The vast majority of people suffering from depression worldwide are not receiving even minimally adequate treatment, according to a study published this week in the British Journal of Psychiatry based on surveys of more than 50,000 people in 21 countries. While the situation improves significantly in developed high-income countries, still only one in five receive adequate treatment where it’s most available. Among the poorest countries, this figure falls to one in 27.
The findings are based on analyses of data collected as part of the WHO World Mental Health Surveys, a collection of 23 community surveys from 10 low- or middle-income countries (Brazil, Bulgaria, Colombia, Iraq, Lebanon, Mexico, Nigeria, People’s Republic of China, Peru, and Romania) and 11 high-income countries (Argentina, Belgium, France, Germany, Israel, Italy, Japan, Netherlands, Portugal, Spain, and the United States). In all, the researchers, led by King’s College London psychiatry professor Graham Thornicroft, tracked 4,331 people with depression.
In more than half of the cases (56 percent), survey respondents were aware that they needed treatment of some kind. Seventy-one percent of that group sought treatment on at least one occasion, while 41 percent of the treatment-seeking group received minimally adequate treatment (defined as either regular talk therapy with any professional or pharmacological treatment coupled with regular doctors visits).
According to the the Global Burden of Disease 2010 Study—which is cited in the current paper—major depressive disorder (MDD) ranks as the second leading cause of years lived with disability in the world. According to that study, MDD is the 19th most common disease in the world, and rates as among the most severe, based on the proportion of people with depression that will have it for a relatively long period of time.
“There is an increasing awareness that MDD can be reliably diagnosed and treated in primary care settings using antidepressant medications and/or brief structured psychological therapies, but substantial barriers exist to this care being delivered,” Thornicroft and colleagues write. “These include supply-side factors (for example, policies to invest resources, and consequent scarce mental health services, community, and human resources), as well as demand-side issues (for example, lack of awareness of MDD as a treatable illness, and stigma and social exclusion associated with lower rates of help-seeking).”
In other words, this is pretty shitty. But hardly surprising.
Also not surprising: “Substantial economic costs are the consequence both for people with MDD and for society, because of low rates of treatment and recovery.”
So, this is mostly more confirmation that a huge treatment gap exists with respect to depression. Part of the treatment gap revealed here is especially vexing. While over half of those with depression believe they need treatment and have access to it, only a small number of them actually seek it out, while an even smaller number adhere to it to the degree that it reaches the threshold of minimally adequate. The study notes that this can trace back to a few things, including the perceived quality of available services and high rates of treatment drop-out.
In all, we’re talking about hundreds of millions of people with depression (there are 350 million in total worldwide) who are suffering when they may be helped by treatment. That shouldn’t really be acceptable.
Finally, in a King’s College statement, Thornicroft offers this: “Providing treatment at the scale required to treat all people with depression is crucial, not only for decreasing disability and death by suicide, but also from a moral and human rights perspective, and to help people to be fully productive members of society.”
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