Depression is one of the major causes of disability and is killer of our time that is growing rapidly. Depression will be the second largest killer after heart disease by 2020 -- and studies show depression is a contributory factor to fatal coronary disease (1). Depression effect developed country and underdeveloped country alike.

Lack of Accesses to psychiatrist is an issue of great concern not only for poor nations but also even in developed countries. But is not only the lack of access which is contributing to this predicament, there are other factors which turn depression from difficult to more difficult matter to deal with, many patient do not consider depression as a disease, for example in united states 54% of people believe depression is a personal weakness (2). But it is even more complicated in developed countries where along these personal believes, culture, tradition and even some false religious believes make things more complicated.

Afghanistan is one of the world’s poorest country. Two-decade war destroyed the little development that had been made through many years. Many lives were lost and most of population of the country are disabled either physically or mentally or both. According to survey made by center for disease control and prevention at 2002, The prevalence of respondents with symptoms of depression was 67.7% (95% confidence interval [CI], 54.6%-80.7%) and 71.7% (95% CI, 65.0%-78.4%), and symptoms of anxiety 72.2% (95% CI, 63.8%-80.7%) and 84.6% (95% CI, 74.1%-95.0%) for nondisabled and disabled respectively. And prevalence of PTSD was 42.2% in both disabled and non disabled. Although these number are astonishing, but more striking is the fact that these issues are not addressed or acknowledged and there in no effective mechanism and program in place to address these issues. There are many challenges in a destroyed country where even basic elements (food and water) are not accessible for every one. Fighting depression is big task and need a lot of resources and effort, there is many challenges in each step of this big fight that need to be addressed and discussed. Although problem of this magnitude can not be solved by without active rule of afghan government, afghan ministry of public health and all public health professions and foreign donors and general population. There is no one willing to take that fight. That is why I am calling on Afghan Psychiatric Association to play an active and leading rule in at least starting this fight and keeping it alive. It is not easy task and there is no easy path and no one can do it alone so building effective partnerships will be a key toward success. Following are few examples of step that can be consider tackling this problem:

1- Rising awareness: first and most important task is making every one aware of the problem. Unfortunately not only the general population that are not aware of this big problem but also most health care providers are either not aware of the problem or either do not think that it is a series issue. So that is the most important step and needs a lot of work and building of many partnerships. This huge problem need to be addressed in many levels, among health care providers, authority, and general population, through building partnership with media, s, ministry of public health, ministry of education, medical associations, medical schools, ministry of higher education, hospitals, local authorities, masks, private providers and more.

2- Train all public health workers with basic knowledge of depression: Right now there are not enough psychiatrist available, which is through even about major cities. So even thought we need more psychiatrist but since it is not going to happen fast enough simply because it is time and resource consuming, so we can ask for help from all health providers, in fact all health care workers. By organizing short workshops to have them learn basic knowledge of depression and how to deal with simple cases. In the mean time all health care workers need to understand that all mentally ill and depressed patient are vulnerable and they need to change there attitude towards them.

3- Screening for Depression: screening for depression should be part of routine exam. Every patient should be screen for depression and suicidal idea, regardless of the reason of their visit. It is either visit to hospital, emergency room, doctor office or other facilities.

4- Afghanistan is a male dominant country and some men would not allow their women to be seen by male physician. More females need to be trained either by long or short duration classes to work under direct supervision of primary care physician or psychiatrist in the local communities to assist these physician helping those in need.

5- Creating anonymous groups will be also very effective and should be consider. This can be very helpful in addressing many issues, especially among women.

6- Family disputes and interferences is a well-known problem of afghan society, as we witnesses many fold increase in self-inflected burns among afghan women, which are caused by family issues. That is why creating as many as possible family counseling and training them with basic of mood disorders and screening methods for depression and suicidal idea will be very beneficial.

7- Afghanistan is a poor country and almost all of the patient cannot afford to pay for new generation antidepressants, that is why there is a need to seek help from governmental and non-governmental organization to provide hospitals new generation drug, which have less side effects. So that way patient will comply with their medication.

References:

1-WHO report on mental illness released October 4, 2001. Health news stories: Depression Link to Heart Disease, Hostility, Depression May Boost Heart Disease

2-National Mental Health Association (NMHA) study reported in MSNBC Health Today, March 10, 2004