3 out of 4 people suffering from major depression do not receive adequate treatment
World Health Day 2017 focuses on depression – the second-largest contributor to disability or health loss and a leading underlying cause for the 128 000 suicide deaths that occur each year in the WHO European Region. The number of people with depressive disorders in the Region amounts to 40 million, with prevalence in countries ranging from 3.8% to 6.3% of the total population, according to newly released WHO global health estimates for 2015.
Despite being very common and affecting anyone at any stage of life, depression is still vastly under-recognized and under-treated; there is, consequently, a need to open up dialogue and tackle the stigma associated with this disabling condition. “Although depression can be treated and prevented, at least 75% of all people suffering from major depression do not receive adequate treatment. However, it is not enough to simply scale up services – it is equally important to raise awareness, build understanding and reduce stigma,” said WHO Regional Director for Europe Dr Zsuzsanna Jakab. “The WHO campaign ‘Depression: let’s talk’ aims to inform the general public about the consequences and management of depression, and how to provide support to people living with depression. You may not be able to talk yourself out of a depression, but talking about depression is an important first step.”
Even when services are available, many people suffering from depression avoid or delay treatment due to fear of prejudice and discrimination. This, together with low governmental spending, has led to huge gaps in diagnosis and treatment and has resulted in only a fraction of people suffering from depression receiving the appropriate help they need.
Depression often occurs with other conditions and can lead to suicide
At worst, depression leads to suicide, which is the second-leading cause of death among 15–29 year-olds, after road traffic accidents. The low- and middle-income countries in the Region have the highest suicide rates in the world. Although depression is twice as common among women as among men, suicide rates are higher among men: in low- and middle-income countries in the Region, 4 males committed suicide for every 1 female in 2015.
Depression increases the risk of anxiety disorders, substance abuse disorders and other noncommunicable diseases, such as diabetes and heart disease. The opposite is also true, meaning that people with these other conditions have a higher risk of depression. Partly because of this, depression can and should be managed in nonspecialized health care settings and integrated into existing service delivery platforms for other noncommunicable diseases and priority programmes, such as those for maternal, child and adolescent health.
A recent WHO-led study estimated that the global costs of depression and anxiety disorders exceed US$ 1 trillion each year. “Not taking action is expensive as the economic costs of depression and other common mental disorders are enormous, mainly due to productivity losses caused by absenteeism and lower work productivity. Moreover, a high percentage of people receiving social welfare benefits or disability pensions have a mental disorder as their primary condition – most often depression,” said Dr Dan Chisholm, Programme Manager for Mental Health at the WHO Regional Office for Europe.
Treating depression with therapy or antidepressants, or a combination of both, is cost-effective and even cost-saving: every US$ 1 invested leads to a return of US$ 4 in better health outcomes and work ability. Despite cost-effective treatments, governmental spending on mental health services is extremely low; according to WHO’s “Mental health atlas 2011” survey, an average of only 3% of health budgets is spent on mental health, ranging from less than 1% in low-income countries to 5% in high-income countries.
Over the past 15 years, knowledge has increased substantially in terms of identifying target groups, underlying risk factors, and the impacts of preventive and treatment interventions for depression. It has been shown that interventions can not only decrease the prevalence of depression, but also prevent the occurrence of new cases or recurrent episodes. Since the majority of people with depression have experienced at least one episode of depression before, reducing the recurrence of this condition can bring large-scale benefits.
More effective prevention and treatment of depression, combined with greater awareness of the disease, will be a vital part of countries’ efforts to move towards universal health coverage and social inclusion. Such efforts will help countries to achieve Target 3.4 of the Sustainable Development Goals – by 2030, to reduce by one-third premature mortality from noncommunicable diseases through prevention and treatment and to promote mental health and well-being.
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Download the report: Depression and Other Common Mental Disorders Global Health Estimates