1. Understanding Clinical Depression in Fiji
By:
Brandan Shamsher

2. What is Clinical Depression?
Clinical Depression, more specifically known as Major Depressive Disorder is a serious mental health state of instability and low self- esteem which effects much of the Fijian Population.
For decades, Clinical Depression, has been overlooked by Medical Professionals in Fiji, but in recent years, the sudden alarming hike in Depression induced Self-Harm and Suicide Cases have left physicians as well as the Ministry of Health of Fiji no choice but to develop and establish a framework like in more developed countries in properly identifying, treating and preventing Depression.

3. Similar Depressive Disorders
Melancholia, an extremely severe level of Depression which has a prominent effect on the movement, mobility and productivity of an individual.
Psychotic Depression is the association of Psychosis with Depression, which makes an individual unable to differentiate between reality and hallucinations due to the increased onset of delusions and paranoia.
Bipolar Disorder, which many argue to be the opposite of depression due to its intense periods of mania or episodes of irritation, frustration, hyperactivity and is often misdiagnosed for Depression.

4. Symptoms of Clinical Depression
Symptomatically, anxiety, paranoia, low self-esteem, changes in sleeping or eating patterns, fatigue and in severe cases, suicidal thoughts are associated with clinical depression but these may differ among patients from different socio-economic backgrounds, with age and gender at paramount.
Although the Depression Gene is known to be inherited, environmental and climatic factors have also been found to contribute greatly towards the development of Clinical Depression in a person from a mild to a severe state and is generally compared or mistaken for Bipolar Disorder which is more periodic.

5. Self-Harm & Suicide
One of the main consequential factors of Clinical Depression which sets its apart from other Mental Health Conditions is the increased Self-Harm & Suicidal Tendencies.
With the suicide rate in Fiji being at 34.8% per 100,000 of the Population in 2014, out of which 2.7% are Young, Unmarried Indo- Fijian Males of High Education Levels.
Of the 5581 Hospitalized Cases of Self-Harm in 2012, 10% confessed to previous attempts.
Individuals who are Clinically Depressed tend to have the urge to end their life thus ending their feelings of hurt or pain or indulge in Self- Harm to gain the attention or empathy of others close to them.

6. Genetics and Clinical Depression
Clinical Depression is known to have a Hereditary Component, similar to other Psychological Disorders.
Depressive Disorders have a unique Biochemical Quantitative Makeup which makes it rather difficult to target but both physical and genomic characteristics confirm the Inheritance Link of Clinical Depression among Generations.
The Depressive Gene is also known to be recessive and skip a Generation. This is shown through studies conducted on ADHD Cases and the Family Generational Lineage in which a generation gap was found.

7. NCD’s & Clinical Depression
Non Communicable Diseases and Clinical Depression form a inter- twined cycle in which individuals diagnosed with Clinical Depression tend to eventually develop Non-Communicable Diseases such as Hypoglycaemia or Hypertension due to sudden change in attitudes towards diet and physical changes brought about by behavioural onsets resulting in Genomic Influxes.
This notation is also found in a reversed scenario whereby individuals who are found to suffer from Diabetes or Obesity eventually show Depressive Disorder Symptoms.

8. Clinical Depression in Teenagers
57% of Suicide & Self-Harm Cases are between the ages of
School Based Studies conducted in Fiji show that 1 out 9 Pupils were suffering from Clinical Depression like Symptoms and 1 out of 15 had Self-Harm Tendencies.
Educators must have the necessary training and approach in order to properly identify, handle and assist students suffering from Clinical Depression.
Educators must also be able to refer with privacy at paramount, Students who submit to Self-Harm and with Suicidal Thoughts.

9. Men, Women & Clinical Depression
Studies have also shown that women are more likely to be diagnosed with Clinical Depression compared to men, but this has made experts to bring about a theory which suggests that most men who do suffer from Clinical Depression would rather not seek professional treatment or undergo therapy as to be diagnosed with a disorder of such would be deemed weak and fear that it would have a negative impact on their employment, family and relationships.
Such stereotypes with being diagnosed with a Mental Disorder are quite prominent in Fiji therefore once a diagnosis is made, that is, if it is made, it may generally be at a very crucial stage of Depression whereas many of the undiagnosed patients are identified after they have induced harm to themselves and even committed suicide.

10. Stereotypes & Attitudes Associated with Clinical Depression
Most Clinical Depression Cases choose not to seek Professional Help with the Treatment of their Disorder due to the underlying Stigma associated with being Diagnosed with it.
A trend is noted in which there is now an increase in the number of diagnosed Individuals with Clinical Depression compared to 10 Years ago and this is main attributed to the fact the Clinical Depression is being acknowledged and more awareness being conducted on the disorder.
Many fear that being diagnosed with Clinical Depression would have a drastic impact on interpersonal relationships, employment and financial stability and this is brought about by the mismanagement of patient information, misinterpretation of and improper Clinical Practices.

11. Ministry of Health & Medical Services
The Ministry of Health in Fiji, is yet to prioritize the mental health needs of the Fijian population which in recent days is becoming quite a notable area for discussion as outlined above due to the increase of self-harm and suicidal cases.
Instead of referring the patient directly to law enforcement agencies for investigation, a parameter must be setup to ensure the proper psychological assessment of the patient and a full pathophysiological evaluation is done which would not only allow other Clinically Depressed sufferers to come forward and seek the medical attention they need but also elevate the attitude shown towards Clinical Depression and the profound stigma associated with it.

12. Mental Health & Counselling Services
There are a number of Counselling Services available in Fiji for both teenagers and adults such as Empower Pacific and Lifeline Pacific as well University or Employer based in-house Counselling Services.
But the reason people don’t approach or use these Services are concerns about privacy and being categorized as “insane”.
Proper Case Management, Patient Data Confidentiality, Neutrality of Space and Equal Opportunity with Prejudice is essential in being integrated with Current Legislations and the proper Training, Certification and Registration of Mental Health Practitioners would drastically change the outlook in handling Clinical Depression in Fiji.

13. Thank You
Questions ?