Call for urgent action on spiralling global depression crisis

Covid-19 pandemic has exacerbated mental health problems but experts say more can be done

Depression affects millions of people worldwide and the report says more can be done to prevent it. Getty Images

The world is failing to tackle a global crisis of depression, according to new research.

The Lancet and World Psychiatric Association Commission report on depression says a whole-of-society response is now required.

The report was produced by 25 experts from 11 countries spanning disciplines from neuroscience to global health and advised by people with experience of depression.

Despite abundant evidence that much can be done to prevent depression and aid recovery even in resource-limited settings, an estimated 5 per cent of the adult population around the world in any year are living with depression.

In high-income countries, about half of people suffering from depression do not receive a diagnosis or treatment, and this proportion rises to 80 per cent to 90 per cent in low and middle-income countries.

“There is arguably no other health condition which is as common, as burdensome, as universal, or as treatable as depression, yet it receives little policy attention and resources," says commission co-chair, associate professor Christian Kieling from the Universidade Federal do Rio Grande do Sul in Brazil.

“Effective psychosocial and medical treatments are difficult to access, while high levels of stigma still prevent many people, including the high proportion of adolescents and young people at risk for or experiencing depression, from seeking the help required to have healthy and productive lives.”

Depression myths perpetuate

Despite its global prevalence, many myths continue to cloud depression, perpetuating inaction. These include common misconceptions that it is is simply sadness, a sign of weakness, or restricted to certain cultural groups.

The commissioners stress that depression is a distinct health condition characterised by its persistence, substantial effect on daily functioning, and long-term health consequences.

It can affect anyone, regardless of gender, background, social class, or age – and there is variability in types and prevalence of depressive symptoms and signs among cultures and populations.

The risk of depression increases in settings of adversity, including poverty, violence, displacement and in gender, racial and other forms of discrimination.

Depression is linked to a wide variety of chronic physical illnesses – a person’s physical health can influence their mental health and vice versa.

At its worst, depression can lead to suicide.

Studies indicate that 70 per cent to 80 per cent of people who die by suicide in high-income countries, and about half of those in low and middle-income countries, suffer from mental illness, of which depression is the most common cause.

Depression also has an enormous, under-recognised social and economic toll on individuals, families, communities and countries.

Even before the pandemic, the loss in economic productivity linked to depression cost the global economy an estimated $1 trillion a year.

The commission stressed the need for whole-of-society strategies that reduce exposure to adverse experiences in childhood (including neglect and trauma) and across the lifespan to lower the prevalence of depression.

Interventions are also needed at the individual level, focusing on lifestyle factors (eg, smoking, alcohol consumption, physical inactivity) and other risk factors such as intimate partner violence and stressful life events such as bereavement or financial crisis.

“Prevention is the most neglected aspect of depression. This in part because most interventions are outside of the health sector," said co-author Dr Lakshmi Vijayakumar from Sneha, Suicide Prevention Centre and Voluntary Health Services, Chennai, India.

“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."

Binary nomenclature requires overhaul

The commissioners emphasised that the current system of classifying people with symptoms of depression into just two categories – either they have clinical depression or not – is too simplistic.

“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,” said commission co-chair Prof Vikram Patel from Harvard Medical School.

“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.”

The coronavirus pandemic has created additional challenges with social isolation, bereavement, uncertainty, hardship, and limited access to health care taking a serious toll on the mental health of millions.

“Depression is a global health crisis that demands responses at multiple levels," said commission chair Prof Helen Herrman from Orygen and the National Centre for Excellence in Youth Mental Health at the University of Melbourne, Australia.

"This commission offers an important opportunity for united action to transform approaches to mental health care and prevention globally.

"Investing in reducing the burden of depression will give millions of people the chance to become healthier, happier and more productive members of society, help to strengthen national economies, and advance the United Nation’s Sustainable Development Goals for 2030."