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Depression significantly impairs health but is unrecognized and untreated

By Teri Robert

“Treatment for depression should at least be on a par with that for other chronic diseases.” 2

An article in this week’s edition of The Lancet  based on World Health Organization (WHO) surveys concludes that depression produces the greatest decline in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. Still, the percentage of people with depression who receive treatment remains deplorably low.

In an accompanying Comment, Professor Gavin Andrews and Dr Nickolai Titov, Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent's Hospital, Sydney, Australia, say,

 

"In Australia, less than 30% of patients receive good treatment with anti-depressants, cognitive behavioural therapy, and proactive maintenance care. By contrast, 80% of patients with arthritis and 90% of patients with asthma receive an acceptable standard of care. Perhaps differential access to treatment is one reason why disability is less with the physical disorders. Treatment for depression should at least be on a par with that for other chronic diseases." 2

Study methods

The WHO World Health Survey (WHS) studied adults aged 18 years and older to obtain data for health, health-related outcomes, and what determined those outcomes. The prevalence of depression in participants was estimated. Prevalence values for four chronic physical diseases—angina, arthritis, asthma, and diabetes—were also estimated. Their analysis produced mean health scores that were then compared across different disease states and demographic variables.

Study findings

  • Observations were available for 245,404 participants from 60 countries in all regions of the world. Overall,
  • On average, between 9·3% and 23·0% of participants with one or more chronic physical disease had comorbid (comorbid conditions exist at the same time, but do not cause each other) depression.
  • This result was significantly higher than the likelihood of having depression in the absence of a chronic physical disease.
  • After adjustment for socioeconomic factors and health conditions, depression had the largest effect worsening health compared with the other chronic conditions. Consistently across countries and different demographic characteristics, respondents with depression comorbid with one or more chronic diseases had the worst health scores of all the disease states
  • Disease prevalence:
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