Lecture 2D: How Can We Treat & Prevent Depression in Low- and Middle-Income Countries?
Public Mental Health is the application of the principles of medicine and social science to prevent the occurrence of mental and behavioral disorders and to promote mental health of the population. This course illustrates the principles of public health applied to depressive disorder, including principles of epidemiology, transcultural psychiatry, health services research, and prevention. It is predicted that by 2020 depressive disorder will be the most important cause of disease burden in the entire world! Every human being suffers from feeling depressed at some point or other, but only about one fifth of the population will experience an episode of depressive disorder over the course of their lives. This course illuminates the public health approach to disease, and the particular complexities of applying this approach to mental disorders, using depression as the exemplar.
This week we will be covering depression from a global public health perspective.
can treat and prevent depression in low and middle income countries?
Let's start with a systematic review conducted by Vicram Patel and colleagues.
on global mental health, the first series in 2007.
It's a series of, I believe, five papers on global mental health.
you to take at a look at these papers.
provide a great introduction to, to global mental health.
in this table evaluations for treating depression.
for rigorous evaluation of treatments.
effective interventions, effective treatments, exist.
of my colleagues have tested group interpersonal psychotherapy.
psychological treatments have been evaluated.
Chile, a, a multi-component steps care program was tested in primary care.
and Mexico, psycho-educational group sessions were, were tested.
depression which is really good news.
systematic review has been conducted recently by Atif Rahman and colleagues.
And they found 13 randomized control trials.
Specifically looking at the effectiveness of treatment for maternal depression.
They were often delivered by a, by general community health workers.
which is considered a moderate, moderately large effect size.
The I squared statistic that you can see there between brackets.
was, and how effective these treatments were.
And, an I square of more than 50% indicates significant variation.
the strength of the benefit that they could bring for maternal depression.
treatments improved interactions between mothers and infants.
They lead to better cognitive development and growth.
They reduced diarrhoeal episodes and increased immunization rates.
So again, there's there's good news from research.
effect on the impact that depression has on children.
World Health Organization in what's called the mhGAP program.
World Health Organizations, Department of Mental Health.
there are effective treatments available in low and middle income countries.
disorders in low and middle income countries, don't receive any treatment.
The treatment gap is as large as 80% to 90% in many places.
issues, even though we know that those treatments exist.
scaling up the interventions, that we know work.
integrating these treatments into primary care settings.
focus here is on making treatments available in primary care.
primary care settings in low and middle income countries.
And one of these priority disorders is depression.
people went through the existing evidence for mental health treatments.
looks like, it's the first module in the intervention guide.
various places in the world at the moment.
really important that we think about preventing depression.
in nature and could potentially be addressed through, through social action.
of mental health, depression particularly, could be a very viable strategy.
Commission on the Social Determinants of Health.
major recommendations built on existing evidence.
Number one is that we need to improve daily living conditions.
That can really have, a decisive impact on health.
We must tackle the equitable distribution of borrower money and resources.
understand the problem and assess the impact of action.
The problem here being the, the social determinates of of health.
That is for health in general.
you can see that there is a large overlap.
of determinants for, for mental health and for depression, as we have seen.
health problems through reducing poverty? It's a really tantalizing idea.
clinics or go into the community to identify people with depression.
Instead of that we could prevent depression before it happens.
way of addressing the issue. So, does this work?
Can we improve mental health through reducing poverty?
involved a systematic review to find studies that, that address this question.
And they found four randomized controlled trials.
the relationship between poverty and mental health is bidirectional.
increased chances for mental health problems.
problems may also increase, your levels of poverty.
their impacts on mental health in Mexico, in Ecuador, in South Africa and in Uganda.
information to make any, any firm, strong conclusions.
specific types of poverty reduction strategies.
but there is no fantastic, strong effect across the board of these studies.
In fact, in one study there were deteriorations in mental health.
kind of poverty reduction strategy was evaluated.
team with a high level of input, etcetra.
And just to, to go back to what I said previously.
The relationship between poverty and mental health is complex.
Poverty consists of a large range of issues.
Not just if you have little money.
But also how you compare to other people in the neighborhood.
basic needs, healthcare needs, education needs etc.
It's not an easy issue to deal with.
strategies will have different impacts on mental health.
people, and intervene with only one specific aspect of poverty.
So you can imagine that the results were not uniformly positive.
bit of prevention research has to, has to struggle with.
they're suffering from a whole range of risk factors.
Including other risk factors of poverty, but also non-poverty related issues.
for how poverty reduction could improve mental health.
So, poverty reduction might address one specific dimension of, of poverty.
For instance, it's financial aspect but it might not address other issues.
relative wealth aspects might play a role, et cetera.
We don't yet have a firm answer on that question.
But I do feel that it's a very promising area.
targeting the social determinants of depression.
as part of the series on public health perspectives on depression.
I hope that you enjoyed listening.
Thanks very much for your attention.