Mental health under-treated worldwide

A meta-analysis of 149 studies from around the world shows that treatment rates for major depressive disorder (MDD) remain low worldwide. According to the review, one in three people with major depressive disorder in high-income countries, and less than one in 12 in low to middle-income countries, receive treatment. Researchers from the University of Queensland and their international collaborators published the findings in the open-access journal PLOS Medicine.

“Overall, we estimated that treatment rates for this disorder remain low, especially in low and middle-income countries,” says Dr Alize Ferrari, an epidemiologist at the University of Queensland and leading author of the study. “Even in high-income countries where treatment rates are comparatively higher, many individuals do not receive a level of care consistent with practice guideline recommendations.”

Ferrari and colleagues included data from 84 countries between 2000 and 2021. The team applied a statistical method known as Bayesian meta-regression analysis to combine the data and examine depression treatment rates worldwide.

The team found an apparent disparity between countries with different resources. In particular, 33% of people with MDD in high-income countries and just 8% in low and middle-income countries had access to mental health services.

But the researchers estimated that only 23% of people with MDD received appropriate treatment in high-income countries. The percentage dropped to 3% in low and middle-income countries. 

“Major depressive disorder is a mental disorder that imposes a large amount of disability on the population’s health. Our findings highlight the importance for governments and policymakers to reconsider the availability of appropriate care for this disorder,” Ferrari says.

According to a Lancet and World Psychiatric Association Commission on depression, “the world is failing to tackle the persisting and increasingly serious global crisis of depression.” 

The international commission, which includes Australian experts, called for concerted and collaborative efforts by governments, healthcare providers, researchers, people living with depression, and their families to improve care and prevention, fill knowledge gaps, and increase awareness to tackle one of the leading causes of avoidable suffering and premature death worldwide.

“Evidence has accumulated over decades that depression is a leading cause of avoidable suffering in the world. Yet not enough is done to avoid and alleviate the suffering and disadvantages linked with depression, and few governments acknowledge the brake that depression places on social and economic development,” they write.

“It is important for us to reconsider what services would have the most impact in reducing the burden due to major depressive disorder, and how best to deliver these to those in the population who need treatment the most,” says Ferrari. “It is also important for us to have access to more high-quality mental health survey data from low and middle-income countries that would allow us to understand better and track treatment for major depressive disorder.”

MDD can affect people of any age and is caused by genetic, environmental, psychological and social factors. Behavioural and physical symptoms of MDD may include changes in sleep, appetite, energy level, concentration, daily behaviour or self-esteem.

According to The Black Dog Institute, one in seven people experience depression in their lifetime in Australia. Depression has the third-highest burden of all diseases (13%) and is the number one cause of non-fatal disability in Australia (23%).

The WHO estimates that 3.8% of the population is affected, with approximately 280 million people worldwide experiencing depression. When untreated, depression can cause great suffering and loss of function at work, school and home. At its worst, depression can lead to suicide. Every year, over 700,000 people die due to suicide, making it the fourth leading cause of death in 15 to 29-year-olds.

In the past two years, several studies have highlighted how the COVID-19 pandemic has further exacerbated the global mental health crisis and hindered access to appropriate treatment.

One study published this week in PLOS ONE by researchers at the University of Tasmania and Cambridge University, UK, found that COVID-19 death rates and fear caused by the pandemic may have contributed to poor mental health in the UK even more than lockdowns.

Another study published this week in the open-access journal Globalization and Health found that Australia’s extended international border closures during the pandemic might have led to high levels of psychological distress across the community.

Of the almost 4,000 participants in the survey, the vast majority, over 81%, reported that waiting to be reunited with partners, family and friends harmed their mental health.  

“The vast majority of participants reported being negatively affected by the restrictions and showed high or very high levels of psychological distress,” says Flinders University researcher Dr Kathina Ali, a co-author of the study.  

“A fifth of respondents believed they needed help for mental health problems,” she says. “Health and mental healthcare providers should be aware of this crisis and provide appropriate support options and practical strategies to mitigate the risk of further deterioration.”