The vast majority of people with depression across the world are not receiving even minimally adequate treatment for their condition, according to a new study of more than 50,000 people in 21 countries carried out by King’s College London, Harvard Medical School and the World Health Organization (WHO).
The research reports that of 4,331 people with depression across all 21 countries, treatment rates vary widely. In high income countries only one in five people with depression receive adequate treatment. The situation in the poorest countries of the world is far worse, where one in 27 people with depression receive adequate treatment.
Globally, an estimated 350 million people of all ages suffer from depression, and the condition is the leading cause of disability worldwide. There is an increasing awareness that depression can be reliably diagnosed and treated in primary care settings using psychological therapy or medication, yet these scientifically proven and effective treatments are not being delivered on a wide scale.
The researchers analysed data from the WHO World Mental Health Surveys, a series of 23 community surveys in 21 countries. These included 10 low or middle income countries (Brazil, Bulgaria, Colombia, Iraq, Lebanon, Mexico, Nigeria, People’s Republic of China (PRC), Peru and Romania) and 11 high income countries (Argentina, Belgium, France, Germany, Israel, Italy, Japan, Netherlands, Portugal, Spain and the USA).
The researchers defined minimally adequate treatment as receiving either pharmacotherapy (at least one month of medication plus four or more visits to a doctor) or psychotherapy (at least eight visits with any professional including religious or spiritual advisor, social worker or counsellor).
Professor Graham Thornicroft from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, who led the study, said: ‘We call on national and international organisations to make adequate resources available for scaling up the provision of mental health services so that no one with depression is left behind. Our results indicate that much treatment currently offered to people with depression falls far short of the criteria for evidence-based and effective treatment.
‘Intriguingly, about half of all people with depression did not think they had a problem that needed treatment and this proportion fell to only a third in the poorest countries. This strongly suggests that we also need to support people with depression and their family members to recognise that they have a treatable condition and should seek treatment and care.’
Professor Thornicroft added: ‘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.’
The study was carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative and is published in the British Journal of Psychiatry.