Health Science Reviews

By Mbalentle Madlala

What comes to mind when you read the words “mental health”? Your answer may depend on several factors. One factor may be age. Many of us may be aware of the “infamous” feud between the so called “baby boomers” (born 1944 – 1964) and “Generation Z” (born 1995 – 2015). There have been several social media posts noting the differences in opinions and world-views between the two groups as well as informative discussions that have occurred on media platforms, such as Jubilee. One topic that often comes up for discussion is what people from two completely different generations know and think about mental health. Is mental illness real, or is it just an excuse/justification for laziness/not fulfilling an expectation?

Another factor that could influence your answer may be cultural background and exposure. Often, mental illness can be thought of as being a result of out-of-line behaviour and/or wrong choices/beliefs. This can lead to mental illness being dismissed as being able to happen to anybody, being attributable to pathology, and being treatable.

These factors could all contribute to the formation of, what scientists have called, concealable stigmatised identities (CSIs). A CSI is an identity that can be kept hidden or concealed from others and that has negative attributes or stereotypes attached, which can result in a loss of status and/or discrimination in society. HIV/AIDS and mental disorders are examples of CSIs.

Depression, one of the most common CSIs, is a mental disorder characterised by having a low mood and loss of interest and enjoyment in usual activities. As many as 1 in 6 South Africans suffer from anxiety, depression or substance-use problems according to the South African Depression and Anxiety Group. Furthermore, research reveals that over 40% of South Africans living with HIV have a diagnosable mental disorder, making them affected by two concealable identities.

In addition to the lack of mental healthcare resources in South Africa, stigmas surrounding mental health pose a major stumbling block when it comes to treating the disease. As discussed at the beginning of this piece, cultural background and “traditional” thinking may add to the stigma against depression. Thus, the review done by Dai and colleagues (2019) showing how depression can be related to actual structural and functional abnormalities in the brain not only sums up the knowledge we have in the field whilst highlighting the gaps, it also presents the opportunity to address the stigma against depression by validating its biological attributes.

MRI = Magnetic Resonance Imaging; a non-invasive imaging technology that produces three dimensional detailed anatomical images, often used for disease detection, diagnosis, and treatment monitoring

So what does this review help us understand about abnormalities in certain parts of the brain being related to depression? By using tools in the form of big machinery, different machine settings and computer programs, such as Magnetic Resonance Imaging (MRI), biological information about the brain’s structure and functional capacity can be obtained. Firstly, listed below are the type of structural changes we can see in patients diagnosed with major depression disorder according to the review:

• Changes in the brain’s volume is seen, meaning that physiological senses and higher functions such as muscle control, vision and hearing, memory, emotion, language, decision-making and self-control can be compromised.
• Reduced brain connectivity is seen, leading to impaired information delivery, which may cause deficits in attention, declarative memory, executive function, and intelligence.
• Blood vessel changes in the brain are seen, and we all know our brains CONSTANTLY need an adequate supply of oxygen!

Secondly, the impact this mental disorder has on the brain functionality is seen when brain network connectivity changes were assessed and changes in brain activity in different regions were seen using the above-mentioned technologies.

Interestingly enough, this review pointed out how most changes seen in the brain involve specific systems and networks that together cause a variety of clinical symptoms in people with depression. HOWEVER, the authors conclude that more data is required from patients of different age groups, symptoms and other related disorders to obtain highly specific results. Finding the commonality of the brain structure and/or brain function of patients in various subgroups is necessary to better diagnose individuals and find the best treatment for this disorder.

So whilst this review did well to highlight research that shows evidence of structural and functional changes associated with depression – which could contribute to validating its existence in the eyes of many and helping break down the shame attached with CSIs – it ends with the call to stand up and step forward. Diverse data is still in need. Thus, barriers need to be broken and stigmas need to be addressed. Research in this field will move forward once we choose to move forward in our thinking. In this way we make room for those who suffer in silence, those who feel too old/too far gone to be helped, or those who’ve been taught not to recognise mental health, to feel comfortable and free to share their experiences and consequently receive help.

References:

1. Dai L, Zhou H, Xu X, Zuo Z. Brain structural and functional changes in patients with major depressive disorder: a literature review. PeerJ. 2019 Nov 29;7:e8170–e8170.
2. Cooper KM, Gin LE, Brownell SE. Depression as a concealable stigmatized identity: what influences whether students conceal or reveal their depression in undergraduate research experiences? Int J STEM Educ. 2020 Jul 13;7:NA.
3. Pillay Y. State of mental health and illness in South Africa. South African J Psychol. 2019 Jun 18;49(4):463–6.
4. The South African College of Applied Psychology, “The shocking state of mental health in South Africa in 2019”. https://www.sacap.edu.za/blog/management-leadership/mental-health-south-africa/.