Interventionsmöglichkeiten bei Depressionen im Jugend- und jungen Erwachsenenalter aus Public-Health-Sicht

 

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Zusammenfassung

Bei Überlegungen, die durch Depressionen und ihre Folgen verursachte Krankheitslast zu verringern, rücken depressive Erkrankungen von Heranwachsenden und jungen Erwachsenen zunehmend in den Fokus des Interesses. Die Prävalenz ist in dieser Gruppe hoch und es muss mit einer Zunahme gerechnet werden. Die Prognose jugendlicher Depressionen ist besonders ungünstig. Diese Überblicksarbeit diskutiert das Potenzial zum Beeinflussen der Krankheitslast durch Interventionen wie Therapie, indizierter, selektiver und universeller Prävention und Gesundheitsförderung für Jugendliche und junge Erwachsene. Am meisten Einfluss ist hierbei von der effektiven Therapie sowohl von Depressionen als auch anderen psychischen Erkrankungen mit hoher Depressionskomorbidität zu erwarten. Es gibt Hinweise für die Wirksamkeit von Prävention im Bereich der Depression, die meisten Präventionsansätze erscheinen jedoch für eine bevölkerungsweite Implementierung zurzeit noch ungeeignet. Sie können aber als offene Angebote von individuellem Nutzen sein. Verhältnisorientierte Gesundheitsförderung sollte insbesondere auf die Familie fokussieren. Politische Maßnahmen, welche die Lebensverhältnisse von Eltern verbessern, fördern auch die psychische Gesundheit der Kinder. Schließlich muss die Diskussion um die durch Depressionen verursachte Krankheitslast auch vor dem Hintergrund der gegenwärtigen gesellschaftlichen Normen geführt werden. Dabei ist die Frage, wie viel Depression und wie viel Funktionsverlust noch als normal und nicht interventionsbedürftig gelten sollte, von besonderem Interesse.

Abstract

When considering measures to decrease the burden of disease that is caused by depression, the depressive diseases of adolescents and young adults are of increasing interest. The prevalence in this group is high and an increase in prevalence has to be considered. The prognosis for juvenile depression is particularly bad. This review discusses the potentials to influence the burden of disease through interventions such as therapy, indicated, selective and universal prevention and health promotion for adolescents and young adults. The most impact can thereby be expected from an effective treatment of depression and other mental diseases that have high co-morbidity with depression. There is some evidence for the effectiveness of preventive interventions for depression, however, most approaches currently seem to be unsuitable for wide implementation in the population. However, as open measures, they can offer individual benefit. Health promotion that focuses on political, living and societal conditions should be directed at the family. Policy measures that improve the living conditions of parents also promote the mental health of children. Finally, the discussion about the burden of disease that is caused by depression should be held by considering current societal norms. In this context, it is of special interest as to how much depression and how much loss of function should be still considered as normal and not eligible for intervention.

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Dr. Anke Bramesfeld MPH

Abteilung für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, OE 5410

Carl-Neuberg-Str. 1

30625 Hannover

Email: Bramesfeld.anke@mh-hannover.de