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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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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In the citing paper
“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
In the citing paper
“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].”
In the citing paper
“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 the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Metadata
- 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
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › 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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