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Welcome Out of respect to Colleagues, please turn all mobile devices to silent whilst in the conference room Thank you

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Dr. Mary Baker Welcome address Objectives of the conference President Year of the Brain 2015 European Brain Council Hashtag #YotB2015 Tweet at @EU_Brain

Robert Madelin Conference Opening Senior Adviser for Innovation European Political Strategy Centre European Commission Hashtag #YotB2015 Tweet at @EU_Brain

Setting the Scene Session Chair: Prof. David Nutt The societal impact of depression in Europe President European Brain Council Hashtag #YotB2015 Tweet at @EU_Brain

Depression: definition and key facts on the burden of disease Setting the Scene Prof. Gabriel Ivbijaro President, World Federation for Mental Health Hashtag #YotB2015 Tweet at @EU_Brain

Professor Gabriel Ivbijaro MBE JP MBBS, FRCGP, FWACPsych, MMedSci, DFFP, MA, IDFAPA WFMH President Family Doctor London UK Visiting Professor Population Health NOVA University Lisbon Portugal Depression: definition and key facts on the burden of disease LIFTING THE DARK CLOUDS: What can Europe do to reduce the burden of depression in the workplace?

Acknowledgements • Members of the European Brain Council • Co-participants & co- presenters • Dr Mary Baker, organisers and sponsors 8 Depression: definition and key facts on the burden of disease

What I hope to cover • Provide some key definitions • Highlight some key findings • Propose some potential solutions and highlight the role of advocacy 9 Depression: definition and key facts on the burden of disease

Depression: some facts from WHO 10 Depression: definition and key facts on the burden of disease

Depression in the workplace: some facts • 10% of the employed population have taken time off work for depression • Average of 36 workdays lost per depression episode • 50% of people with depression are untreated • Up to 94% experience cognitive symptoms • 43% of managers want better policies (European Depression Association (EDA) 2012) 11 Depression: definition and key facts on the burden of disease

Unemployment, underemployment & depression • Depressive disorder is a leading cause of psychiatric morbidity • Adverse psychosocial factors in the workplace lead to an increase in depressive symptoms (Bonde 2008) • Return to work after depression is more likely in people: • With higher educational achievement • With a good income • With a perception that their health is generally good • With less physical & mental health co-morbidity • With premorbid feelings of general wellbeing & social inclusion • Who were always physically active (Elinson et al 2004) 12 Depression: definition and key facts on the burden of disease

Life expectancy England & EU in 15+: Birth, 1990 and 2013 Public Health England 13 Depression: definition and key facts on the burden of disease

What is a Disability Adjusted Life Year? DALY: a measure of the overall burden of disease It adds the years of life lost due early death and years spent living with disability or ill-health together Public Health England 14 Depression: definition and key facts on the burden of disease

Leading causes of DALYs in 2013 and percentage change since 1990 (Males) Public Health England 15 Depression: definition and key facts on the burden of disease

Leading causes of DALYs in 2013 and percentage change since 1990 (Females) Public Health England 16 Depression: definition and key facts on the burden of disease

Advocacy is necessary Would you ever tell your boss you have depression? Photo: ALAMY 17 Depression: definition and key facts on the burden of disease

18 Depression: definition and key facts on the burden of disease

How to respond? Individual & Health promotion & community response prevention Early recognition & Health response access to health Advocacy, support & NGO response community resilience Legal framework & Government & policies employer response 19 Depression: definition and key facts on the burden of disease

WFMH response • Make mental health visible – World Dignity Project www.worlddignityproject.com WMHD 2016: • Psychological & mental health first aid WMHD 2017: • Mental health in the workplace Please become a partner gabriel.ivbijaro@gmail.com 20 Depression: definition and key facts on the burden of disease

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Comorbidity of depression and physical illness: a major challenge Setting the Scene Prof. Norman Sartorius Former Director of WHO, Division of Mental Health Hashtag #YotB2015 Tweet at @EU_Brain

Comorbidity of depression and physical illness Prof. N. Sartorius, MD, PhD, FRCPsych Geneva Professor N. Sartorius, Brussels 2015 23

Definitions • Multimorbidity is the simultaneous presence of several diseases • Comorbidity is the simultaneous presence of one or more diseases with an index disease • Multimorbidity usually leads to general practice while comorbidity leads to specialists • Comorbidity is usually less well recognized and managed then multimorbidity Professor N. Sartorius, Brussels 2015 24

Definitions • Depressive disorders are well defined syndroms responding to specific treatment interventions • Depresive symptoms can be observed in the course of depressive disorders and in persons who do not have depressive disorders Professor N. Sartorius, Brussels 2015 25

Definitions Some of the symptoms of depression are observable in the course of physical illnesses and vice versa – some of the symptoms of physical illness can be seen in depression Professor N. Sartorius, Brussels 2015 26

Depressive symptoms Depressive symptoms Symptoms Symptoms of of physical depressive illness disorders Professor N. Sartorius, Brussels 2015 27

Definitions There are significant cultural differences – in the expression of experience of depresion; – in the perception of gravity and origin of symptoms by individuals and communities – In the definition of health and the thresholds of illness Professor N. Sartorius, Brussels 2015 28

Definitions Disease Illness Sickness Professor N. Sartorius, Brussels 2015 29

The diagnosis of depression • Symptoms are no more than one ingredient of diagnosis: others include information about person’s life and family, about the environment and about the course of the ailment • This information also allows the identification of individuals at higher risk of depression Professor N. Sartorius, Brussels 2015 30

Comorbidity of depression • Depressive disorders are most frequently comorbid with chronic noncommunicable diseases including in particular – Diabetes – Cardiovascular diseases – Cancer – Arthroses Professor N. Sartorius, Brussels 2015 31

Cancer and diabetes • Depressive symptoms and other signs of distress are frequent in people with cancer. • The prevalence of depressive disorders in people with cancer varies with the site of the cancer and with its severity – Cancer of the brain, head and neck …….. 40 -85% – Pancreas ……………………………………………… 35 -50% – Breast …………………………………………………. 19 -37% – Various other sites……………..……………….. 10 -30% Professor N. Sartorius, Brussels 2015 32

Depressive disorders and cardiovascular diseases • Depressive disorders increase the risk of mortality for coronary heart disease • The prevalence of depressive disorder in various forms of cardiovascular illness varies from 10 to 30 %, • The incidence of depression and of cardiovascular diseases has a dose-effect relationship with the history of abuse in childhood Professor N. Sartorius, Brussels 2015 33

% EDS in 'no diabetes' 45% % EDS in diabetes 40% 35% 35% 30% 25% 20% 20% 18% 15% 18% 15% 10% 10% 5% 8% 6% 6% 6% 0% Global and continental prevalence of an episode of depressive symptoms [EDS] in people with and without diabetes (Mommersteeg et al, 2013) Professor N. Sartorius, Brussels 2015 34

Depression often goes undetected in people with diabetes: 100% 90% 80% 44 49 detection rate 70% 70 75 75 75 78 60% 50% 40% 30% 56 51 20% 30 25 25 25 22 10% 0% NIH 1993 Rubin 2004 Pouwer 2006 Pouwer 2006 - Hermanns Katon 2004 Hermanns subthreshold clinical 2006 2006 clinical subthreshold detection no detection Hermanns et al., 2009 Professor N. Sartorius, Brussels 2015

Professor N. Sartorius, Brussels 2015 36

Depresive disorders and other physical illnesses • The presence of depressive disorders increases the probability of falling ill with diseases depending on self-neglect • The non-recognition of depressive disorders can lead to (un- necessary) treatment of mis-diagnosed conditions similar in their symptoms to depressive disorders Professor N. Sartorius, Brussels 2015 39