Lund University Publications

The devil in the details: public health and depression.

• Mark

Vilhelmsson, Andreas ^LU

Abstract

Background: Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. This description is, however, not without controversy, and some scholars are skeptical of how, for instance, depression is viewed as an increasing widespread ill health problem.

Discussion: While public health medicine has long engaged in strategies of disease prevention and health promotion, more individualized practices of risk are argued to have become a central dimension of the politics of life in the twenty-first century. By trying to assess potential risk factors for disease and disorders at earlier stages, the concepts of illness and risk may become increasingly blurred. Non-medical problems... (More)

Background: Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. This description is, however, not without controversy, and some scholars are skeptical of how, for instance, depression is viewed as an increasing widespread ill health problem.

Discussion: While public health medicine has long engaged in strategies of disease prevention and health promotion, more individualized practices of risk are argued to have become a central dimension of the politics of life in the twenty-first century. By trying to assess potential risk factors for disease and disorders at earlier stages, the concepts of illness and risk may become increasingly blurred. Non-medical problems have become medical ones with risking leading to overdiagnosis and overtreatment as the definition of what constitutes an abnormality gets increasingly broader. If normal events are misdiagnosed as depression, this will risk leaving those who are depressed untreated (extended waiting lists to health care, wrong medications or lack of resources) and thereby create undertreatment and overtreatment simultaneously.

Summary: For the sake of public health, arguments for increased diagnosis must therefore be related to a possible danger of medicalizing social problems and life crises. By including people with mild problems in estimates of mental illness, we risk losing support for treating those people who have legitimate disorders. (Less)