Cited by 356Mental Health Treatment and AccessTreatment of Major DepressionPsychological Treatments and Disorders

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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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Moitra, Modhurima, Santomauro, Damian, Collins, Pamela Y., Vos, Theo, Whiteford, Harvey, Saxena, Shekhar, Ferrari, Alize J.·2022·PLOS Medicine

DOI 10.1371/journal.pmed.1003901PMC PMC8846511

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Abstract

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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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: Moitra, Modhurima
Santomauro, Damian
Collins, Pamela Y.
Vos, Theo
Whiteford, Harvey
Saxena, Shekhar
Ferrari, Alize J.
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
DOI: 10.1371/journal.pmed.1003901
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: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
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: 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, 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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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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