Undertreatment of people with major depressive disorder in 21 countries

Graham Thornicroft¹, Somnath Chatterji², Sara Evans-Lacko², Michael Gruber², Nancy Sampson², Sergio Aguilar-Gaxiola², Ali Al-Hamzawi², Jordi Alonso², Laura Andrade², Guilherme Borges², Ronny Bruffaerts², Brendan Bunting², Jose Miguel Caldas de Almeida², Silvia Florescu², Giovanni de Girolamo², Oye Gureje², Josep Maria Haro², Yanling He², Hristo Hinkov², Elie Karam², Norito Kawakami², Sing Lee², Fernando Navarro-Mateu², Marina Piazza², Jose Posada-Villa², Yolanda Torres de Galvis², Ronald C Kessler²

Affiliations

¹ Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA graham.thornicroft@kcl.ac.uk.
² Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 27908899
PMCID: PMC5288082
DOI: 10.1192/bjp.bp.116.188078

Undertreatment of people with major depressive disorder in 21 countries

Graham Thornicroft et al. Br J Psychiatry. 2017 Feb.

. 2017 Feb;210(2):119-124.

doi: 10.1192/bjp.bp.116.188078. Epub 2016 Dec 1.

Authors

Affiliations

¹ Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA graham.thornicroft@kcl.ac.uk.
² Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 27908899
PMCID: PMC5288082
DOI: 10.1192/bjp.bp.116.188078

Abstract

Background: Major depressive disorder (MDD) is a leading cause of disability worldwide.

Aims: To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.

Method: Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.

Results: Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.

Conclusions: Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.

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Conflict of interest statement

Declaration of interest In the past 3 years, R.C.K. received support for his epidemiological studies from Sanofi Aventis, was a consultant for Johnson & Johnson Wellness and Prevention and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. R.C.K. is a co-owner of DataStat Inc., a market research firm that carries out healthcare research.

Comment in

International suicide rates versus adequate treatments.
Baldessarini RJ, Tondo L. Baldessarini RJ, et al. Br J Psychiatry. 2017 Apr;210(4):298-299. doi: 10.1192/bjp.210.4.298a. Br J Psychiatry. 2017. PMID: 28373225 No abstract available.
Western depression is not a universal condition.
Summerfield DA. Summerfield DA. Br J Psychiatry. 2017 Jul;211(1):52. doi: 10.1192/bjp.211.1.52. Br J Psychiatry. 2017. PMID: 28673947 No abstract available.

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Undertreatment of people with major depressive disorder in 21 countries

Affiliations

Undertreatment of people with major depressive disorder in 21 countries

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

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Grants and funding

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Full Text Sources

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Medical

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