International Mental Health Awareness Day falls on 10 October every year. And with it, the South African Depression and Anxiety Group (SADAG) releases shocking statistics regarding the mental health conditions within South Africa.
As quoted in their newsletter:
“One in every five people will suffer from a mental illness. Every 24 hours in South Africa, 22 people commit suicide and 220 people attempt suicide. 9.5% of teen deaths are due to suicide. That means roughly 12 people every hour attempt to kill themselves”.
One might think that these are exaggerated and sensationalised numbers meant to frighten and confuse people from what really matters. However, I challenge you to read up not only on the statistics but also on the personal experiences of health practitioners worldwide and to even reflect on your own lived experience. This will give you an indication of the impact of depression.
The more recent statistics in October 2020 revealed that 1 in 6 individuals in South Africa struggle with a mental illness, adding that calls to SADAG had increased by 63% in 2020. These were individuals seeking help for their depressive or anxious symptoms.
Personally, while I had read all about these statistics in my training to become a psychologist, I was unprepared for the scope of reality. I worked at the Chris Hani Baragwanath Academic Hospital in Johannesburg providing mental health services for patients being treated there. In a matter of three hours, twice a week, I would see up to eight people who had attempted suicide. These are people that had fortunately not succeeded in their attempts but as you have heard, “where there is smoke, there is fire”. For all those who had attempted, there was also a tragically high number of people who had succeeded in their attempts. On an individual basis many have also dealt with family members who are depressed or have even asked themselves “am I depressed” at some point. This signifies the amount of preoccupation around this issue and how the concept of mental health and depression, in particular, has become so prevalent.
Depression is described as a disabling condition that can adversely affect health, family relationship, work, and one’s social life. This condition is experienced as debilitating and immobilising. If one thinks of emotions as existing on a continuum then we could think of depression as existing on one extreme end of the spectrum. On the opposite side, one would find sadness. This is the kind of sadness that is appropriately expressed as an emotional response to loss, offense or injustice. Depression then is that exact feeling in a heightened and more debilitating presentation. A presentation that could or could not be a response to any external incident and also one that is overwhelming and blinding. One might find themselves struggling to concentrate at work or school, constantly tired, eating less or more, sleeping less or more, isolating themselves from those around them and disinterested in activities that previously brought them joy.
In 2001, The World Health Organisation (WHO) predicted that depression would be the second leading cause of the global burden of disease by 2020. We are over a year into the Covid-19 pandemic and WHO has recognised depression as one of the leading causes of disability and suicidality as the second leading cause of death among 15-29 year olds. Depression is among the leading causes of the global burden of disease and subsequently the reason behind the impaired quality of life of many struggling with depression. One of the many side effects of Covid-19 is psychological. The heightened arousal many have been experiencing due to the unprecedented uncertainty has tripled the rates of reported or experienced depression. Owing to the fact that depression can coexist with anxiety - an increase in anxiety rates subsequently increases rates of depression. The relationship between anxiety and depression is quite cyclical. Individuals who struggle with anxiety may start to beat themselves up for not being able to “get it together” and be productive and calm. These individuals may start feeling guilty, worthless, and fatigued which then can lead to the presentation of depression.
Suicidality or suicidal ideation is then common in depression. One activist described it in the following way:
Depression is like being in a burning building. Suicide, then, is choosing to jump out of the burning building – Zamokuhle Masondo
This will sound all too familiar and may resonate with many who have sought any and every way to make their pain stop, to slow down their thoughts and to calm their distress. The rate at which we escape and avoid our problems is a signal to exactly the same desire that many depressed individuals might have. One of ending the pain, and a somewhat hopefulness of something better after the distressing storm one might find themselves in. It is vital to reach out for help at these crucial moments, even if one believes that life cannot improve or that particular circumstances cannot change. Research around help-seeking behaviours with regards to mental-related problems illustrates that people do not frequently seek the help of loved ones or professionals when in distress. An article released by SACAP in 2019 revealed that over 75% of individuals struggling with mental illnesses did not receive help. This was owing to accessibility of resources but also the help-seeking practices of such individuals. The devastating reality about depression will cause one to withdraw and isolate themselves at a time when they should be leaning into their support structure even more.
So is depression a pandemic?
Some argue that it isn’t, in the technical sense of the word, but even those individuals agree that it requires urgent and impactful assistance. The disagreements around whether or not depression is a pandemic do not negate, neither diminish our efforts at comforting and supporting those that are unwell. The mere fact that someone may not even meet the full diagnostic criteria for depression does not mean that the person should not seek professional attention or that professional attention shouldn’t be made available for them.
In essence, we could sit debating the severity of depression but no one can dismiss that it is a problem. It is a problem that requires all hands on deck in the form of information being shared widely and resources being made available for individuals. Although suicidality is not among the top 10 causes of death in South Africa, it does account for up to 23.5 per 100 000 (13774) as reported by WHO in 2019.
The loss of lives is no small worry and whether or not it is statistically shocking, whether or not it qualifies to be called a pandemic, it still needs to be prioritised urgently.
Asanda Madi is a clinical psychologist who believes in educating others to make basic psychological principles applicable in everyday life.