Depression's Heavy Toll In Afghanistan: A National Crisis Unveiled

Afghanistan has been devastated by violence, with an estimated half of the population experiencing depression, anxiety, or post-traumatic stress. Despite this, the government only spends about $0.26 per capita on mental health, out of $7 spent annually per capita on health services in general.

According to a national survey, 64.67% of the Afghan population had personally experienced at least one traumatic event, with women and those aged 35 and above being more at risk. The 12-month prevalence of PTSD was 5.34%, GAD was 2.78%, and the 12-month MDE was 11.71%.

The World Health Organization estimates that over a million Afghans suffer from depressive disorders, while over 1.2 million suffer from anxiety disorders. These figures are likely to be much higher.

The prevalence of anxiety and depression among hypertensive outpatients in Afghanistan is also high, with 42.3% of patients experiencing anxiety disorders and 58.1% experiencing depressive disorders.

Afghanistan's mental health crisis is a huge obstacle to a better future for the country.

Depression is a common mental illness characterised by persistent sadness and a loss of interest in activities

In Afghanistan, depression is a leading cause of ill health and disability. According to the World Health Organization (WHO), more than a million Afghans suffer from depressive disorders, while over 1.2 million suffer from anxiety disorders. These figures are likely to be much higher, as accurate data on depression and mental health disorders is not available in the country.

The risk of becoming depressed is increased by multiple factors such as poverty, insecurity, conflict, unemployment, physical illness, gender-based violence, and drug use. Depression can have devastating consequences on people's ability to carry out everyday tasks and maintain relationships with family and friends. It can also lead to suicide, which is now the second leading cause of death among 15-29-year-olds globally.

In Afghanistan, the mental health system is under-resourced and under-developed. The government spends very little on mental health, and there is a lack of trained professionals to provide adequate care. Accessing psychosocial support and mental health services is a challenging task for Afghans, especially women and girls, due to individual, cultural, and structural barriers.

However, there have been some efforts to address the issue. The Afghan government has trained over 700 professional psychological counsellors and 101 specialised mental health doctors. Additionally, international donors have invested in improving the mental health system through technical assistance and support. But more needs to be done to ensure that all Afghans have access to the help they need.

Women in Afghanistan are disproportionately affected by depression and PTSD

Several factors have been found to affect the mental health status of Afghan women, including education, age, marital status, ethnicity, coping mechanisms, and regular income.

Education has been found to be a protective factor for mental health. However, the relationship between education and mental health appears to be more complex among Afghan women. The increase in years of education was associated with the experience of PTSD in the current study. In addition, having received no education was also positively associated with PTSD.

The possible reason for the positive association with the length of education and PTSD among Afghan women may be the interaction between education and its sociocultural context. Those with more years of education may be more westernized and less conservative, and thus, might experience a subjectively higher degree of trauma due to the cultural distance in the Afghan social and political environment than those who are more accustomed to Afghan culture.

Other factors that have been found to affect the mental health status of Afghan women include age, income, general health status, and life satisfaction.

The prevalence of depression and anxiety is higher among hypertensive patients in Afghanistan

According to the World Health Organization, approximately 280 million individuals worldwide suffer from depression. The prevalence of depression among healthcare workers in the Eastern Mediterranean Region was found to be 33.03%. In Afghanistan, the prevalence of depression among healthcare workers was found to be 73.6%. The prevalence of depression among Afghan women living in urban areas under the Taliban government was found to be 80.4%. The prevalence of depression among Afghan school-going adolescents was found to be 65.3%. The prevalence of depression among hospitalized patients in Afghanistan was found to be 65.8%.

The Afghan government spends very little on mental health services

Afghanistan has been devastated by decades of violent civil war, political unrest, and conflict. This has taken a huge toll on the population's mental health, with around half of Afghans experiencing depression, anxiety, or post-traumatic stress. Despite this, the government spends very little on mental health services.

Lack of government spending on mental health

The Afghan government only spends about $0.26 per capita on mental health, out of $7 spent annually per capita on health services in general. This is far below the $3 to $4 per capita that the World Health Organization says is needed for an appropriate mental health system in low-income countries.

Insufficient mental health services

The lack of government spending has resulted in a scarcity of mental health services across the country. Most Afghans with mental health problems cannot access the care they need or are afraid to seek help. It is estimated that only 3% of people visiting health centers are offered help for their mental health.

Overreliance on international donors

Mental health services in Afghanistan have been heavily reliant on funding from international donors. However, these donors have focused primarily on physical health rather than mental health. Recently, the loss of funding from international donors has pushed the Afghan health system to the brink of collapse, further limiting access to mental healthcare.

Stigma and lack of awareness

Mental health is considered a taboo topic in Afghanistan, and many people hide their mental health problems due to stigma, shame, and discrimination. There is also a lack of awareness about mental health issues, with many Afghans unaware that mental illnesses are treatable.

Lack of mental health professionals

There is a shortage of mental health professionals in Afghanistan, including psychiatrists, psychiatric nurses, psychosocial counselors, and social workers. This further limits access to mental health services for those in need.

Impact of insufficient mental health spending

The lack of government spending on mental health has had a detrimental impact on Afghans suffering from mental illnesses. Many Afghans face barriers in accessing psychosocial support and mental health services, particularly women and girls. Those who do access services may suffer abuse, such as forced hospitalizations and treatments.

Recommendations for improvement

To improve mental health services in Afghanistan, the government should increase its spending and take several other steps. These include:

• Conducting public awareness campaigns to reduce stigma and inform people about mental health.
• Training health workers to proactively provide referrals to mental health services, with a focus on the needs of women and children.
• Integrating mental health into basic health services to make it more accessible.
• Increasing the number of mental health professionals and ensuring they have adequate training.

Access to psychosocial support and mental health services is a basic human right

Unfortunately, people with mental health conditions around the world experience a wide range of human rights violations. Many experience coercive practices, including involuntary admission and treatment, seclusion, and restraint. People with mental health conditions are also often excluded from community life, discriminated against, denied basic rights such as food and shelter, and prohibited from voting or getting married.

In Afghanistan, it is estimated that half the population experiences depression, anxiety, or post-traumatic stress. Despite this, the government only spends about $0.26 per capita on mental health, out of $7 spent annually per capita on health services in general. The World Health Organization (WHO) estimates that an appropriate mental health system in low-income countries such as Afghanistan would require an investment of $3 to $4 per capita.

To promote the human rights of people with mental health conditions, it is necessary to ensure that laws and policies related to mental health are in line with internationally agreed-upon human rights conventions. Additionally, it is important to improve human rights in mental health services, replace psychiatric institutions with community care, change attitudes and raise awareness, empower people with mental health conditions and their families, and increase investment in mental health.

A robust rights-based approach to mental health is needed to overcome the effects of commercial interests on the mental health field. Commercialized science, or the use of science primarily to meet industry needs, deflects attention away from the sociopolitical determinants of health and undermines several key elements of a rights-based approach to mental health, such as the right to participation, the right to acceptable health care, and the importance of population-based health interventions.

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