According to the Lancet and World Psychiatric Association Commission, the world is currently failing to tackle the persistent and increasingly severe global crisis of depression. Experts at the organisations have outlined an ambitious set of recommendations to tackle global inequities in diagnosis, treatment, and prevention, including prioritising an innovative staged approach to care and early intervention.
Globally, the World Health Organisation estimates that 5% of adults worldwide suffer from depression each year. Nevertheless, it remains a neglected health crisis, which is frequently first experienced from the onset of adolescence.
Despite long-establish research demonstrating that there is much that policymakers can be doing to prevent depression and aid recovery even in a resource-limited setting, in high-income countries, around half of the people suffering from depression are not diagnosed or treated. In contrast, this rises to 80-90% in middle-income countries.
The Covid-19 pandemic has created additional challenges, notably social isolation, bereavement, uncertainty, economic insecurity, and limited access to healthcare, which are all serious factors taking a severe toll on the mental health of millions worldwide.
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Against this backdrop, the Lancet and World Psychiatric Association Commission’s ‘Time for united action on depression’ document calls for a concerted and collaborative effort by governments, healthcare providers, researchers, people living with depression, and their families to improve care and prevention efforts radically. The document has been written by 25 experts from 11 countries spanning disciplines from neuroscience to global health and has been advised by people with experience of depression.
Childhood prevention and early intervention in adulthood
Commission Chair Professor Helen Herrman, National Centre for Excellence in Youth Mental Health, The University of Melbourne, Australia, described depression as a “global health crisis” that requires a response on “multiple levels”. By this, Prof Herrman and the Committee stressed that there needs to be a whole-of-society strategy to reduce exposure to both adverse experiences in childhood (such as by neglect and trauma) and across the lifespan to decrease the prevalence of depression through targeted intervention.
Dr Lakshmi Vijayakumar, Suicide Prevention Centre and Voluntary Health Services, Chennai, India, explained: “Prevention is the most neglected aspect of depression. This [is] in part because most interventions are outside of the health sector.”
“In the face of the lifelong effects of adolescent depression, from difficulty in school and future relationships to risk of substance abuse, self-harm, and suicide, investing in depression prevention is excellent value for money. It is crucial that we put into practice evidence-based interventions that support parenting, reduce violence in the family, and bullying at school, as well promoting mental health at work and addressing loneliness in older adults.”
A more reflective, personalised, staged approach to care
The Commissioners recommend that the current system of classifying people with symptoms of depression into the categories of either clinical depression or not is abandoned. They argued that depression is far too complex a condition, with a wide range of symptoms, severity levels, and duration to be considered so simplistically.
Alternatively, experts at the Commission support the use of a personalised, staged approach to depression care, which recognises the chronology and intensity of symptoms tailored to an individual’s symptoms.
Professor Vikram Patel, Commission Co-Chair, Harvard Medical School, USA, said:
“No two individuals share the exact life story and constitution, which ultimately leads to a unique experience of depression and different needs for help, support, and treatment. Similar to cancer care, the staged approach looks at depression along a continuum—from wellness to temporary distress, to an actual depressive disorder—and provides a framework for recommending proportional interventions from the earliest point in the illness.”
Furthermore, the Commission proposes adopting collaborative care strategies to scale up evidence-based intervention in routine care. In addition to combating the acute shortage of skilled providers and financial barriers to care, using locally recruited, low-cost non-mental health specialists, such as community health workers.
Although ultimately the team of experts concluded that far more significant investment globally is needed to ensure that everyone receives the care they need, where and when they need it.