PLoS Medicine: The global gap in treatment coverage for major depressive disorder in 84 countries

27 February, 2022

Only 3% of people with major depressive disorder in low- and lower middle-income countries receive even 'minimally adequate treatment', according to this new study.

Citati, author summary and a cmment from me below.

CITATION: The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: A systematic review and Bayesian meta-regression analysis

Modhurima Moitra et al

Published: February 15, 2022


Why was this study done?

- Major depressive disorder (MDD) is one of the major contributors to disability worldwide, but treatment rates for this condition are remarkably low.

- To the best of our knowledge, previous systematic reviews on this topic provide more descriptive summaries of treatment rates without accounting for differences in study attributes that may contribute to variation in reported treatment rates.

- An updated systematic review that is more reflective of the recent literature on treatment rates as well as an improved analytical approach may provide more accurate estimates of treatment rates by resource setting and geography.

What did the researchers do and find?

- We conducted a systematic review and meta-regression analysis using data on treatment rates for MDD from 149 studies and 84 countries between 2000 and 2021.

- We estimated pooled treatment rates adjusted for parameters of interest including age, sex, treatment type, study methods, and location.

- Mental health service use ranged from 33% (95% uncertainty interval (UI) 8, 66) in high-income countries to 8% (95% UI <1, 36) in low- and lower middle-income countries.

- Minimally adequate treatment (MAT) ranged from 23% (95% UI 2, 55) in high-income countries to 3% (95% UI <1, 25) in low- and lower middle-income countries.

What do these findings mean?

- This systematic review provides updated evidence on treatment rates for MDD, and results suggest that there are wide disparities in treatment rates by resource setting.

- More high-quality data on depression treatment coverage and adequacy are needed from low- and lower middle-income countries.

- These findings may help prioritize efforts to scale up depression treatment in locations with clearly identified treatment gaps.

COMMENT: This is a shocking indictment of global mental health. The vast majority of people with major depression worldwide are denied the benefits of modern medicine. There is an urgent need to understand better the reasons for this failure to translate evidence into policy and practice, and how provision of effective interventions caan be improved. We are aware of one important, pratical approach thanks to HIFA member Vikram Patel: task sharing and training of lay health workers in basic mental healthcare skills.

Neil Pakenham-Walsh, HIFA Coordinator,