The neglected triple burden of mental health
The double burden of disease is well-mentioned in the earlier blogs. It entails the situation where people, especially from low- and middle-income countries, live under a burden of communicable diseases (CD’s) as well as non-communicable diseases (NCD’s). The first triple burden of disease was described in the post: Child and maternal health in refugee camps (nov. 20), where being a mother or child in a refugee camp proposed an extra health burden on its own and also increased the risks on CDs and NCDs. Now, another triple burden will be discussed, namely the triple burden of mental health.
Mental-health burden in MENA-region
The wars and conflicts that continue to terrorize the MENA-region, have devastating effects on general mental health. Mass loss of life, fleeing from homes, and acute physical health problems due to conflict put horrendous mental strains on people’s lives. As a result, (highly) elevated levels in the prevalence of mental health disorders have been found by multiple research teams.
One in five individuals living in those conditions end up with mental health disorders, such as post-traumatic stress disorder (PTSD), depression, or anxiety disorder. Poor mental health is directly linked to higher chances of developing CDs and NCDs, and vice versa. As there are only a few studies conducted on mental health in the MENA region, it is difficult to get a clear overview of the total burden of mental disorders. However, from the studies that have been done in some of its countries, depression came forth as one of the most common mental health disorders.
Beginning with the relationship with CDs, depression increases the chances of getting infected by a communicable disease, such as Hepatitis C and HIV. Contrary, depression could be the product of the stressful burden that comes from living with an infectious disease, or either be the direct result of the impact on the central nervous system. Looking at cardio-vascular disease (CVD) as a prime example for NCDs in the MENA region, this disease increases the chances of getting depressed. To name one explanation, CVD can limit someone’s feeling of joy in life because of its burden. In return, depression could inflict changes in lifestyle and dietary choices that subsequently enlarge the risk of developing CVD. A WHO-study conducted in the MENA-region on the co-morbidity of depression and NCDs showed that CVD was linked to increased chances of depression. It also showed that the comorbidity with this mental disorder was linked to having the lowest health scores.
Looking at vulnerable groups, another study that assessed the impact of mental chronic diseases in Jordan, showed that women and children were more likely to have developmental disorders. An analysis conducted by the WHO on the burden of diseases in the MENA-Region found that roughly half of both boys and girls from 6 to 12 years old in Palestine showed signs of behavioral and emotional disorders. However, mental suffering is hardly ever recognized, as the main focus of families is to get through the day alive…
Unmet needs
It is clear that there is a significant need for mental health care to ease the triple burden of mental health. The availability of mental health care and the government funds that are being invested in this sector play both a role in being able to react to this demand. Low- and middle-income countries (LMIC) have been found to spend less money in general on mental health care than high-income countries (HIC). This is a concerning fact when two-third of the countries in the MENA-region are regarded as LMIC. Even more because the mental health budget in high-income countries is only around 7% of the total health budget, which is not enough as mental disorders represent 13% of the total burden of disease.
Alongside the limited invested funds, there is a lack of human resources. The following clip was produced by the Turkisch state-owned new channel (TRT World) after the release of the shocking report by the WHO on the current mental-health situation in the MENA-region (also referred to earlier). In this clip, the unavailability of mental-health care workers in the MENA-region is clearly portrayed:
The lack of invested funds and available human resources leaves a lot of needs unmet. This is worrying, as the triple burden of mental health is evident. Even when there is not a lot of data available concerning this subject, the burden has to be taken seriously nonetheless. This is especially true for mental health care aimed at children, as they are affected the most by the burden. When this is left unaddressed, the MENA region seems to be storing up problems for later…
