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Depression: A global public health concern

  • Retired from World Health Org Shahid Beheshti University of Medical Sciences
A Global Public Health Concern
Developed by Marina Marcus, M. Taghi Yasamy, Mark van Ommeren, and Dan Chisholm, Shekhar Saxena
WHO Department of Mental Health and Substance Abuse
Depression is a signicant contributor to the global
burden of disease and affects people in all communi-
ties across the world. Today, depression is estimated
to affect 350 million people. The World Mental
Health Survey conducted in 17 countries found that
on average about 1 in 20 people reported having an
episode of depression in the previous year. Depres-
sive disorders often start at a young age; they reduce
people’s functioning and often are recurring. For
these reasons, depression is the leading cause of dis-
ability worldwide in terms of total years lost due to
disability. The demand for curbing depression and
other mental health conditions is on the rise glob-
ally. A recent World Health Assembly called on the
World Health Organization and its member states to
take action in this direction (WHO, 2012).
What is depression?
Depression is a common mental disorder that
presents with depressed mood, loss of interest or
pleasure, decreased energy, feelings of guilt or low
self-worth, disturbed sleep or appetite, and poor
concentration. Moreover, depression often comes
with symptoms of anxiety. These problems can
become chronic or recurrent and lead to substantial
impairments in an individual’s ability to take care
of his or her everyday responsibilities. At its worst,
depression can lead to suicide. Almost 1 million
lives are lost yearly due to suicide, which translates
to 3000 suicide deaths every day. For every person
who completes a suicide, 20 or more may attempt to
end his or her life (WHO, 2012).
There are multiple variations of depression that a
person can suffer from, with the most general dis-
tinction being depression in people who have or do
not have a history of manic episodes.
• Depressive episode involves symptoms such as
depressed mood, loss of interest and enjoyment,
and increased fatigability. Depending on the
number and severity of symptoms, a depressive
episode can be categorized as mild, moderate,
or severe. An individual with a mild depressive
episode will have some difculty in continu-
ing with ordinary work and social activities, but
will probably not cease to function completely.
During a severe depressive episode, on the other
hand, it is very unlikely that the sufferer will be
able to continue with social, work, or domestic
activities, except to a very limited extent.
• Bipolar affective disorder typically consists of
both manic and depressive episodes separated
by periods of normal mood. Manic episodes
involve elevated mood and increased energy,
resulting in over-activity, pressure of speech and
decreased need for sleep.
While depression is the leading cause of disability
for both males and females, the burden of depres-
sion is 50% higher for females than males (WHO,
2008). In fact, depression is the leading cause of
disease burden for women in both high-income and
low- and middle-income countries (WHO, 2008).
Research in developing countries suggests that
maternal depression may be a risk factor for poor
growth in young children (Rahman et al, 2008).
This risk factor could mean that maternal mental
health in low-income countries may have a substan-
tial inuence on growth during childhood, with the
effects of depression affecting not only this genera-
tion but also the next.
Managing depression
Depression is a disorder that can be reliably diag-
nosed and treated in primary care. As outlined in
the WHO mhGAP Intervention Guide, preferable
treatment options consist of basic psychosocial sup-
port combined with antidepressant medication or
psychotherapy, such as cognitive behavior therapy,
interpersonal psychotherapy or problem-solving
treatment. Antidepressant medications and brief,
structured forms of psychotherapy are effective.
Antidepressants can be a very effective form of
treatment for moderate-severe depression but are
not the rst line of treatment for cases of mild or
sub-threshold depression. As an adjunct to care by
specialists or in primary health care, self-help is an
important approach to help people with depression.
Innovative approaches involving self-help books or
internet-based self-help programs have been shown
to help reduce or treat depression in numerous stud-
ies in Western countries (Andrews et al, 2011).
Treatment effectiveness in resource-constrained
Over the past decade, a number of clinical trials
have shown the effectiveness of treatment for
depression across a range of resource settings.
• Uganda: A trial carried out in rural Uganda, for
example, showed that group interpersonal psy-
chotherapy substantially reduced the symptoms
and prevalence of depression among 341 men
and women meeting criteria for major or sub-
syndromal depression (Bolton et al, 2003).
• Chile: A trial was conducted with 240 low-in-
come women suffering from major depression to
examine the effectiveness of a multi-component
intervention that included psycho-educational
group intervention, structured and systematic
follow-up, and drug treatment for those with
severe depression. The trial found that there was
a substantial difference in favor of the collabora-
tive care program as compared to standard care
in primary care. A depression test administered
at the 6-month follow up point showed that
70% of the stepped-care group had recovered,
as compared with 30% of the usual-care group
(Araya et al, 2006).
• India: A trial was conducted to test the effec-
tiveness of an intervention led by lay health
counselors in primary care settings to improve
outcomes for people with depression and anxiety
disorders. The intervention consisted of case
management and psychosocial interventions
led by a trained lay health counselor, as well as
supervision by a mental health specialist and
medication from a primary care physician. The
trial found that patients in the intervention group
were more likely to have recovered at 6 months
than patients in the control group, and therefore
that an intervention by a trained lay counselor
can lead to an improvement in recovery from
depression (Patel et al, 2010).
Despite the known effectiveness of treatment for
depression, the majority of people in need do not
receive it. Where data is available, this is glob-
ally fewer than 50%, but fewer than 30% for most
regions and even less than 10% in some countries.
Barriers to effective care include the lack of resourc-
es, lack of trained providers, and the social stigma
associated with mental disorders.
Reducing the burden of depression
While the global burden of depression poses a sub-
stantial public health challenge, both at the social
and economic levels as well as the clinical level,
there are a number of well-dened and evidence-
based strategies that can effectively address or
combat this burden. For common mental disorders
such as depression being managed in primary care
settings, the key interventions are treatment with
generic antidepressant drugs and brief psychother-
apy. Economic analysis has indicated that treating
depression in primary care is feasible, affordable
and cost-effective.
The prevention of depression is an area that deserves
attention. Many prevention programs implemented
across the lifespan have provided evidence on the
reduction of elevated levels of depressive symp-
toms. Effective community approaches to prevent
depression focus on several actions surrounding the
strengthening of protective factors and the reduction
of risk factors. Examples of strengthening protec-
tive factors include school-based programs targeting
cognitive, problem-solving and social skills of chil-
dren and adolescents as well as exercise programs
for the elderly. Interventions for parents of children
with conduct problems aimed at improving parental
psychosocial well-being by information provision
and by training in behavioral childrearing strategies
may reduce parental depressive symptoms, with
improvements in children’s outcomes.
Depression is a mental disorder that is pervasive
in the world and affects us all. Unlike many large-
scale international problems, a solution for depres-
sion is at hand. Efcacious and cost-effective
treatments are available to improve the health and
the lives of the millions of people around the world
suffering from depression. On an individual,
community, and national level, it is time to educate
ourselves about depression and support those who
are suffering from this mental disorder.
Andrews G, Cuijpers P, Craske MG, McEvoy P, Titov N. Computer therapy
for the anxiety and depressive disorders is effective, acceptable and practical
health care: a meta-analysis. PLoS One. 2010 Oct 13;5(10):e13196.
Araya R, Flynn T, Rojas G, Fritsch R, Simon G. Cost-effectiveness of a prima-
ry care treatment program for depression in low-income women in Santiago,
Chile. Am J Psychiatry. 2006;163:1379–87.
Bolton P, Bass J, Neugebauer R, et al. Group interpersonal psychother-
apy for depression in rural Uganda randomized controlled trial. JAMA.
Patel V., Weiss H.A., Chowdhary N., Naik S., Pednekar S., Chatterjee S., De
Silva M.J., (...), Kirkwood B.R. Effectiveness of an intervention led by lay
health counsellors for depressive and anxiety disorders in primary care in Goa,
India (MANAS): A cluster randomised controlled trial (2010) The Lancet, 376
(9758), pp. 2086-2095.
Rahman A, Patel V, Maselko J, Kirkwood B. The neglected ‘m’ in MCH pro-
grammes–why mental health of mothers is important for child nutrition. Trop
Med Int Health 2008; 13: 579-83
World Health Organization 2008, The Global Burden of Disease 2004
report_2004update_full.pdf Accessed 16.6.2012
World Health Organization, World suicide prevention day 2012. http://www.
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... Major depressive disorder, or 'depression' for short, is a common but serious mental disorder that widely affects populations around the world [1]. Its cause is believed to be a combination of genetics [2] and environmental factors [3], such as, major life changes, trauma, or long-lasting exposure to difficulties. ...
... It usually presents with persistent depressed mood, loss of interest and enjoyment, feelings of sadness, guilt or low self-esteem, poor concentration, and at its worst, suicidal actions [4]. According to the World Health Organization (WHO) [1], depression is one of the leading causes of disability, affecting more than 300 million people. ...
... Despite the physiological correlates of depressed patients, since individuals with depression tend to withdraw from social activities [1] [8], and so leaving them with less chance to access these facilities, our goal is to investigate physiological signals of observers to identify others' depression level. Our previous work demonstrated the feasibility of using observers' physiological signals as indicators of other individuals' depression [23] using neural networks. ...
... Depression [7] is a common mental condition that may affect anybody at any age and results in a constant sensation of unhappiness and loss of interest. The issue is that it is frequently still not recognized and addressed, which harms both a person's physical and mental health. ...
... According to Marcus et al. (2012), it is often differentiated by a lack of interest, feelings of guilt or low self-worth, disturbed sleep or food, exhaustion, and impaired focus, as well as social isolation and slower speech. It hurts a patient's physical health, including severe aches and pains, insomnia or hypersomnia, and weight issues. ...
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Depression is a common mental condition that can significantly affect both person’s daily life and mental health. The goal is to create a Depression Detection system for students and patients. The system consists of a depression quiz that takes the opinion of users (Questionnaire) and records a video which is then analyzed to determine the sentiments of patients. In this study, we have used Facial Emotion Recognition – A Kera’s-based Deep Learning model which generates six universal sentiments: angry, sad, disgusted, surprised, fearful, and happy this is then mapped with curated standard questions asked by counsellors. These approaches are then synchronized to produce a depression score which is used to prepare health reports. This health report is sent to the counselor for further treatment.
... A recent World Health Assembly called on the World Health Organization and its member states to take action in this direction (WHO, 2012). 1 According to the meta-analysis it was estimated that the prevalence of the major depressive disorder among adolescents aged 13-18yr to be 5.6 percent. 2 The proportion of the global population with depression in 2015 is estimated to be 4.4%. Depression is more common among females (5.1%) than males (3.6%). ...
... The total estimated number of people living with depression increased by 18.4% between 2005 and 2015 this reflects the overall growth of the global population, as well as a proportionate increase in the age groups at which depression is more prevalent. 1 According to WHO, prevalence of depression in Nepal is 3.2% and the prevalence of depression in (15-19 years) is 7.6%. Female students are highly depressed than male students. ...
... Those with diabetes are two times more likely to die than those of a similar age who do not have the chronic condition [2]. Depression is a common mental condition that manifests as a gloomy mood, lack of interest in or pleasure in previously enjoyed activities, guilt or low self-worth sentiments, interrupted sleep or food, low energy, and difficulty concentrating [3]. The loss of a significant person, thing, connection, or aspect of one's health are common causes, although it can also arise for no apparent reason. ...
Background: Diabetes and depression are major issues globally, with CBT identified as the most effective treatment for depression. Self-help CBT in Pakistan has shown positive results for depression treatment. A study has found that CBT leads to a higher remission rate for depression in Type 2 diabetes patients, highlighting the need for proper treatment of diabetes-related depression to improve health outcomes.Methods: In a randomized controlled trial a total of 32 patients with diabetes and depression were allocated to CBT therapy (n=16) and controls without CBT therapy (n=16). The study was conducted at the Department of Psychiatry, and diabetic’s clinic of Department of General Medicine, Pakistan Institute of Medical Sciences, Islamabad, in a period of 2 months. Known cases of Type 2 Diabetes fulfilling the diagnostic criteria of Depression and anxiety using DSM –V research criteria, and who lived within the catchment area were approached. Formal approval from hospital ethical committee and written informed consent from participants were obtained. Those persons, who agreed to enter the study, were assessed 2 weeks after the first screening, to fill in the baseline measures when they attended their first appointment. These persons were asked to attend further appointments and were assessed every two weeks till end of the study final assessment were made. Results: The mean age of patients was 50.9 + 7.5 years in group A (CBT) and 45.4 + 10.1 years in group B (without CBT). Male and female cases were equally selected in both groups respectively. The mean HADS was found similar at baseline in both study groups while post intervention phases in group A, greater improvement was observed (8.8 + 2.6) compared to (10.3 + 2.9) in group B. The WHO quality of life scale was almost similar in both groups at baseline, however, greater improvement in quality of life was observed in group A (90.7 + 9.0) compared to group B (82.1 + 13.9) and the difference in mean WHOQOL was found statistically significant (p-value = 0.04). Conclusions: The CBT intervention has a clear role in the management of depression in diabetic patients. In this study it has shown significant improvement in the health and depression scales and also in the overall quality of life according to WHO scale.
... While considered a public health concern, depression is classified among the disorders that ponder most heavily on individuals, families, and society [1]. Depression, as a mental disorder, portrays the presence of anhedonia (loss of pleasure), physical fatigue with reduced energy (anergy), a feeling of culpability, lack of self-assurance, disrupted sleep and appetite, with cognitive disorders, in particular, an attenuation of concentration and memory problems [2]. Likewise, depression often begins in early life, recurring at different stages, hence correlated with various negative consequences, encompassing higher morbidity and mortality rates and reduced quality of life [3]. ...
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Background The Hamilton Depression Rating Scale (HDRS or HAMD) is widely used scale for depression assessment. A shortened version of the HDRS, composed of 7 items, was implemented. The latter is timesaving compared to the original version, while still providing similar precision. Our objective in this study was to assess the psychometric properties of the Arabic HAMD-7 scale among non-clinical and clinical samples of Lebanese adults.Methods In study 1, 443 Lebanese citizens enrolled in this cross-sectional study (June-September 2021). The total sample in study 1 was divided into two subsamples to conduct the exploratory-to-confirmatory factor analysis (EFA-to-CFA). Another cross-sectional study was conducted in September 2022 on another sample of Lebanese patients (independent from the sample of study 1) and included 150 patients attending two psychology clinics. The Montgomery-Asberg Depression Rating Scale (MADRS), Lebanese Depression Scale (LDS), Hamilton Anxiety Scale (HAM-A) and Lebanese Anxiety Scale (LAS) were used to assess the validity of the HAMD-7 scale.ResultsThe results of the EFA (subsample 1; study 1) showed that the HAM-D-7 items converged into a one-factor solution (McDonald's ω = .78). The CFA (subsample 2; study 1) confirmed the one-factor solution obtained in the EFA (ω = .79). CFA indicated that fit of the one-factor model of the HAM-D-7 was acceptable: χ2/df = 27.88/14 = 1.99, RMSEA = .066 (90% CI = .028, .102), SRMR = .043, CFI = .960, TLI = .939. All indices suggested that configural, metric, and scalar invariance was supported across gender. The HAMD-7 scale score positively correlated with the MADRS (r = 0.809; p
... In this study, the effect of chromotherapy applied in elderly hypertensive patients on the blood pressure and stress levels of the elderly will be explained in light of the literature. (Marcus et al., 2012). Stres tedavisi, hipertansiyon ilaçlarının ayrılmaz bir parçasıdır. ...
Conference Paper
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The current stage of development of market relations in Azerbaijan increases the demand for information support in the management of business processes. Accounting and financial reporting are important as the main elements of information support. However, reporting indicators obtained on the basis of accounting data may not always be sufficiently complete and reliable. The legal legislation regulating accounting and reporting in service enterprises is mainly focused on the goals and tasks of tax accounting and tax reporting. As it is known, financial statements are submitted to the enterprise that will provide financial means in order to attract investment to the service enterprises, currently, business entities prepare individual reports for these purposes. However, in order to attract bank capital to service subjects, high-quality financial reports reflecting the real economic situation of the enterprise are needed. The indicators of tax reports do not meet the requirements of credit institutions. There is a great need to improve the quality of accounting and reporting in service enterprises in the market economy. The demand for the financial status and financial results of service subjects by internal and external users creates a need for methodological development in the direction of improving the quality of accounting and reporting of the enterprise. The main research object of the dissertation is the methodological support for the application of financial statements in service enterprises in accordance with national legislation and international standards and the shortcomings in solving the problem.
... It has been estimated that anxiety and depression make up 43% of mental disorders among adolescents aged 10-19 years, within which nearly 31.4% of males and 56.3% of females were affected (5). Given the early onset and substantial societal, health, and economic burden of anxiety and depression (6)(7)(8)(9), it is critical to examine the modifiable risk factors for the prevention and early intervention of mental disorders. ...
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Background Evidence examining the longitudinal associations between different types of screen behaviours and mental health among adolescents is limited. The present study examined the association between five types of screen behaviours and symptoms of anxiety and depression one year later. This study also assessed how changes in screen time were associated with changes in anxiety and depressive symptoms and whether the observed relationships were moderated by sex. Methods Longitudinal data of 17,174 students in grades 9–12 (53.5% females; mean age: 15.1 ± 0.9 years) attending high schools in Canada from two waves (year 6: 2017/18, year 7: 2018/19) of the COMPASS study were analyzed. Leisure screen time and mental health measures were self-reported. To test if the associations between screen time and anxiety, and depression vary by sex, two-way interactions were examined for sex. Analyses accounted for school clustering, race/ethnicity, sex, age, income, body mass index z -score, and previous year anxiety and depression symptoms. Results There were significant longitudinal associations between time spent on each type of screen and subsequent anxiety and depression symptoms. The strength of the associations varied by type of screen behaviour. Interaction analysis indicated a sex difference for television viewing and anxiety and depression symptoms, and internet surfing and anxiety symptoms. A dose-response relationship was observed between phone talking and anxiety symptoms. Beta estimates indicated that an increase in screen duration was associated with a further increase in anxiety and depression symptoms. Conclusion Higher screen time was longitudinally associated with higher anxiety and depression symptoms at one-year follow-up in adolescents. Time-change associations between screen usage and depressive and anxiety symptoms were observed. Also, associations differed based on sex and scree-type, whereby greater increases in screen use predicted greater emotional distress. Findings from this prospective analysis suggest that screen time is an important determinant of anxiety and depressive symptoms among adolescents. Future studies are recommended to help inform programs promoting screen time reduction with a goal to enhance adolescents’ mental health.
... However, these are costly and time-consuming to produce. Furthermore, although the majority of people with mental illness will not seek treatment [33], they will often express their moods or feelings through social media. Accordingly, the analysis of social media has become an important means to enhance understanding mental health problems. ...
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Mental illnesses are one of the most prevalent public health problems worldwide, which negatively influence people's lives and society's health. With the increasing popularity of social media, there has been a growing research interest in the early detection of mental illness by analysing user-generated posts on social media. According to the correlation between emotions and mental illness, leveraging and fusing emotion information has developed into a valuable research topic. In this article, we provide a comprehensive survey of approaches to mental illness detection in social media that incorporate emotion fusion. We begin by reviewing different fusion strategies, along with their advantages and disadvantages. Subsequently, we discuss the major challenges faced by researchers working in this area, including issues surrounding the availability and quality of datasets, the performance of algorithms and interpretability. We additionally suggest some potential directions for future research.
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Introduction-Depressed mood, loss of interest or pleasure, decreased energy, guilt or a sense of low self-worth, interrupted sleep or food, and trouble concentrating are all symptoms of depression, a common mental condition. Women are more likely than men to have it. Some indications and symptoms of depression include irritability, exhaustion, difficulty concentrating, difficulties making decisions and remembering things, and recurrent thoughts of death, dying, or suicide. There are many different factors that can contribute to depression, including heredity, chemical changes brought on by drug or alcohol abuse, family/marriage issues, medical conditions, natural disasters (fires, floods, storms), crime victims, financial difficulties, losses like the death of a loved one, and ageing. Material and Methods-This hospital-based case-control study comprised 50 diagnosed patients with depression under 18-65 age group who visited the psychiatric department as cases and 50 healthy individuals who were matched for age and gender and took part in the study as controls. After outlining the goals and specifics of the study, all participants in both groups provided written, fully informed consent. Serum TSH, T3, and T4 levels are calculated using ECi. Calcium, magnesium, and phosphorus are also determined using Vitros 4600. Results: Although T3 and T4 values were significantly lower (P=0.000 and P=0.004, respectively) and serum Ca levels were lower (P=0.000), TSH levels were significantly higher (P=0.076) in the depressed patients group. The levels of serum Po4 were considerably increased (P=0.004). The serum Mg levels were lower in the depression group (P=0.020). Conclusions: We conclude from the current study that the function of thyroid hormones (TSH, T 3 and T 4) and minerals (calcium, phosphorus, and magnesium) in depressed patients and compares their levels to those of healthy controls. As a result, depressed sufferers often have reduced thyroid hormone levels. Our observations of high serum Po4 levels and decreased Ca and Mg levels suggested that the thyroid gland was underactive. Numerous factors can cause the aforementioned minerals to fall out of equilibrium. More research
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Objective: Social media has become a safe space for discussing sensitive topics such as mental disorders. Depression dominates mental disorders globally, and accordingly, depression detection on social media has witnessed significant research advances. This study aims to review the current state-of-the-art research methods and propose a multidimensional framework to describe the current body of literature relating to detecting depression on social media. Method: A study methodology involved selecting papers published between 2011 and 2022 that focused on detecting depression on social media. Three digital libraries were used to find relevant papers: Google Scholar, ACM digital library, and ResearchGate. In selecting literature, two fundamental elements were considered: identifying papers focusing on depression detection and including papers involving social media use. Results: In total, 46 papers were reviewed. Multiple dimensions were analyzed, including input features, social media platforms, disorder and symptomatology, ground truth, and machine learning. Various types of input features were employed for depression detection, including textual, visual, behavioral, temporal, demographic, and spatial features. Among them, visual and spatial features have not been systematically reviewed to support mental health researchers in depression detection. Despite depression's fine-grained disorders, most studies focus on general depression. Conclusion: Recent studies have shown that social media data can be leveraged to identify depressive symptoms. Nevertheless, further research is needed to address issues like depression validation, generalizability, causes identification, and privacy and ethical considerations. An interdisciplinary collaboration between mental health professionals and computer scientists may help detect depression on social media more effectively.
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The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile. A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis. Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars). The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.
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Depression and anxiety disorders are common mental disorders worldwide. The MANAS trial aimed to test the effectiveness of an intervention led by lay health counsellors in primary care settings to improve outcomes of people with these disorders. In this cluster randomised trial, primary care facilities in Goa, India, were assigned (1:1) by computer-generated randomised sequence to intervention or control (enhanced usual care) groups. All adults who screened positive for common mental disorders were eligible. The collaborative stepped-care intervention offered case management and psychosocial interventions, provided by a trained lay health counsellor, supplemented by antidepressant drugs by the primary care physician and supervision by a mental health specialist. The research assessor was masked. The primary outcome was recovery from common mental disorders as defined by the International Statistical Classification of Diseases and Related Health Problems-10th revision (ICD-10) at 6 months. This study is registered with, number NCT00446407. 24 study clusters, with an equal proportion of public and private facilities, were randomised equally between groups. 1160 of 1360 (85%) patients in the intervention group and 1269 of 1436 (88%) in the control group completed the outcome assessment. Patients with ICD-10-confirmed common mental disorders in the intervention group were more likely to have recovered at 6 months than were those in the control group (n=620 [65·0%] vs 553 [52·9%]; risk ratio 1·22, 95% CI 1·00-1·47; risk difference=12·1%, 95% CI 1·6%-22·5%). The intervention had strong evidence of an effect in public facility attenders (369 [65·9%] vs 267 [42·5%], risk ratio 1·55, 95% CI 1·02-2·35) but no evidence for an effect in private facility attenders (251 [64·1%] vs 286 [65·9%], risk ratio 0·95, 0·74-1·22). There were three deaths and four suicide attempts in the collaborative stepped-care group and six deaths and six suicide attempts in the enhanced usual care group. None of the deaths were from suicide. A trained lay counsellor-led collaborative care intervention can lead to an improvement in recovery from CMD among patients attending public primary care facilities. The Wellcome Trust.
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Depression and anxiety disorders are common and treatable with cognitive behavior therapy (CBT), but access to this therapy is limited. Review evidence that computerized CBT for the anxiety and depressive disorders is acceptable to patients and effective in the short and longer term. Systematic reviews and data bases were searched for randomized controlled trials of computerized cognitive behavior therapy versus a treatment or control condition in people who met diagnostic criteria for major depression, panic disorder, social phobia or generalized anxiety disorder. Number randomized, superiority of treatment versus control (Hedges g) on primary outcome measure, risk of bias, length of follow up, patient adherence and satisfaction were extracted. 22 studies of comparisons with a control group were identified. The mean effect size superiority was 0.88 (NNT 2.13), and the benefit was evident across all four disorders. Improvement from computerized CBT was maintained for a median of 26 weeks follow-up. Acceptability, as indicated by adherence and satisfaction, was good. Research probity was good and bias risk low. Effect sizes were non-significantly higher in comparisons with waitlist than with active treatment control conditions. Five studies comparing computerized CBT with traditional face-to-face CBT were identified, and both modes of treatment appeared equally beneficial. Computerized CBT for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated. Australian New Zealand Clinical Trials Registry ACTRN12610000030077.
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Despite the importance of mental illness in Africa, few controlled intervention trials related to this problem have been published. To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa. For this cluster randomized, controlled clinical trial (February-June 2002), 30 villages in the Masaka and Rakai districts of rural Uganda were selected using a random procedure; 15 were then randomly assigned for studying men and 15 for women. In each village, adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function. Based on these interviews, lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depression or subsyndromal depression. Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village, totaling 284. Of these, 248 agreed to be in the trial and 9 refused; the remainder died or relocated. A total of 108 men and 116 women completed the study and were reinterviewed. Eight of the 15 male villages and 7 of the 15 female villages were randomly assigned to the intervention arm and the remainder to the control arm. The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks. Depression and dysfunction severity scores on scales adapted and validated for local use; proportion of persons meeting DSM-IV major depression diagnostic criteria. Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls (P<.001). Mean reduction in dysfunction was 8.08 and 3.76 points, respectively (P<.001). After intervention, 6.5% and 54.7% of the intervention and control groups, respectively, met the criteria for major depression (P<.001) compared with 86% and 94%, respectively, prior to intervention (P =.04). The odds of postintervention depression among controls was 17.31 (95% confidence interval, 7.63-39.27) compared with the odds among intervention groups. Results from intention-to-treat analyses remained statistically significant. Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction. A clinical trial proved feasible in the local setting. Both findings should encourage similar trials in similar settings in Africa and beyond.
In most societies, mothers are the primary providers of nutrition and care to young children. This is a demanding task, and poor physical or mental health in mothers might be expected to have adverse consequences on their children's health, nutrition and psychological well-being. Child nutrition programmes do not adequately address maternal mental health. In this article, we consider the evidence from less developed countries on whether maternal mental health influences child growth, with respect to evidence from both observational studies and from clinical trials. We estimate how much of the burden of undernutrition might be averted in one setting, and propose that promoting maternal mental health and treating maternal mental illness offer important new opportunities to tackle the twin scourges of maternal ill-health and child undernutrition.