Western Ontario – Health and Wellness Centre
University of Manitoba – Mental health on campus
University of Saskatchewan – Counselling services
University of Alberta – Student Wellness
University of Calgary – SU Wellness Centre
UBC – Thrive at UBC
Learning resources
Canadian mental health association – Many resources including public mental health policy
AmiQuébec – Variety of literature and resources about mental health
Mental Health Commission – Informational webinars, online anti-stigma training and more
Portico Network – clinical tools and evidence-based materials for health care providers, social service workers and others
Mental Health First Aid Canada – Training to aid people in mental health crisis
QPR suicide prevention training ($30 cost, but often offered for free through Universities. Inquire at yours!)
