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November 2010
Raising awareness on the relationship between depression and physical diseases: a WPA Programme

Mario Maj
President, World Psychiatric Association

Depression has been repeatedly reported to be highly prevalent in persons suffering from various physical diseases; to be underdiagnosed and undertreated in those persons; to have a deleterious impact on the course and outcome of several physical diseases; to negatively affect patients’ adherence to medical treatments; to contribute significantly to the disability of patients with physical diseases and to the impairment of their quality of life; and to have a poorer prognosis when associated with physical diseases.

Depression and CancerHowever, there is still a remarkable degree of uncertainty on the range of “normal” psychological responses to physical illness, and their variations according to age, gender, education, and personality characteristics; on what should be regarded as a “case” of depression in persons with a physical disease (i.e., what should be the threshold for diagnosis and treatment); on which instruments should be used to detect the presence of depression in those persons; on the relative effectiveness and cost-effectiveness of the various medications and psychotherapies in the management of depression in those persons; and on the role of psychiatrists, other mental health professionals, general practitioners and specialists of the various medical disciplines in the detection, diagnosis and management of depression in persons with the various physical diseases.

Moreover, there is a lack of practical guidelines about the differential diagnosis of depression in persons with the various physical diseases (some of which have manifestations mimicking depressive symptoms), and of treatment algorithms taking into account the specific problems of persons with the various diseases.

Depression and Heart DiseaseAll these issues appear even more problematic from a cross-cultural perspective, since the coping strategies adopted by individuals suffering from physical diseases, the phenomenology of depression, the threshold for its diagnosis, the applicability of assessment instruments, the availability of medications and psychotherapies, the organization of physical and mental health services, and the role of mental and physical health professions are likely to differ widely in the various geographic and cultural contexts.

The WPA has just published with Wiley/Blackwell three volumes addressing comprehensively the comorbidity of depression with diabetes, cancer and heart disease, with chapters on epidemiology, detection, diagnosis, pathogenesis, management, pathways of care, medical and social costs, the role of culture and social disparities, and public health implications. The first editors of the books are, respectively, Wayne Katon, David Kissane and Alexander Glassman.

Depression and DiabetesFor each book, a set of slides has been produced and is being translated in several languages. On the WPA website, the slides on depression and diabetes are currently available in English, Spanish, French, German, Russian, Portuguese, Italian, Swedish, Croatian, Estonian, Bosnian, Azeri, Romanian and Czech. The slides on depression and cancer are available in English, Spanish, German, Portuguese and Italian. The slides on depression and heart disease are available in English, Spanish, German, Portuguese and Italian.

The WPA Member Societies are welcome to use these slides for educational purposes. If they are willing to supervise the translation of the slides into other languages, they are welcome to contact the WPA Secretariat.

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