A Project

on

VIDEO ON DEPRESSION and MENTAL HEALTH (AN2106)

Submitted in partial fulfillment of the requirements for the award of the degree of

Bachelor of Commerce
in

Finance & Marketing

By

Student name
Enrollment No. A60004617073

Under the guidance of

Mr. Sanjay Sikarwar

Assistant Professor & Studio Coordinator

Amity School of Communications

Amity University Madhya Pradesh, Gwalior
April 2020
Amity Business School
Amity University Madhya Pradesh, Gwalior

Declaration

I hereby declare that the work, which is being presented in the research paper, entitled,
“VIDEO ON DEPRESSION AND ANXIETY” in partial fulfillment for the award of
Degree of B.Com (Honours) submitted to the Amity School of Communication, Amity
University, Madhya Pradesh is a record of my own investigation carried under the
guidance of Mr. Sanjay Sikarwar, of Amity School of Communication.

I have not submitted the matter present in this report anywhere for the award of any other
Degree.

Student Name
Date: (Enrollment No. – A60004617073)
 i

Acknowledgement

I am very much thankful to our honorable Vice Chancellor Lt Gen. V. K. Sharma AVSM (Retd) for allowing me
to carry out my practical training. I would also like to thank Prof. (Dr.) M. P. Kaushik, Pro-Vice Chancellor, and
Amity University Madhya Pradesh for his support.

I extend my sincere thanks to Prof. (Dr.) Sumit Narula, HOI, Amity School of Communication, Amity University
Madhya Pradesh, Gwalior for his guidance and support for the selection of appropriate industry for my practical.

I am also very grateful to Mr. Sanjay Sikarwar, Assistant Professor, Amity School of Communication, Amity
University Madhya Pradesh for their constant guidance and encouragement provided in this endeavor.

Student name
Date: (Enrollment No. – A60004617073)
 ii

ABSTRACT

Depression as a disorder has always been a focus of attention of researchers in India. Over the
last 50-60 years, large number of studies has been published from India addressing various
aspects of this commonly prevalent disorder.

The various aspects studied included epidemiology, demographic and psychosocial risk factor,
neurobiology, symptomatology, comorbidity, assessment and diagnosis, impact of depression,
treatment related issues and prevention of depression in addition to the efficacy and tolerability
of various antidepressants.

Here, we review data on various aspects of depression, originating from India.

iii
 CONTENTS
Front Page
Declaration by student i
Acknowledgement ii
Abstract iii
Contents iv

Chapter 1: Introduction 1-5

Chapter 2: Overview By WHO 6-8
Chapter 3: Research Methodology 9
Chapter 4: Making of the Video 10-12
Chapter 5: Conclusion 13-14
Chapter 6: Summary 15

v
 Chapter 1
INTRODUCTION

1.1 Mental Health and Depression In India

Depression is a disorder of major public health importance, in terms of its prevalence and the
suffering, dysfunction, morbidity, and economic burden. Depression is more common in
women than men. The report on Global Burden of Disease estimates the point prevalence of
unipolar depressive episodes to be 1.9% for men and 3.2% for women, and the one-year
prevalence has been estimated to be 5.8% for men and 9.5% for women.

It is estimated that by the year 2020 if current trends for demographic and epidemiological
transition continue, the burden of depression will increase to 5.7% of the total burden of
disease and it would be the second leading cause of disability-adjusted life years (DALYs),
second only to ischemic heart disease.In view of the morbidity, depression as a disorder has
always been a focus of attention of researchers in India.

Various authors have tried to study its prevalence, nosological issues, psychosocial risk
factors including life events, sympto matology in the cultural context, comorbidity,
psychoneurobiology, treatment, outcome, prevention, disability and burden. Some of the
studies have also tried to address various issues in children and elderly.

This review focuses on research done on various depressive disorders in India. For this, a
thorough internet search was done using key words like depression, life events, prevalence,
classification, cultural issues, outcome, prevention, disability and burden etc in various
combinations. The various search engines like Pubmed, Google Scholar, Sciencedirect,
Search Medica, Scopus, And Medknow etc were used. In addition thorough search of all the
issues of Indian Journal of Psychiatry available online was done. Hand search of some of the
missing issues was also attempted and this yielded a few more articles. Review articles which
were felt to be not reflecting the Indian scenario to a large extent or not covering the available
Indian data were excluded.

Treatment issues (antidepressants) are reviewed separately by us in this compilation of

annotations to be published. Data from animal studies and originating in the form of case
reports and small case series, until felt necessary haven’t been included.

1
The available data has been organized under the headings of epidemiology, demographic and
psychosocial risk factors, neurobiology, symptomatology, comorbidity, assessment and
diagnosis, impact of depression, treatment related issues and prevention of depression.

1.2 Epidemiology

Many studies have estimated the prevalence of depression in community samples and the
prevalence rates have varied from 1.7 to 74 per thousand population. Reddy and
Chandrasekhar carried out a metanalysis, which included 13 studies on epidemiology of
psychiatric disorders which include 33572 subjects from the community and reported
prevalence of depression to be 7.9 to 8.9 per thousand population and the prevalence rates
were nearly twice in the urban areas.

The findings with regard to prevalence in urban population are in line with the findings of a
survey done on the entire adult population of an industrial township, which showed that the
prevalence rate for depression to be 19.4 per thousand.

A recent large population-based study from South India, which screened more than 24,000
subjects in Chennai using Patient Health Questionnaire (PHQ)-12 reported overall prevalence
of depression to be 15.1% after adjusting for age using the 2001 census data. In another
recent study, Nandi et al. compared the prevalence of depression in the same catchment area
after a period of 20 years (first in 1972 and then in 1992) and reported that the prevalence of
depression increased from 49.93 cases per 1000 population to 73.97 cases per 1000
population. Studies done in primary care clinics/center have estimated a prevalence rate of
21-40.45%. Studies done in hospitals have shown that 5 to 26.7% of cases attending the
psychiatric outpatient clinics have depression.

Studies on the elderly population, either in the community, inpatient, outpatient and old age
homes have shown that depression is the commonest mental illness in elderly
subjectsNandi et al. studied psychiatric morbidity of the elderly population of a rural
community in West Bengal. In a sample of 183 subjects (male 85, female 98) they found 60%
of the population to be mentally ill with higher morbidity in women compared to men (77.6%
and 42.4% respectively). There was significantly more morbidity in population in the age
group 70-74 and 80+ as compared to normal population. The total mental morbidity rate was
as high as 612/1000 population. Depression was the commonest illness of old age in this
sample, the rate being 522/1000 population (101 cases out of 112 were diagnosed as cases of
depression).

2
Women had a higher rate of depression-704/1000 population. Another significant finding was
the high rate of morbidity amongst the widowed persons.

An epidemiological study from rural Uttar Pradesh showed that psychiatric morbidity in the
geriatric group (43.32%) was higher than in the nongeriatric group (4.66%) and most
common psychiatric morbidity was neurotic depression, followed by manic-depressive
psychosis depression, and anxiety state. Psychiatric morbidity was more prevalent in those
who were socially, economically, and educationally disadvantaged. Recent community-based
studies have reported a prevalence rate of 21.7% to 45.9%.

Chhabra and Kar studied the profile of psychiatric disorders in elderly psychiatric inpatients
and reported that mood disorders were the most common diagnosis (46.5%). Older studies
from Gero-psychiatric clinics reported a prevalence of depression ranging from 13 to 22.2%.

A recent outpatient study, which evaluated psychiatric morbidity in 100 randomly selected
elderly subjects attending geriatric clinic, found that 29% patients suffered from psychiatric
illness of which depressive disorders were the most common. Another study also reported
depression to be the most common psychiatric diagnosis among the 1586 elderly subjects
(age ≥60 years), who attended the Geriatric Clinic of the All India Institute of Medical
Sciences, New Delhi. In a study of old age home population, Guha and Valdiya reported that
major depressive disorder (13.4%) was the most common psychiatric diagnosis in this
population.

With regard to epidemiology of depression in children and adolescents in a community

sample from south India, Srinath et al. reported a prevalence of 0.1% in the 4-16 year age
group and no child in the age group 0-3 was diagnosed to have depression. Another study
from north India reported an annual incidence rate of 1.61/1000 children in a community
based study on school children.

Clinic-based studies have reported a prevalence rate of 1.2 to 9.2% for the affective dis
orders, amongst which unipolar depression was the commonest category in most of the
studies.However, in a recent study evaluating the trend of various diagnoses in clinic
population, Malhotra et al. reported increase in prevalence of affective disorders from 2% to
13.49% in children (0-14 years) attending the psychiatric outpatient clinics. Studies done in
women during and after pregnancy have reported incidence of post-natal depression to be
11%.

3
Demographic and psychosocial risk factors for depression

In terms of socio demographic variables studies have shown that depression is more common
in women, younger subjects, in subjects from poor economic background and subjects with
poor nutritional status, Muslims, those who are divorced or widowed, those residing in
nuclear families and urban areas. Studies which have evaluated the subjects with late onset or
old age depression (first episode of depression at or after the age of 50) have also shown that
depression is more common in low social class, widowed state, unemployed condition, low
educational level, in subjects living in nuclear family or in those living alone. With regard to
gender most of the studies have reported that it is more common in elderly females, however,
some clinic-based studies suggest that it is more common in elderly males. It is also seen that
prevalence of depression increases with increasing age in elderly.

Studies have shown that compared to healthy controls and subjects with schizophrenia,
depressed patients have significantly greater number of life events prior (6-12 months) to the
onset of their illness. In terms of type of life events, it is seen that depressed patients
experience significantly higher proportion of life events related to death of a family member,
personal health related events, bereavement, interpersonal and social events and lower
number of life events in the form of illness of family members compared to patients with
schizophrenia.

It is also seen that compared to patients with mild depression patients with moderate and
severe depression tend to use avoidance as a coping strategies more frequently for the
stressful life events, suggesting that it may be a maladaptive way to cope with the situation,
which is responsible for development of depression. Studies have also reported that parental
loss before the age of 18 years, parental disharmony and eldest birth order tend to be more
common in subjects with depression.

Studies in elderly also suggest that life events, especially financial problems and death in the
family are as important a precipitating event for depression as they are in young adult. It is
also seen that stressful life events were specifically more in the elderly females and those
with lower per capita income.

With respect to life events in children and adolescents, Patel et al. found that depressed
adolescent girls report life events in the form of death of a family member, change in
residence, failure in examination, end of a relationship and serious illness. Other risk factors
identified to be associated with depression in children include stress at school and family as
well as family history of mental illness.

4
However, one of the older studies failed to find a link between childhood bereavement and
depression.

Women as a group have also received considerable attention with regard to risk factors for
development of depressive disorders. In an incidence study of common mental disorders,
Patel et al. reported that poverty (low income and having difficulty in making ends meet),
being married as compared with being single, use of tobacco, experiencing abnormal vaginal
discharge and reporting a chronic physical illness were associated with risk of developing a
common mental disorder. Studies have also reported that economic and interpersonal
relationship difficulties, partner violence, sexual coercion by the partner as the common
causal factors related to development of depression in general and depression during
antenatal and postnatal period. It has been shown that gender of the newborn child is an
important determinant of postnatal depression.

Among the psychological factors, attribution style was proposed to predispose individuals to
depression and maintain depressive symptoms once they develop. A study using the
Attribution Style Questionnaire showed that depressed patients have a specific attribution
style for their failures and successes in comparison to patients with schizophrenia and
medical disorders. According to this study, patients with depression made more internal,
stable and global attributions for bad events when compared to other disorders.

A study evaluating the cognitive model of depression as given by Beck failed to find support
for the causal role of cognitive errors in relapse of depressed subjects as a significant
proportion of patients were free from cognitive distortions following remission. However, it
was also observed that those who had persistent cognitive distortions during remission ran the
risk of early relapse. It has also been seen that patients with neurosis, including depression,
have poor social interactions and reports of more interactions of unpleasant type and less of
pleasant type of social interactions as compared with healthy controls.

With regard to personality factors, a study showed that higher scores on the hardiness, a
personality trait, correlates with lower scores on the depression scale suggesting that presence
of hardiness doesn’t allow depressive feelings to become more severe.

5
 Chapter 2
OVERVIEW BY WORLD HEALTH ORGANISATION

Depression is a common illness worldwide, with more than 264 million people affected.
Depression is different from usual mood fluctuations and short-lived emotional responses to
challenges in everyday life. Especially when long-lasting and with moderate or severe
intensity, depression may become a serious health condition. It can cause the affected person
to suffer greatly and function poorly at work, at school and in the family. At its worst,
depression can lead to suicide. Close to 800 000 people die due to suicide every year. Suicide
is the second leading cause of death in 15-29-year-olds.

Although there are known, effective treatments for mental disorders, between 76% and 85%
of people in low- and middle-income countries receive no treatment for their
disorder(2).  Barriers to effective care include a lack of resources, lack of trained health-care
providers and social stigma associated with mental disorders. Another barrier to effective
care is inaccurate assessment. In countries of all income levels, people who are depressed are
often not correctly diagnosed, and others who do not have the disorder are too often
misdiagnosed and prescribed antidepressants.

The burden of depression and other mental health conditions is on the rise globally. A World
Health Assembly resolution passed in May 2013 has called for a comprehensive, coordinated
response to mental disorders at the country level.

 
Types and symptoms

Depending on the number and severity of symptoms, a depressive episode can be categorized
as mild, moderate or severe.

A key distinction is also made between depression in people who have or do not have a
history of manic episodes. Both types of depression can be chronic (i.e. over an extended
period) with relapses, especially if they go untreated.

Recurrent depressive disorder: this disorder involves repeated depressive episodes. During

these episodes, the person experiences depressed mood, loss of interest and enjoyment, and
reduced energy leading to diminished activity for at least two weeks.

6
Many people with depression also suffer from anxiety symptoms, disturbed sleep and
appetite, and may have feelings of guilt or low self-worth, poor concentration and even
symptoms that cannot be explained by a medical diagnosis.

Depending on the number and severity of symptoms, a depressive episode can be categorized
as mild, moderate or severe. An individual with a mild depressive episode will have some
difficulty in continuing with ordinary work and social activities but will probably not cease to
function completely. During a severe depressive episode, it is unlikely that the sufferer will
be able to continue with social, work or domestic activities, except to a limited extent.

Bipolar affective disorder: this type of depression typically consists of both manic and
depressive episodes separated by periods of normal mood. Manic episodes involve elevated
or irritable mood, over-activity, pressure of speech, inflated self-esteem and a decreased need
for sleep.

Contributing factors and prevention

Depression results from a complex interaction of social, psychological and biological factors.
People who have gone through adverse life events (unemployment, bereavement,
psychological trauma) are more likely to develop depression. Depression can, in turn, lead to
more stress and dysfunction and worsen the affected person’s life situation and depression
itself.

There are interrelationships between depression and physical health. For example,
cardiovascular disease can lead to depression and vice versa.

Prevention programmes have been shown to reduce depression. Effective community

approaches to prevent depression include school-based programmes to enhance a pattern of
positive thinking in children and adolescents. Interventions for parents of children with
behavioural problems may reduce parental depressive symptoms and improve outcomes for
their children. Exercise programmes for the elderly can also be effective in depression
prevention.

Diagnosis and treatment

There are effective treatments for moderate and severe depression. Health-care providers may
offer psychological treatments such as behavioural activation, cognitive behavioural therapy
(CBT) and interpersonal psychotherapy (IPT), or antidepressant medication such as selective
7
serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Health-care
providers should keep in mind the possible adverse effects associated with antidepressant
medication, the ability to deliver either intervention (in terms of expertise, and/or treatment
availability), and individual preferences. Different psychological treatment formats for
consideration include individual and/or group face-to-face psychological treatments delivered
by professionals and supervised lay therapists.

Psychosocial treatments are also effective for mild depression. Antidepressants can be an
effective form of treatment for moderate-severe depression but are not the first line of
treatment for cases of mild depression. They should not be used for treating depression in
children and are not the first line of treatment in adolescents, among whom they should be
used with extra caution.

WHO response

Depression is one of the priority conditions covered by WHO’s mental health Gap Action
Programme (mhGAP). The Programme aims to help countries increase services for people
with mental, neurological and substance use disorders through care provided by health
workers who are not specialists in mental health. WHO has developed brief psychological
intervention manuals for depression that may be delivered by lay workers. An example is
Problem Management Plus, which describes the use of behavioural activation, relaxation
training, problem solving treatment and strengthening social support. Moreover, the manual
Group Interpersonal Therapy (IPT) for Depression describes group treatment of depression.
Finally, Thinking Healthy covers the use of cognitive-behavioural therapy for perinatal
depression.

8
 Chapter 3
RESEARCH METHODOLOGY

3.1 Objective of this Project

The main objective of this project is:
“To know and understand depression and studies related with mental health and
awareness”

3.2 Basis of Study and Video

This video is small compilation of various clips depicting that how different people react and
deal with depression and also what people think of depression and their various perspectives
regarding it.

9
 Chapter 4
Making of the Video
4.1 Video Script
SEGMENT 1
‘Video Starts’
[MUSIC: Soft Instrumental]
[TEXT] Are you Depressed?
[TEXT] Are you Okay?
[TEXT] Yeah. I’m FINE.
*[Video Playing : Boy asking a Girl, are you alright?]*
[TEXT] In Mind, It all Bothers
[TEXT] Yet….
[TEXT] We Ignore. And Hide.
*Clip 2 playing- From Shakdoosh Films*
*Clip 3 playing- Short film- “I’M FINE”*
**BACKGROUNG MUSIC PLAYING THROUGHOUT: “LOW TREE- SHAL
REGION”**

SEGMENT 2

[TEXT] We need to talk.

[TEXT] 1 in 5 youth 13-18 aged experience mental disorder at some point during their
life.
[TEXT] Source: National alliance on Mental Illness
[TEXT] Suicide is the second leading cause of death for people aged 15-34
[TEXT] Each day an estimated 18-22 veterans die by suicide
[TEXT] We need to remove the stigma
and talk about mental illness.
[TEXT] What it looks like,
What it feels like,
What treatment is available.
Why there is more hope for recovery than ever before.

*CLIP 4 Playing- Bites of people on depression*

10
*Clip 5- Deepika Padkone on Depression in an speech with World Health Organisation*

SEGMENT 3
*Clip 6-Cinematic View*

[TEXT] DO YOU FEEL LOW

TOO, SOMETIMES?
[TEXT] DON'T WORRY
WE ALL DO! AT SOME
POINT IN OUR LIVES
[TEXT] BUT,
HERE'S SOMETHING
FOR YOU TO
REMEMBER!
[TEXT] THE ONLY THING
MORE EXHAUSTING THAN BEING
DEPRESSED IS
PRETENDING THAT
YOU'RE NOT.

[TEXT] IT'S NOT THE TIME TO HIDE.

OR TO IGNORE.
[TEXT] IT'S TIME
TO SAY IT.
[TEXT] I AM NOT FINE.
[TEXT] BUT I WILL BE
[TEXT] Because,
[TEXT] You’re not alone in this.

*Clip 7- Near the Beach walking*

[TEXT] So, Breathe.

[TEXT] Feel.
[TEXT] It’s Life. Live it.

11
END (VIDEO CREDITS)
[TEXT] CREDITS

Credit One Outlook India

Credit Two John Hopkins Medicine
Credit Three The Traveller
Credit Four Aepidio
Credit Five Austin Lottimer
Credit Six Cinematic Videos
Credit Seven John Gryson
Credit Eight Kobena
Credit Nine Skadoosh Films
Credit Eleven Youtube.Com

Project Information
Made by: Presented to:
Student Name Mr. Sanjay Sikerwar
B.COM (HONS.) -A (6th Sem) Assistant Professor
Amity Business School Amity School of Communication
Amity University Madhya Pradesh Amity University Madhya Pradesh
474005 474005

Sources (Web)
Google.Com
World Health Organisation (Who.int)
Youtube.Com:
Outlook India
John Hopkins Medicine
The Traveller
Aepidio
Austin Lottimer
Cinematic Videos
John Gryson
Kobena
Skadoosh Films

12
 Chapter 5
CONCLUSION
Depression is one of the most common conditions in primary care, but is often unrecognized,
undiagnosed, and untreated. Depression has a high rate of morbidity and mortality when left
untreated. Most patients suffering from depression do not complain of feeling depressed, but
rather anhedonia or vague unexplained symptoms. All physicians should remain alert to
effectively screen for depression in their patients.

There are several screening tools for depression that are effective and feasible in primary care
settings. An appropriate history, physical, initial basic lab evaluation, and mental status
examination can assist the physician in diagnosing the patient with the correct depressive
spectrum disorder (including bipolar disorder). Primary care physicians should carefully assess
depressed patients for suicide. Depression in the elderly is not part of the normal aging process.
Patients who are elderly when they have their first episode of depression have a relatively higher
likelihood of developing chronic and recurring depression. The prognosis for recovery is equal in
young and old patients, although remission may take longer to achieve in older patients. Elderly
patients usually start antidepressants at lower doses than their younger counterparts.

Most primary care physician can successfully treat uncomplicated mild or moderate forms of
major depression in their settings with careful psychiatric management (e.g., close monitoring of
symptoms, side effects, etc.); maintaining a therapeutic alliance with their patient;
pharmacotherapy (acute, continuation, and maintenance phases); and / or referral for
psychotherapy. The following situations require referral to psychiatrist: suicide risk, bipolar
disorder or a manic episode, psychotic symptoms, severe decrease in level of functioning,
recurrent depression and chronic depression, depression that is refractory to treatment, cardiac
disease that requires tricyclic antidepressants treatment, need for electroconvulsive therapy
(ECT), lack of available support system, and any diagnostic or treatment questions.

13
Antidepressant medications’ effectiveness is generally comparable across classes and within
classes of medications.  The medications differ in side effect profiles, drug-drug interactions, and
cost.  The history of a positive response to a particular drug for an individual or a family
member, as well as patient preferences, should also be taken into account.  Most psychiatrists
agree that an SSRI should be the first line choice.  The dual action reuptake inhibitors
venlafaxine and bupropion are generally regarded as second line agents.  Tricyclics and other
mixed or dual action inhibitors are third line, and MAOI’s (monoamine oxidase inhibitors) are
usually medications of last resort for patients who have not responded to other medications, due
to their low tolerability, dietary restrictions, and drug-drug interactions.  Most primary care
physicians would prefer that a psychiatrist manage patients requiring MAOI’s.

Psychotherapy may be a first line therapy choice for mild depression particularly when
associated with psychosocial stress, interpersonal problems, or with concurrent developmental or
personality disorders. Psychotherapy in mild to moderate depression is most effective in the
acute phase, and in preventing relapse during continuation phase treatment. Psychotherapy is not
appropriate alone for severe depression, psychosis, and bipolar disorders. For more severe
depression, psychotherapy may be appropriate in combination with the use of medications. The
most effective forms of psychotherapy are those with structured and brief approaches such as
cognitive behavioral therapy, interpersonal therapy, and certain problem solving therapies.
Regardless of the psychotherapy initiated, “psychiatric management” must be integrated at the
same time.

Patients, who live with depression, and their family and friends, have enormous challenges to
overcome. Primary care physicians can provide compassionate care, important education,
psychiatric monitoring, social support, reassurance, and advocacy for these patients and their
loved ones.

14
 Chapter 6
SUMMARY

Research suggests that continuing difficulties, such as long-term unemployment, living in an

abusive or uncaring relationship, long-term isolation or loneliness or prolonged exposure to
stress at work can increase the risk of depression. 

Significant adverse life events, such as losing a job, going through a separation or divorce, or
being diagnosed with a serious illness, may also trigger depression, particularly among people
who are already at risk because of genetic, developmental or other personal factors.

Although there has been a lot of research in this complex area, there is still much that we do not
know. Depression is not simply the result of a chemical imbalance, for example because a person
has too much or not enough of a particular brain chemical. However, disturbances in normal
chemical messaging processes between nerve cells in the brain are believed to contribute to
depression. 

Some factors that can lead to faulty mood regulation in the brain include:

 genetic vulnerability
 severe life stressors
 taking some medications, drugs and alcohol
 some medical conditions.

Most modern antidepressants have an effect on the brain’s chemical transmitters, in particular
serotonin and noradrenaline, which relay messages between brain cells. This is thought to be
how medications work for depression. 

Other medical treatments such as transcranial magnetic stimulation (TMS) and electroconvulsive
therapy (ECT) may sometimes be recommended for people with severe depression who have not
recovered with lifestyle change, social support, psychological therapy and medication. While
these treatments also have an impact on the brain’s chemical messaging process between nerve
cells, the precise ways in which these treatments work is still being researched. 

15