Disability for severe depression

SAMHSA’s National Helpline | SAMHSA

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  • SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.

    Also visit the online treatment locator.

SAMHSA’s National Helpline, 1-800-662-HELP (4357) (also known as the Treatment Referral Routing Service), or TTY: 1-800-487-4889 is a confidential, free, 24-hour-a-day, 365-day-a-year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.

Also visit the online treatment locator, or send your zip code via text message: 435748 (HELP4U) to find help near you. Read more about the HELP4U text messaging service.

The service is open 24/7, 365 days a year.

English and Spanish are available if you select the option to speak with a national representative. Currently, the 435748 (HELP4U) text messaging service is only available in English.

In 2020, the Helpline received 833,598 calls. This is a 27 percent increase from 2019, when the Helpline received a total of 656,953 calls for the year.

The referral service is free of charge. If you have no insurance or are underinsured, we will refer you to your state office, which is responsible for state-funded treatment programs. In addition, we can often refer you to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. If you have health insurance, you are encouraged to contact your insurer for a list of participating health care providers and facilities.

The service is confidential. We will not ask you for any personal information. We may ask for your zip code or other pertinent geographic information in order to track calls being routed to other offices or to accurately identify the local resources appropriate to your needs.

No, we do not provide counseling. Trained information specialists answer calls, transfer callers to state services or other appropriate intake centers in their states, and connect them with local assistance and support.

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Last Updated: 08/30/2022

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FGBNU NTsPZ. ‹‹Depression in General Medicine: A Guide for Physicians››

Depressive states are the most common form of mental pathology in patients seeking help in general medical institutions, both outpatient and hospital networks.

According to modern estimates, the proportion of depression in patients of this contingent ranges from 10 [Katon W., Sulliven M. D., 1990] to 22-33% [Shmaonova L. M., Bakalova E. A., 1998; Ustun T. V., Sartorius N., 1995; Lyketsos C. G. et al, 1999].

Among elderly and senile patients who visit the territorial polyclinic, patients with depression make up 17. 4% [Zozulya T.V., 1998].

Among the outpatients of the neurological clinic, as evidenced by the data of S. Kirk and M. Saunders (1997), when examining 2716 patients, affective disorders are found in 17% of cases.

When studying an approximately equal sample size (1927 patients of a psychiatric office of one of the territorial polyclinics of Moscow), the proportion of depressive disorders was 38.2% of the identified mental pathology. Reactive depressions predominate - 28.1% (of which 18.9% mild and 9.2% moderately severe), the remaining 10.1% are shallow endogenous depressions within the framework of cyclothymia [Shmaonova L.M., Bakalova E.A., 1998].

As a result of our [Smulevich A. B. et al., 1999] on the basis of a territorial polyclinic of a continuous clinical and epidemiological examination of 495 patients who applied to a local therapist, it was found that depressive disorders in the aggregate occur in 21.5% of cases.

In economically developed countries (Sweden, Spain, USA, Australia, Japan, etc. ), the frequency of depressive states in patients in a somatic hospital who applied for psychiatric counseling is comparable to the above indicator and reaches 20-29% [Ruskin P. E., 1985; Pauser H. et al., 1987; Al-Ansari E. A. et al., 1990; Hattori T. et al., 1990; Bertolo L D. et al., 1996].

Endogenous depressions (38.5%) and dysthymia (33.8%) predominate, accounting for 2/3 of depressive disorders (72.3%).

The third place in frequency is occupied by vascular depressions - 16.9%, which coincides with the data of T. M. Siryachenko and N. M. Mikhailova (1998), according to which the frequency of vascular depressions in geriatric outpatient practice (specialized psychiatric office of the Moscow polyclinic) is 14 %. nine0003

Psychogenic depressions account for 10.8% (of which 6.2% are nosogenic and 4.6% are reactive).

According to the data of a continuous clinical and epidemiological survey of 921 patients of a large multidisciplinary hospital in Moscow [Smulevich A. B. et al., 1999], the frequency of depressive disorders approximately corresponds to the indicators obtained in the territorial polyclinic: every fifth (20.5%) patient suffers from depression.

In contrast to the outpatient contingent, psychogenic depressions are most common here. Their share is more than half (59.3%) of all depressive conditions. This part of depressive disorders is represented mainly by nosogenic depressions (45%), while reactive depressions associated with other psycho-traumatic effects were detected in 14.3% of patients.

Dysthymia accounts for about 1/5 of cases of depressive states (21.2%).

Endogenous depressions (cyclothymia) are much less common - 13.8%, and vascular depressions are at least - only 5.7%.

Analysis of the ratio of depressive disorders of various origins with somatic diseases reveals the following dependencies (Table 4). nine0003

Table 4

Correlation between the form (nosological affiliation) of depression and the diagnosis of a somatic disease

Dysthymia Endogenous depression (cyclothymia) Vascular depression

Nosological affiliation of depression

Diagnosis of a somatic disease

Patients with depression (% of the total number of patients diagnosed with this disease)

Psychogenic nosogenic*

myocardial infarction


eye injury

38. 5

Mallory-Weiss syndrome


Acute peritonitis


Systemic scleroderma


Lung cancer nine0003


Pancreas cancer


primary tuberculosis


Severe concomitant injury


ENT Cancer


Rectal cancer


prostate cancer


Chronic circulatory failure


Chronic ischemic heart disease


chronic colitis


Osteochondrosis of the thoracic spine


Osteochondrosis of the cervical spine


Type II diabetes


Chronic gastritis




Residual effects after cerebrovascular accident


Congestive chronic circulatory failure


chronic pneumonia



7 nine0003



* Reactive depressions due to other (non-nosogenic) psychotraumatic effects are evenly distributed across all categories of somatic diseases .

Among psychogenic depressions, nosogenic depressions (45% of all depressive disorders) are significantly more common in patients with severe, life-threatening or disabling somatic diseases. Such depressions are detected in more than 30 patients who have had a myocardial infarction, patients with oncological pathology (lung cancer, pancreatic cancer) and systemic connective tissue diseases, as well as in people with primary tuberculosis. The frequency of nosogenic depressions is quite high (37.5%) in patients with acute surgical pathology requiring urgent surgical intervention (acute peritonitis, Mallory-Weiss syndrome), as well as in patients with severe concomitant trauma (27%) and traumatic lesions of the organs of vision ( 38.5%). nine0003

At the same time, reactive depressions, which make up 14.3% of all depressions in the studied sample, do not show preference in relation to any individual forms of pathology of the internal organs. This, apparently, is explained by the fact that, unlike nosogenic depressions, reactive depressions are not directly related to somatic suffering and are caused by events related to family life or work.

Dysthymic disorder, which occurs in 22.1% of patients suffering from depression in a somatic hospital, is associated with protracted somatic diseases and occurs with a frequency of up to 25-30% in cancer patients (cancer of the rectum, ENT organs, prostate), less often (17 %) in chronic circulatory failure and even less frequently (7%) in chronic ischemic heart disease. nine0003

Endogenous depressions (13.8% of all depressions in the study sample) show a significant relationship with gastroenterological and neurological pathology. This type of depressive disorder is more common in patients with the main diagnoses of chronic colitis (43%), chronic gastritis (12%), cholelithiasis (7%). The frequency of endogenous depressions in patients diagnosed with osteochondrosis of the thoracic and cervical spine is 27 and 18%, respectively. Similar indicators for this pathology are also given by other researchers. Some authors believe that these calculations reflect an inadequately broad diagnosis of somatic pathology (osteochondrosis, colitis), but in reality we are talking about symptoms of depression that occurs with somatic algic and functional disorders. In our opinion, it is more adequate to consider the discussed ratios in connection with the negative impact of an affective disorder on the somatic state of the patient - with the manifestation of depression, the symptoms of diseases such as chronic gastritis, chronic colitis worsen, pain in patients with spinal osteochondrosis aggravates, which necessitates more intensive care and, accordingly, seeking inpatient care. nine0003

Vascular depressions (5.7% of all depressions in the studied sample) are significantly more often associated with diseases associated with impaired blood supply to the brain (residual effects after acute disorders of cerebral circulation - 8%, dyscirculatory encephalopathy - 6%, congestive chronic circulatory failure - 7% ). Vascular depression has a similar frequency (7%) also in patients with chronic lung diseases (chronic pneumonia, emphysema) accompanied by cerebral hypoxia. It should also be emphasized that vascular depressions are more common in neurological and cardiological clinics. nine0003

The data obtained generally confirm the results of other studies. The calculations given by the authors depend on the nature of the clinical manifestations and the characteristics of the course of the disease. It has been shown that with a high frequency of depression, reaching 20-25%, in patients with oncological diseases, in general [Plumb B., Holland J., 1977; Kathol R. et al, 1990] this indicator depends on the localization of the malignant neoplasm: with the greatest frequency, depressive disorders are detected in patients with pancreatic cancer and lung cancer [Holland J. C., 1986; Green A., Austin S., 1993; Passik S. D., Breitbart W., 1996; Zabora J. R. et al., 1996]. According to the results of our own study [Smulevich A. B. et al., 1999], in these forms of cancer, nosogenic depression prevails, the frequency of which reaches 33%, while dysthymic depressions are more typical for patients with prostate and colon cancer (25% ). The risk of developing depression increases in proportion to the duration of the oncological disease, the degree of maladjustment, the severity of the pain syndrome and other symptoms of cancer [Derogatis L. R. et al., 1983; Bukberg J. et al., 1984]. If the prevalence of depression in women is revealed in the population (in a ratio of 2: 1), then in oncological practice these disorders are approximately equally distributed among both sexes [DeFlorio M. L, Massie M. J., 1995].

A number of diseases of the digestive system are also associated with an increased frequency of depressive disorders. These include, in particular, Crohn's disease and ulcerative colitis [Addolorato G. et al, 1997]. The highest frequency of comorbid depressive states in the so-called functional gastrointestinal disorders. Thus, in irritable bowel syndrome, the lifetime prevalence of depression reaches 60-70% [Walker E. et al., 1990; Tollefson G. et al., 1991]. A high frequency of depressive disorders has also been established for other variants of functional disorders of the gastrointestinal tract (GIT) - functional dyspepsia, gallbladder dysfunction, etc. [Drossman A. D. et al., 1994]. In such cases, endogenous (cyclothymic) and chronic (dysthymia) depressions predominate, the frequency of which reaches 60% (a joint study of the Department for the Study of Borderline Mental Pathology and Psychosomatic Disorders of the RAMS Scientific Center for Health and Psychology and the Laboratory of Chronobiology and Clinical Gastroenterology of the Russian Academy of Medical Sciences) [Komarov F. I. et al. ., nineteen99].

The frequency of depressive disorders in patients with acquired immunodeficiency syndrome (AIDS), as already mentioned, is at least 20% of the number of corporatized [May M., 1996]. The value of this indicator may depend on several factors (the psycho-traumatic content of information about the incurability of the infection, its progressive, disabling course), the importance of which increases due to the young age of patients and the negative attitude towards the AIDS patient of family members, colleagues and society as a whole. nine0003

We have received statistically significant confirmation of the adverse effect of depression of various origins on the adaptation of somatically ill patients, as already partly discussed in the introduction. The proportion of disabled people of groups I and II in terms of somatic disease with comorbid depression significantly exceeds the corresponding indicator for the studied sample as a whole.

Given in table. 5 differentiated data make it possible to verify that relatively more severe and prolonged vascular and endogenous depressions are especially unfavorable for the patient's adaptation to the manifestations of a somatic disease: when they are added to a somatic disease, the probability of disability in group 2 almost doubles (45.5 and 46.2% respectively, against 20.4% of patients of group 2 in the studied sample as a whole). The least favorable prognosis for working capacity in vascular depression, when almost 9times more often disability of the 1st group is registered (9.1% versus 0.9% in the general sample).

Table 5. Correlation of depression with disability due to somatic disease in patients of a large multidisciplinary hospital, % ( n = 921)


Physical disability

The proportion of disabled people with depression of various origins

For the entire sample







I group

1. 2






II group







* Significantly higher than in the studied sample as a whole (p < 0.05) .

It can also be seen that reactive depressions also have a negative impact on the performance and adaptation of somatic patients. Disability is more severe when physical illness and reactive depression occur in connection with the same event (eg, myocardial infarction and depression due to a family tragedy). Such psychosomatic diseases are especially difficult - the frequency of registration of disability in group II increases from 20 to 37%, and in group I - from 0.9up to 3.7%.

We also note the significant role of nosogenic depressions, in which group II disability due to a somatic disease is registered more often than in patients without depression (31.8 versus 20%). However, in comparison with reactive nosogenic depressions, they have a less severe and protracted course, and therefore the proportion of patients with group I disability among patients with nosogenic depressions does not differ from that in the studied sample as a whole.

Depressive disorders shorten a person's life by 3.8%

Depressive disorders reduce human life by 3.8% - Newspaper.Ru

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Depressive disorders are a major cause of disability and a factor in the risk of coronary heart disease and suicide. On average, depression shortens life by 3.8%.

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Every autumn, the pages of glossy magazines are adorned with advice on how to deal with depression. The advisers have in mind a slight despondency caused by a cold snap and prolonged rains. Real depression is a more serious illness, fraught with disability and even premature death. Experts from several medical centers in Australia, Canada and the United States analyzed more than 400 million cases of depressive disorders reported in 2010, their distribution across countries, gender and age, as well as the impact of depression on the number of suicides and the occurrence of coronary heart disease. The results of the study published in the journal PLOS Medicine , indicate that depression is one of the main causes of disability, it shortens people's lives by an average of 3.8% and places a heavy burden on health care.

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Depressive disorders cause a feeling of melancholy and hopelessness that lasts for months and sometimes years. nine0003

Patients lose interest in their usual activities, they develop physical ailments such as sleep disturbance. One depressive disorder, clinical depression, is a chronic illness that can lead to suicide. It includes at least one episode, lasting at least two weeks, during which the patient constantly experiences intense anguish, sometimes committing suicide. There is a mild form of depression - dysthymia . Patients with dysthymia are constantly unhappy, these are the eternal Pierrots. Both types of depression are treated with antidepressants and psychotherapy. nine0003

Researchers analyzed available statistics and surveys and counted 298 million cases of clinical depression and 108 million cases of dysthymia in 2010. Even small children suffer from these disorders, starting from the age of five, but the main contingent of patients is adults of working age. Women get sick more often than men: they accounted for 187 million cases of depression and 62 million cases of dysthymia, while men accounted for 111 million and 44 million cases, respectively.



Scientists have calculated how many years people spend on disability caused by depression, and how many years of healthy life they have lost due to associated complications and premature death (clinical depression contributes to the development of coronary heart disease and provokes patients to commit suicide).

In the 1990s and 2000s, depressive disorders were one of the leading causes of disability.

In 2010, the disease is not losing ground. Depressive disorders were the second leading cause of disability. Clinical depression reduces life by an average of 2.5%, and dysthymia by 0.5%. When depression-induced suicide and coronary disease are taken into account, this rises to 3.8%. nine0003

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These are averages. In different countries they get sick in different ways. Researchers associate different levels of morbidity with military conflicts, sexual violence, and child abuse. The leaders in incidence are Afghanistan, North Africa and the Middle East. The most likely reason for this situation is protracted military conflicts. Often and seriously fall ill with depressive disorders in Russia and Eastern Europe, the least common in Japan, China, Australia and Mexico. nine0003

The relative severity of depressive disorders also varies.

Depression ranks 11th among the disabling diseases, this is the world average,

but in North Africa, the Middle East and the Pacific coast of Latin America (in the Andes) it is higher, where depression ranks third among the causes disability. In South West Africa, depression is only 19th, not because of a quiet life, but because it has been supplanted by infectious diseases such as AIDS and malaria. nine0003

Researchers emphasize that depression should be a focus of attention, a priority for public health.

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