The ethical context of population-level interventions against depression

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Holm, Søren ; Burgess, Stephen ; Cardiff University (2006)
  • Publisher: Cardiff University
  • Subject: H1

Depression is often seen as a growing public health issue, and this is reflected in a growing number of interventions. This paper discusses the ethical implications of interventions conducted at the population, as opposed to the individual, level. We start by outlining the main ethical considerations of such approaches. Particularly we argue that given the stigma associated with diagnoses and labels of mental illness, including depression, allocation or adoption of such labels greatly effects the lives of sufferers. While long-term social and legal efforts may be made to reduce stigma and discrimination, the potential consequences of such labels must be recognised and greater sensitivity to this must illuminate discussions and practice of diagnosis, intervention and treatment. With this in mind, we proceed to consider several specific large-scale interventions to address depression. These include: webbased interventions; over the counter sales of anti-depressants; school-based interventions and interventions in the young and environmental interventions. We conclude that many types of large-scale intervention are not ethically unproblematic and that there is a significant difference between treating people who seek help, and searching for people whom we think need help. Consequently, in the current climate of prevailing attitudes towards mental health generally, and depression in particular, the use of population-level interventions raises serious ethical considerations that cannot be ignored.
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