JAVNOZDRAVSTVENI ZNAČAJ DEPRESIJE – MOGUĆNOSTI INTERVENCIJE U PRIMARNOJ ZDRAVSTVENOJ ZAŠTITI - Despotovic, Mile Lj (PONS - medicinski časopis, 2016)
SAŽETAK Depresija je jedan od najčešćih duševnih poremećaja čiju psihopatološku osnovu čini promena raspoloženja. Karakteriše se nekontrolisanim padom raspoloženja koji utiče na razmišljanje, opažanje, ponašanje, fizičko i socijalno funkcionisanje. U svetu od depresije boluje oko 120 miliona ljudi, a stopa prevalencije iznosi 5-10%. Depresija će 2030. godine, sa udelom od 6,3%, zauzimati prvo mesto u ukupnom opterećenju bolestima (SZO). Približno 2/3 osoba koje počine suicid boluju od depresije, dok 15-20% bolesnika sa depresivnim poremećajem okončava živort suicidom. Pacijenti sa karcinomima i preležanim infarktom miokarda praćeni depresijom imaju višu stopu smrtnosti u odnosu na osobe bez depresije. Depresija predstavlja vodeći uzrok invalidnosti među psihičkim bolestima u Evropi, sa godišnjim troškovima od 115 milijardi €. Osobe sa nižim prihodima, stariji od 65 godina, žene, deca i adolescenti čine vulnerabilne grupe. Lečenje od strane lekara opšte medicine i model psihijatrije u zajednici najbolje zadovoljava potrebe pacijenata sa depresijom (SZO). U primarnoj zdravstvenoj zaštiti (PZZ) lekar orijentisan prema pacijentu kao ličnosti i uticajima porodičnog, profesionalnog i društvenog okruženja na njegovo psihofizičko zdravlje, može postaviti dijagnozu depresije kod 15-25% pacijenata. Međutim, problem nije bilo moguće rešiti samo u ordinacijama opšte medicine ni u mnogo razvijenijim zemljama. U Srbiji samo 39% pacijenata sa depresijom koji se jave psihijatru predhodno kontaktiraju lekara opšte medicine. Nedovoljno ulaganje u mentalno zdravlje, nedostatak vremena, motivacije i obuke lekara PZZ, loša komunikacija sa sekundarnim nivoom, nepostojanje centara za zaštitu mentalnog zdravlja u zajednici problemi su koji zahtevaju multisektorski pristup, partnerstvo i saradnju stručnjaka, pojedinaca i ustanova iz lokalne i šire društvene zajednice. Ključne reči: depresija, mentalno zdravlje, primarna zdravstvena zaštita, društvena sredina, lekar opšte prakse. ABSTRACT Depression is one of the most common mental disorders of which the psychopathological basis lies in mood changes. It is characterized by an uncontrolled mood changes which affects thinking, perception, behavior and both physical and social functioning. Worldwide, depression affects around 120 million people, and the prevalence rate is 5-10%. In 2030, with a share of 6,3%, depression will hold the first place in the overall disease burden (WHO). Approximately, 2/3 of people who commit suicide suffer from depression, while 15-20% of patients with major depressive disorder end their life with suicide. Patients with cancer and with myocardial infarction accompanied by depression have a higher death rate compared to those who do not suffer from depression. Depression is leading cause of disability among mental health problems in Europe, with an annual cost of EUR 115 billion. People with lower income, people older than 65 years, women, children and adolescents are all vulnerable groups. Treatment by doctors of general practice and model of psychiatry in the community successfully meets the needs of patients suffering from depression (WHO). In primary health care (PHC) a doctor who is oriented towards the patient as a person and toward influences of family, professional an social environment on his mental and physical health, can diagnose depression in 15-25% of patients. However, the problem could not be solved only within scope of general practice even in the most developed countries. In Serbia, only 39% patients suffering from depression who visit a psychiatrist have previously contacted a general practitioner. Insufficient investment in mental health, lack of time, motivation and training of PHC doctrs, poor communication with secondary level, the lack of centres for mental health in community-these are all problems that require a multi-sectorial approach, partnership and cooperation of experts individuals and institutions in the local and wider social community. Key words: depression, mental health, primary health care, social environment, general practitioner