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Depression—not a matter of choice

Wednesday, January 11, 2017

We may often casually say we’re depressed, without having any stigmatising thought that we’re experiencing a mental condition. Now, it may not necessarily be the depression classified as mental illness—but since many of us at some point have felt deep sadness or despair, we can relate to the enduring symptoms of clinical, diagnosed depression.

Repeated periods of minor or major depression, without appropriate care or intervention, can become long-term depression. So one may well be living with an undiagnosed clinical condition, and be too scared to find out about it, and extremely reluctant to accept intervention and treatment. For various well-known reasons, only a very small number of people present themselves for diagnosis when they feel depressed (even if they are depressed for prolonged periods, or for episodes recurring in regular patterns).

I am always curious about the number of women who have recurring depression before, during or after the menstrual cycle—while paying no attention to it as a medical/mental health concern. How many “ride it out” month after month, discounting the long-term effect, until it becomes critical? How many dismiss it as PMS without further thought?

How many women know of the depressive illness called premenstrual dysphoric disorder (PMDD) that is different from PMS? According to, PMDD “causes emotional and physical symptoms, like PMS, but women with PMDD find their symptoms debilitating, and it often interferes with their daily lives, including work, school, social life, and relationships.” This sounds like PMS on steroids.

We have been taught to view mental health and mental wellbeing issues in isolation, not recognising that the community with similar circumstances is wider than we can imagine. And then there is the stigma.

Depression, like many other illnesses, is not an issue of personal failure.

It is not an issue of choice, either. One does not awake and say, “Today I am going to be depressed and I will remain in this state for as long as I feel”, and then later, decide to crawl out of that space into which they have placed themselves. Yet too many people believe that mental illness is a situation into which a person places himself (and there are some mental illnesses associated with behaviour and choices), and one from which he can “snap out”. But there is no logic to this belief.

Much of what occurs in our mental state, occurs despite us. Many issues account for that too. At the root are the social determinants of health – the conditions in which people are born, live, grow, work, and age. Circumstances that “are shaped by the distribution of money, power and resources at global, national and local levels” are the main contributors to health and its inequities.

Mental illness exists in all races, genders, populations, and in people from all continents, cultures, and religions. But the disproportionate prevalence cannot be denied: the poor and dispossessed register higher percentages of mental illness. And the wealthy have more healing/helping interventions due to their more-informed status and their access to resources.

As another example, World Health Organization (WHO) recognises gender as “a critical determinant of mental health and mental illness”, saying: “Gender determines the differential power and control men and women have over the socioeconomic determinants of their mental health and lives, their social position, status and treatment in society and their susceptibility and exposure to specific mental health risks.”

Depression will globally overtake all other illnesses in a few years. According to the WHO, (unipolar) depressive disorders will move into the first place as the leading cause of the global burden of disease by 2020.

In fact, I suspect we might be there already, and as is customary, medical science and research will catch up when the evidence is analysed.

To prove me correct, in the gender disparities discussion, the WHO says, “Mental illness is associated with a significant burden of morbidity and disability. Lifetime prevalence rates for any kind of psychological disorder are higher than previously thought, are increasing in recent cohorts, and affect nearly half the population.”

Depression can affect anyone and it is one of the most widespread illnesses, often co-existing with other serious illnesses. Research on depression says:

• The death risk for suicide in depressed patients is more than 20-fold greater than in the general population.

• Depression is an important risk factor for cardiovascular death.

• The risk of cardiac death after an initial heart attack is greater in patients with depression.

• Greater severity of depressive symptoms is associated with significantly higher risk of death including cardiovascular death and stroke.

• Depression increases the risk of decreased workplace productivity – both absenteeism and presenteeism (being at work while ill) (


Caroline Ravello is a strategic communications and media practitioner with over 30 years of proficiency. She holds an MA in Mass Communications and is pursuing the MSc in Public Health (MPH) from The UWI. Write to: [email protected]

Depression will globally overtake all other illnesses in a few years. According to the WHO, (unipolar) depressive disorders will move into the first place as the leading cause of the global burden of disease by 2020.


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