The affective or ‘mood’ disorders are a group of related conditions including the depressive

disorders, mania and hypomania, in which the primary disturbance is thought to be one of mood
or affect. The separation of the anxiety disorders from the depressive disorders into distinct
diagnostic groups is the subject of some contro- versy. Anxiety and depressive syndromes show
exten- sive overlap (comorbidity) in community, primary and secondary care settings), and a
review by Piccinelli1 concluded that there are no clear boundaries between major depression and
generalized anxiety dis- order. Therefore it is important that any discussion of depression must
also include consideration of anxiety.

The key features of the depressive disorders are: • low mood;
 • reduced energy; and
 • loss of
interest or enjoyment.

Other common symptoms include poor concentration, reduced self-confidence, guilty thoughts,
pessimism, ideas of self-harm or suicide, disturbed sleep and altered appetite2 (

Depression is a common disorder with serious per- sonal, interpersonal and societal consequences,
affect- ing about 15% of the general population and accounting for approximately 10% of
consultations in primary care3. Women are twice as likely to suffer from depression, and
symptoms generally increase with age. Recent studies suggest a rising incidence of depression in
younger age groups, particularly young men, which may be linked to the relative rise in suicide
rates. Whilst depressive symptoms are probably more frequent in the socially excluded and
economically disadvantaged, depressive illness can affect people from all sections of society.

At a personal level depression causes significant psychologic distress, reduces quality of life and
increases the mortality from cardiovascular disease, accidents and suicide, which is the cause of
death in approximately 10% of patients with a severe recurrent depressive disorder. It can
contribute to marital and family breakdown, and in depressed mothers may delay the development
of their children. In addition there is a direct economic burden on society from health and social
care costs, and indirectly through lost working days and the costs of premature mortality

Table 1 The costs of depression in the UK4

Direct costs per annum Approximate cost of treated episode Indirect costs
 Working days lost

£300 million £400 £3 billion per annum 155 million per annum

Surveys of the general population in the UK reveal widespread negative public attitudes to
depression. In a 1991 survey of the public conducted on behalf of the United Kingdom Defeat
Depression Campaign5, only 16% believed people with depression should be treated with
antidepressants, while 90% thought counseling should be used, which has disputed efficacy in the
treat- ment of depression. In addition, the vast majority (78%) of the sampled general population
believed that antidepressant drugs are ‘addictive’, probably confusing them with benzodiazepine
anxiolytics.

The overall management of people with depression is often far from ideal. Stigma and dis-
crimination make people who might be suffering from depression reluctant to seek treatment, and
the recogni- tion of depression by doctors and other health profes- sionals is often poor. When
these factors are taken ogether, depression can clearly be seen to constitute a major public health
issue.


Table 2 Criteria for a condition to be a public health issue

• common
 • severe
 • marked associated impairment •

effective treatments
 • acceptable treatments
 • significant
public concern