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Vast Majority of People With Depression Aren't Getting Treatment, Global Review Finds

15 FEBRUARY 2022

Depression has become a leading cause of disability worldwide with no signs of slowing down. By 2030, the World Health Organization predicts the disorder could be the main contributor to the global burden of disease.

 

Even though we now have some effective treatments for depression, including medications and psychological interventions, medical care remains woeful across the board.

In higher income nations, a review of available literature has found just 23 percent of patients with depression are receiving 'minimally adequate' treatment. In lower and middle income nations, a meager 3 percent are receiving the barest minimum of care.

The analysis is based on 149 studies from 84 countries between 2000 and 2021, and while there are certain gaps in the data from regions like South Asia and Sub-Saharan Africa, the findings paint a grim overall picture.

"Treatment coverage for major depressive disorder continues to be low globally, with many individuals failing to receive a level of care consistent with practice guideline recommendations," says epidemiologist Alize Ferrari from the University of Queensland, Australia.

"This highlights the need to reconsider the availability of appropriate care and facilitators of treatment as we respond to the large burden imposed by this disorder."

Previous reviews have found treatment gaps for depression can range from 45 percent in Europe to 67 percent in the African region and 70 percent in the Eastern Mediterranean region.

 

As the current review has revealed, the quality of these treatments can also vary quite a lot depending on where in the world a person lives.

Much like other research has demonstrated before, people around the world seem to be more likely to get treatment for depression if they are female, and as they get older. Younger and male patients, on the other hand, are less likely to seek care for issues to do with emotions or moods.

While mental health services have improved greatly in some nations, and the stigma around this disorder is gradually being reduced, most countries featured in the review still lack basic mental health policy, legislation and resources to guide both patients and doctors.

"Global health financing has historically been prioritized for malaria, HIV/AIDs, and tuberculosis – which are some of the leading causes of disability and mortality in many low- and middle-income countries," the authors write.

"However, financing for mental health is still far from adequate."

In 2019, global funding for 'noncommunicable' diseases like depression and other mental health disorders was less than 2 percent of all the development assistance for health that year.

 

Clearly, we need to scale up effective treatments for depression and anxiety disorders globally. If we can do so, studies show the world could save 43 million additional years of healthy life between 2016 and 2030, not to mention billions of dollars.

If we don't, so much more will be lost.

Chronic feelings of hopelessness, grief, or low self-worth, as well as fatigue, sleep issues, or changes in appetite can take a physical as well as emotional toll, leading to heart rate changes, increased inflammation, metabolic changes, and high levels of stress hormones. 

While not all forms of depression are treatable, it is among the most treatable of all known mental health disorders, with about 80 to 90 percent of people getting better after seeking medication, psychological help, or electroconvulsive therapy.

Even before the pandemic hit in 2020, global cases of depression were projected to increase, and now, a surge seems likelier than ever. Depression rates in the US actually tripled when the pandemic first hit, and they haven't abated since.

In a paper published in 2021, researchers warned we are very unprepared for the future ahead.

"This pandemic has created an increased urgency to strengthen mental health systems in most countries," the paper reads.

"Mitigation strategies could incorporate ways to promote mental wellbeing and target determinants of poor mental health and interventions to treat those with a mental disorder. Taking no action to address the burden of major depressive disorder and anxiety disorders should not be an option."

The study was published in PLOS Medicine.