The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: A systematic review and Bayesian meta-regression analysis
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Background: The treatment coverage for major depressive disorder (MDD) is low in many parts of the world despite MDD being a major contributor to disability globally. Most existing reviews of MDD treatment coverage do not account for potential sources of study-level heterogeneity that contribute to variation in reported treatment rates. This study aims to provide a comprehensive review of the evidence and analytically quantify sources of heterogeneity to report updated estimates of MDD treatment coverage and gaps by location and treatment type between 2000 and 2019. Methods and findings: A systematic review of the literature was conducted to identify relevant studies that provided data on treatment rates for MDD between January 1, 2000, and November 26, 2021, from 2 online scholarly databases PubMed and Embase. Cohort and cross-sectional studies were included if treatment rates pertaining to the last 12 months or less were reported directly or if sufficient information was available to calculate this along with 95% uncertainty intervals (UIs). Studies were included if they made use of population-based surveys that were representative of communities, countries, or regions under study. Studies were included if they used established diagnostic criteria to diagnose cases of MDD. Sample and methodological characteristics were extracted from selected studies. Treatment rates were modeled using a Bayesian meta-regression approach and adjusted for select covariates that quantified heterogeneity in the data. These covariates included age, sex, treatment type, location, and choice of MDD assessment tool. A total of 149 studies were included for quantitative analysis. Treatment coverage for health service use ranged from 51% [95% UI 20%, 82%] in high-income locations to 20% [95% UI 1%, 53%] in low- and lower middle-income locations. Treatment coverage for mental health service use ranged from 33% [95% UI 8%, 66%] in high-income locations to 8% [95% UI <1%, 36%] in low- and lower middle-income countries. Minimally adequate treatment (MAT) rates ranged from 23% [95% UI 2%, 55%] in high-income countries to 3% [95% UI <1%, 25%]) in low- and lower middle-income countries. A primary methodological limitation was the lack of sufficient data from low- and lower middle-income countries, which precluded our ability to provide more detailed treatment rate estimates. Conclusions: In this study, we observed that the treatment coverage for MDD continues to be low in many parts of the world and in particular in low- and lower middle-income countries. There is a continued need for routine data collection that will help obtain more accurate estimates of treatment coverage globally.
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Among women who receive screening, only one-third with depression receive formal mental health care.
“Among the women who receive screening, only one-third with depression receive formal mental health care [192].”
From Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy (2024) · cites this paper as [192]
The Abstract (Methods and findings; page unavailable) estimates mental health service use at 33% among people with major depressive disorder in high-income locations. The Results (Regression results for MDD data; page unavailable) report higher treatment rates for females than males, but the paper does not give a one-third estimate specifically for women who received screening. The claim applies the 33% estimate to a population the source does not identify. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA significant gap exists between mental ill-health and access to clinical services.
“A significant gap exists between mental ill-health and access to clinical services.”
From Providing Self-Led Mental Health Support Through an Artificial Intelligence–Powered Chat Bot (Leora) to Meet the Demand of Mental Health Care (2023) · cites this paper as [2]
Anticipation of discrimination, such as fear of being discredited by police, withdrawing from education, or being avoided by family and friends, accounts for substantial negative effects.
“The anticipation of discrimination, such as the fear of being discredited by police, having to withdraw from educational activities, or being avoided by family, friends, neighbours, also accounts for substantial negative effects.42,79”
From The Lancet Commission on ending stigma and discrimination in mental health (2022) · cites this paper as [42]
Doing so may help bridge the gap in treatment coverage by increasing the range of first line options for patients and health systems.
“Doing so may help bridge the gap in treatment coverage by increasing the range of first line options for patients and health systems.9”
From Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials (2024) · cites this paper as [9]
As many as two-thirds of individuals with depression do not receive the necessary care.
“Notably, a significant proportion of mental health problems remain undiagnosed and untreated, with estimates suggesting that as many as two-thirds of individuals with depression do not receive the necessary care [Moitra et al., 2022].”
From Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot (2024) · cites this paper as Moitra et al., 2022
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- Authors
- Moitra, M., Santomauro, D., Collins, P. Y., Vos, T., Whiteford, H., Saxena, S., & Ferrari, A. J.
- Affiliations
- University of Washington (US)
- The University of Queensland (AU)
- Harvard University (US)
- Corresponding author
- Ferrari, Alize J.
- ORCID
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2022-02-15
- Volume
- 19
- Issue
- 2
- Pages
- e1003901
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC8846511
- OpenAlex
- W4212909683
- Cited by
- 355
- References
- 33
- Citations by year
- 2026: 98 · 2025: 96 · 2024: 81 · 2023: 53 · 2022: 27
- FWCI
- 9.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Bill and Melinda Gates Foundation
- Department of Health, Queensland
- National Health and Medical Research Council Early Career Fellowship Grant (APP1121516)
- 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, treatment coverage, mental health service utilization, health care utilization, global health disparities, low- and middle-income countries, Bayesian meta-regression, study heterogeneity, antidepressant treatment, antidepressant side effects, antidepressant discontinuation
- MeSH terms
- Global Burden of Disease, Bayes Theorem, Major Depressive Disorder, Humans, Regression Analysis, Global Health, Treatment Outcome, Insurance Coverage
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