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The depression it is not just a temporary change in mood, it is a disease. It is also the leading cause of disability worldwide. And if it is not treated, it can lead to suicide. But despite all this, “more than 75% of affected people in low- and middle-income countries do not receive any treatment,” indicates the Pan American Health Organization (OPS). In the framework of World Day to Fight Depression, El Comercio spoke with Carlos Bromley, psychiatrist and member of the technical team of the Directorate of Mental Health of the Ministry of Health (Minsa), on this issue and the increase in cases in the country due to the pandemic due to COVID-19.
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—How to differentiate a case of depression from a picture of deep sadness?
Depression is a mental health problem, with symptoms and signs. To make a diagnosis of depression, one of the first signs is the mood disorders. Other characteristics are pessimistic and low self-esteem thoughts, lack of energy to do daily activities (housework, studies, work), decreased pleasure one felt when doing things one enjoyed, and sleep disorders and appetite.
“When does this require specialized care?”
When the aforementioned symptoms make it difficult for the person to go about their daily life; that is to say, when you can no longer function as before, whether at school, at work or in social and family life. If this happens, it is time to take the person to a specialist. Do not forget that the World Health Organization (WHO) has said that depression is the leading cause of disability worldwide.
– If before the pandemic the impact of the depression was already worrying, has the situation become more complex and dangerous now?
The National Institute of Mental Health Honorio Delgado-Hideyo Noguchi carried out in 2020, in October, a study on different problems of mental health, including depression, and compared the data obtained with information from 2012. They found that cases of depression more than doubled: from 2.8% to 7.5%. It is a worrying panorama, since depression, in serious cases, can lead to suicides.
– Has there been an increase in suicide in the country?
In 2017, 466 people committed suicide in Peru; in 2018, 576; in 2019, 638; in 2020, 612; And in 2021, the number rose to 708. This year, as of January 10, there have already been 14 suicides. Of this number, probably 70% had a problem with depression.
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“In your opinion, is depression underestimated?”
We cannot let depression pass as if it were something that will disappear tomorrow. Depression, as a mental illness, has been totally underestimated. You cannot say to a patient with depression: “hey, get out of bed and do something.” That would be like telling a person who is in pain to stop feeling it. Depression is a disease.
-How is depression treated?
Mild pictures can be treated timely with psychotherapy and resolved in approximately four to six months. Moderate and severe symptoms, in addition to psychotherapy, require drug treatment, and this type of treatment lasts from eight months to a year, with subsequent controls.
—In a pandemic, due to the fear of being infected, the loss of loved ones and isolation, there has been an increase in cases of global depression in the world. Last year, in Peru, how many cases of depression were registered?
We have identified 313,455 cases in 2021, which represents an increase of 12% in relation to the prepandemic stage.. Of this population, 75% correspond to women and 25% to men. Regarding age groups, the most affected were adults (46%), followed by young people (24%), older adults (17%), adolescents (10%) and children (2%).
– What are the regions of the country with the highest number of patients with depression?
Lima is the region with the most cases of depression. We divide Lima into four: North Lima, with 30,656 cases; Downtown Lima, with 28,582; South Lima, with 24,257; and East Lima, with 19,260. The next region is Arequipa, with 17,762 cases; then Junín, with 16,145; Ayacucho, with 14,577; Callao, with 13,034; and Lambayeque, with 12,957.
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—How is the Ministry of Health trying to reverse this significant increase in cases of depression?
In Peru we are implementing the mental health reform. This consists of displacing the attention of the ancient psychiatric hospitals to the community mental health centers. Until eight or ten years ago, people who had mental health problems went to these psychiatric hospitals, like Víctor Larco Herrera. But from the national mental health lawThat has been changing and we now have community mental health centers distributed nationwide. We have already implemented 208 centers. Now care for mental health problems will occur within the same communities. In Peru there are 196 provinces, and we already have at least one mental health center in 111 of them. The goal by 2026 is to have 500 community mental health centers.
– Why is it essential to displace the attention of mental health problems to the communities?
For two reasons. The first because these centers are more accessible within the communities. Second, because it allows the model of care to change. Before, in psychiatric hospitals the model of care was basically biomedical; that is, a more pharmacological approach. Now, in the new model, specialists identify the causes of the problem and seek a change. For example, if it is a case of depression due to abuse at school, the experts go to the educational center and speak with the aggressors, the victims, the teachers and the authorities. And they try to solve not only that case, but the problem of violence within the school.
“Are we going to continue to see an increase in mental health problems in the country?”
I think that mental health problems, this year and the next, will continue to increase. We are beginning the silent pandemic of mental health problems. The challenge is to increase the number of mental health care centers. There is a national mental health law, 30947, which was approved in 2019 and was regulated in 2020. This law includes, among other things, the creation of the National Council of Mental Health, for the first time in Peru. This council is made up of different sectors of the Executive: Ministry of Education, Ministry of Women and Vulnerable Populations, Ministry of Justice, Ministry of the Interior. In this way, a coordinated work between each sector is achieved. This council was installed in 2020 and is developing the national public mental health policy.