Only a small minority of people with depression across the world, just one in 27 in the poorest countries, receive even minimally adequate treatment for their condition, a major study has found.
Researchers from King’s College London, Harvard Medical School and the World Health Organisation (WHO) found that even in wealthy countries only one in five people with depression received adequate treatment.
The results also suggest a lack of knowledge – and possible stigma – surrounding the subject, despite it being the leading cause of disability worldwide, affecting an estimated 350 million people.
Almost half of people with depression did not think they had a problem that needed treatment. In low-income countries only a third believed they needed treatment, compared with almost two-thirds in the highest income countries and 52% in upper-middle income countries.
Given that depression can be reliably diagnosed and treated in primary care settings using psychological therapy or medication, the authors say that more should be done to ensure that proven treatments are widely available.
Prof Graham Thornicroft from the Institute of Psychiatry, Psychology and Neuroscience 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.
“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, published in the British Journal of Psychiatry on Thursday, analysed 4,331 people with depression in 21 countries who took part in WHO health surveys. The 10 low- or middle-income countries were Brazil, Bulgaria, China, Colombia, Iraq, Lebanon, Mexico, Nigeria, Peru and Romania. The 11 high-income countries were Argentina, Belgium, France, Germany, Israel, Italy, Japan, the Netherlands, Portugal, Spain and the US.
Minimally adequate treatment was defined 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 a religious or spiritual adviser, social worker or counsellor.
Last year, mental health was for the first time explicity recognised within the concept of universal health coverage in the United Nations sustainable development goals.
The results of the study highlight that there remains a large gap between provision of mental health and physical health services, despite greater awareness of the disparity and its consequences in recent years. A 2008 study found treatment rates for physical conditions – diabetes (77%), heart disease (51%) and asthma (44%) – in low- and middle-income countries to be much higher.
The authors say low quality of care for mental health problems may contribute to low rates of people seeking help if their local services have a poor reputation.
But in light of the significant proportion of people saying they did not have a problem that needed treatment, they also call for more support for people with depression and their family members to identify the condition and make them aware that it is treatable.
Tiny minority of people with depression get treatment, study finds
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