Undertreatment of people with major depressive disorder in 21 countries
Open accessAbstract
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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A much smaller proportion of people with mental health conditions access adequate care and support.
“A much smaller proportion access adequate care and support.(1-3)”
From The impact of digital interventions on help-seeking behaviour for mental health problems: a systematic literature review (2022) · cites this paper as [3]
The Treatment adequacy section reports that only 16.5% of people with major depressive disorder received minimally adequate treatment. This supports the claim for depression, but the paper does not establish the same proportion for people with mental health conditions generally or for access to support beyond treatment. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAround 40-60% of people with mental health conditions perceive a need for treatment but are not able to access any care.
“Around 40-60% of people with mental health conditions perceive a need for treatment but are not able to access any care.(1-3)”
From The impact of digital interventions on help-seeking behaviour for mental health problems: a systematic literature review (2022) · cites this paper as [3]
The ‘Obtaining treatment once need is recognised’ section reports that 71.1% of people with major depressive disorder who recognised a need for treatment visited a provider, leaving 28.9% who did not. The proportion without a visit is about 40–47% in the middle- and lower-income country groups, but the paper does not establish that they were unable to access care, and its findings do not cover all mental health conditions. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOnly 16.5% of people diagnosed with depression across 21 countries received treatment; treatment rate in MENA was lower, at 7% in Lebanon and 2% in Iraq.
“A study across 21 countries showed that only 16.5% of people diagnosed with depression received treatment; the treatment rate in countries from the Middle East and North Africa (MENA) region was even lower, at only 7% in Lebanon and 2% in Iraq (Thornicroft et al., 2017).”
From An internet‐based cognitive behavioural intervention for adults with depression in Arabic‐speaking countries: A randomized controlled trial. (2024) · cites this paper as Thornicroft et al., 2017
The Treatment adequacy section reports that 16.5% of people with 12-month major depressive disorder received *minimally adequate* treatment, not that only 16.5% received any treatment. Table 1 (p. 121) gives the corresponding figures as 7.0% for Lebanon and 2.5% for Iraq, rather than 2% for Iraq. The cited sentence omits the treatment-adequacy qualifier and slightly understates the Iraq figure. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLow-resource and middle-resource settings often have low rates of recognition and treatment of mental disorders and a paucity of data on the prevalence of mental disorders.
“These settings often have low rates of recognition and treatment of mental disorders 50 and a paucity of data on the prevalence of mental disorders.”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [50]
The Recognition of need for treatment and Treatment adequacy sections report low recognition and treatment rates for major depressive disorder in low-/lower-middle-income countries. The cited paper studies MDD, not mental disorders generally. The citation appears before the separate clause about a paucity of prevalence data, so that clause is not attributed to this source. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe treatment gap for anxiety disorders is even higher than that described for major depressive disorder.
“This finding is consistent with previous studies, and it suggests that the treatment gap for anxiety disorders is even higher than that described for MDD (Thornicroft et al., 2017).”
From Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries (2018) · cites this paper as Thornicroft et al., 2017
Only 1-in-27 people living with major depressive disorder in LMICs receives minimally adequate treatment.
“a recent study conducted in 21 countries found that only 1-in-27 people living with major depressive disorder in LMICs receives minimally adequate treatment [3].”
Depression treatment rates are often below 30% even in high-income countries.
“Even in high-income countries, depression treatment rates are often below 30% (16, 17).”
From Personalised depression forecasting using mobile sensor data and ecological momentary assessment (2022) · cites this paper as [17]
In high-income countries, about one-fifth of people with depression receive minimally adequate treatment, compared with roughly one in twenty-seven in lower-middle-income countries.
“Among people living with depression, only 1 in 5 persons in high-income countries and 1 in 27 in lower-middle income countries receive minimally adequate treatment 1 .”
From Ensuring Quality in Psychological Support (WHO EQUIP): developing a competent global workforce (2020) · cites this paper as [1]
About two thirds of adults with depression do not receive adequate treatment.
“Importantly, about two thirds of adults with depression do not receive adequate treatment.13”
From Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression (2023) · cites this paper as [13]
Only 16.5% of people with depression worldwide receive treatment, indicating a substantial treatment gap.
“However, only 16.5% of people with depression worldwide receive treatment, indicating a substantial treatment gap [3].”
From Immersive technologies for depression care: scoping review (2024) · cites this paper as [3]
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“Despite the fact that these disorders are one of the main causes of disability worldwide and generate a considerable economic, social and personal cost, only a minority of sufferers receive minimally adequate treatment (Alonso et al., 2018; Thornicroft et al., 2017).”
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The Effortless Assessment of Risk States (EARS) Tool: An Interpersonal Approach to Mobile Sensing
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Self-citationDigital Mental Health: The Answer to the Global Mental Health Crisis?
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Universal health coverage in China part 1: progress and gaps
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Self-citationMenezes, P., Quayle, J., Garcia Claro, H., da Silva, S., Brandt, L. R., Diez-Canseco, F., Miranda, J. J., Price, L. N., Mohr, D. C., & Araya, R. (2019) · JMIR Mental Health · doi:10.2196/11698 · Cited by 71 · see citing works
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Epigenome-wide association study of depression symptomatology in elderly monozygotic twins
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- Authors
- Thornicroft, G., Chatterji, S., Evans-Lacko, S., Gruber, M., Sampson, N., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L., Borges, G., Bruffaerts, R., Bunting, B., de Almeida, J. M. C., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hinkov, H., Karam, E., Kawakami, N., Lee, S., Navarro-Mateu, F., Piazza, M., Posada-Villa, J., de Galvis, Y. T., & Kessler, R. C.
- Affiliations
- Universitat Pompeu Fabra (ES)
- Harvard University (US)
- University of Ulster (GB)
- University of Balamand (LB)
- Corresponding author
- Thornicroft, Graham
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2017-02
- Volume
- 210
- Issue
- 2
- Pages
- 119-124
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC5288082
- OpenAlex
- W2559328180
- Semantic Scholar
- 1da8e0e0dfc6b909363bd59684e1ca0ea798177c
- Cited by
- 1,121
- References
- 35
- Citations by year
- 2026: 119 · 2025: 127 · 2024: 130 · 2023: 170 · 2022: 139 · 2021: 136 · 2020: 134 · 2019: 88 · 2018: 54 · 2017: 22 · 2012: 1
- FWCI
- 85.84
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Lirias (submittedVersion)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
- Funders
- Robert Wood Johnson Foundation (044708, Grant 044708)
- John D. and Catherine T. MacArthur Foundation (R01 DA016558, R13-MH066849)
- John W. Alden Trust (R01-MH069864, R13-MH066849)
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- World Health Organization (R03 TW006481)
- South London and Maudsley NHS Foundation Trust
- King's College Hospital NHS Foundation Trust
- Government of the United Kingdom
- Universidad CES
- National Institute for Health and Care Research (FP7/2007–2013, NF-SI-0611-10053, U01-MH60220)
- King's College London
- European Commission (EAHC 20081308, 20081308, 2007–2013, FP7 2007-2013, 1999-01042, QLG5–1999-01042, SANCO2004123, 2004123, FP7/2007)
- Public Health Agency
- Fundação de Amparo à Pesquisa do Estado de São Paulo (03/00204-3, 03/00204?)
- Generalitat de Catalunya (01042, RETICS RD06/0011 REM-TAP, CB06/02/0046)
- Bundesministerium für Gesundheit
- National Insurance Institute of Israel (H13-SHOGAI-023, H16-KOKORO-013, H14-TOKUBETSU-026)
- Ministerio de Salud de la Nación
- Ministry of Health, Labour and Welfare (H16-KOKORO-013, H14-TOKUBETSU-026, H13-SHOGAI-023)
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (307623/2013-0, 2013‐0)
- Universidade de Lisboa
- Ministerio de Ciencia y Tecnología (SAF 2000 158-CE)
- Fundación para la Formación e Investigación Sanitarias de la Región de Murcia
- Servicio Murciano de Salud
- Regione Piemonte (00/0028)
- Fakultet Medicinskih Nauka, Univerziteta U Kragujevcu
- Servier
- H. Lundbeck A/S
- Fundação Champalimaud (R01 MH070884)
- Ministerio de Salud
- National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
- Substance Abuse and Mental Health Services Administration (044708)
- Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
- Pan American Health Organization (FIRCA R03-TW006481)
- Executive Agency for Health and Consumers
- Fundação para a Ciência e a Tecnologia
- Instituto de Salud Carlos III (CB06/02/0046, CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP, FP7/2007-2013, RETICS RD06/0011 REM-TAP, RETICS RD06/0011, RD06/0011, FIS 00/0028, CIBER CB06/02/0046)
- Consejería de Sanidad y Política Social, Comunidad Autónoma de la Región de Murcia
- Departament de Salut, Generalitat de Catalunya (CB06/02/0046, RETICS RD06/0011 REM-TAP)
- National Institute of Mental Health (R13-MH-066849, NIMH R01MH070884, R01‐MH070884, U01-MH-60220, MH60220, MH070884, MH069864, MH066849, U01MH060220, R01‐MH069864)
- National Institute on Drug Abuse (R01DA016558, U01-MH60220)
- Fogarty International Center (FIRCA R03TW006481, R03TW006481)
- Cilag
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- major depressive disorder, undertreatment, treatment seeking, help-seeking, treatment quality, prevalence, mental health services, low- and middle-income countries, global mental health, World Mental Health Surveys
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Major Depressive Disorder, Female, Health Surveys, Humans, Male, Mental Health Services, Middle Aged, Patient Acceptance of Health Care, Global Health, Prevalence, Young Adult
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