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).
The emotional burden of depression is high, both to those who suffer from it, family members and will have a considerable impact on the functioning of the depressed individual. The economic cost of depression to society includes both direct costs, such as treatment costs, and indirect such as loss to productivity due to morbidity and mortality. A Swedish study, combining both direct and indirect costs, showed an increase from 1.7 to 3.5 billion euros between 1997 and 2005 (American Psychiatric Association, 2013). While the direct costs were relatively stable over time the indirect costs increased, primarily sick leave and early retirement.
The epidemiology of depression shows that women are more likely to be affected and have a younger age of onset than men (Schuch JJJ, Roest AM, Nolen WA, Penninx BWJH, de Jonge P., 2014,Lepine JP, Gastpar M, Mendlewicz J, Tylee A1997). Depression prevalence is higher in the younger age groups but then decreases, reaching the lowest point in middle age at around 45 years of age, then increasing again and reaching its peak in adults 80 years or older (Mirowsky, 1992). Obesity increases the risk of depression and being depressed will also increase the risk of developing depression Luppino FS, de Wit LM, Bouvy PF, (2010). Abuse in childhood, whether physical abuse, sexual abuse or neglect, increases the risk of depression in adulthood Horwitz AV, Widom CS, McLaughlin J, White HR (2001). Stressful life events have also been shown to increase the risk of depression Kendler KS, Karkowski LM, Prescott CA. (1999). Furthermore, some people are genetically more vulnerable to develop depression Sullivan PF, Neale MC, Kendler KS. (2000) and this can interact with stressful life events to increase the risk of depression Kendler KS, Kessler RC, Walters EE, (1995). Other risk factors include low socioeconomic status, being single, divorced or widowed, and living in an urban area Lejtzen N, Sundquist J, Sundquist K, Li XJ. (2014).
1.2 Problem Statement
Depression and suicidal ideation are serious mental conditions that put those affected at risk for attempted suicide or suicide. The developed world, unlike developing countries has carried out number of researches that have linked depression in 21st century. Such researches have provided the developed world with statistical data that can be used to provide assistance to those who are prone to depression. Nigeria is not known to have a data bank where information on depression with and without can be accessed. Lack of information on depression in Nigeria is due to religious, cultural and traditional beliefs. Researches on depression in Nigeria will provide statistics that can guide mental health experts and related professionals on how to overcome these problems.
1.3 General Objective of the Study
The general objective of the study is to examine depression as a silent killer in Abuja in the 21st century: causes, effect and treatment
1.4 Specific Objectives of the Study
1. To examine the factors associated with depression in 21st century society in Abuja
2. To examine the effect of depression in 21st century societyIn Abuja
1.5 Research Questions
1. What are the factors associated with depression in 21st century society?
2. What is the effect of depression in 21st century society
3. What is the treatment strategies of depression in 21st century society?
1.6 Significance of the Study
Findings in this study are also significant because they are in line with what has been established in a number of researches in this area in the developed world.
This work may also sensitise Nigerian researchers to carry out more studies of this nature. Carrying out more of these studies in the Nigerian setting would create a database for world bodies such as the World Health Organisation and mental health experts. Information from such databases can be used to intervene in the mental health problems and suicidal behaviours in Nigerian society.
1.7 Scope of the Study
The study will focus on the causes, effect and treatment of the high rate mortality in the 21st century with specific focus on Abuja.
1.8 Limitation of the Study
In every research work, it is likely that the researcher may encounter some limitations. The researcher encountered some challenges during the period of carrying out this research. Some of these challenges include the dearth of materials for a proper and effective research work constituted a major limitation. Again, how to get the true and required information from the respondents through questionnaire also constituted a constraint in the study.
Finally, there was the problem of convincing the students on the primary objectives of the questionnaire so as to give the true and required information. However, the intervention of the community PROs in the selected communities who took time to clear the air and convince his tribal men helped the investigator to administer the instrument successfully.
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