Background

Access to effective treatment for major depressive disorder remains limited and difficult to track across place and time. We analysed the available data on minimally adequate treatment (MAT) for major depressive disorder globally with the aim of providing a useful metric against which to monitor national responses to the growing public health burden imposed by major depressive disorder.

Methods

MAT was defined as pharmacotherapy (1 month of medication, plus four visits to a medical doctor) or psychotherapy (eight visits with any professional). From existing reviews, we identified mental health surveys that assessed major depressive disorder within the general population as well as health service uptake by individuals with major depressive disorder. Data by ethnicity were not available. Estimates of MAT, antidepressant use, or use of any mental health service were extracted. The latter two estimates were adjusted to reflect likely MAT rates via a network meta-analysis. Adjusted MAT estimates were analysed via a Bayesian meta-regression using the Disease Modelling Meta-Regression (DisMod-MR 2.1) tool. This analysis estimated MAT coverage among people with major depressive disorder by age, sex, location, and year. Final MAT estimates were standardised by age and sex against the existing age and sex distribution of people with major depressive disorder globally. People with lived experience were involved in the design, preparation, interpretation, and writing of this manuscript.

Findings

The analysed dataset included 145 estimates from 32 studies, covering 31 countries, 14 regions, and six super-regions. The proportion of people with major depressive disorder receiving MAT globally in 2021 was 9·1% (95% uncertainty interval 7·2–11·6), with 10·2% (8·2–13·1) of females and 7·2% (5·7–9·3) of males with major depressive disorder receiving MAT. MAT coverage was highest in high-income locations (27·0% [21·7–34·4]), with Australasia having the highest rate (29·2% [21·4–40·8]). MAT coverage was lowest in sub-Saharan Africa (2·0% [1·5–2·6]), within which western sub-Saharan Africa (1·8% [1·4–2·5]) had the lowest coverage. Seven countries (Australia, Belgium, Canada, Germany, the Netherlands, South Korea, and Sweden) were estimated to have MAT coverage exceeding 30%, while 90 countries were estimated to have coverage lower than 5%.

Interpretation

Despite many gaps in the available data, estimates show that, globally, most individuals with major depressive disorder do not receive MAT. Services must improve to reach a global coverage that better meets the mental health needs of those with major depressive disorder. Urgent attention should be given to the scale-up of effective intervention strategies, especially in low-income and middle-income countries, as well as further research into better quality treatment options for major depressive disorder. We present a means by which the MAT gap for major depressive disorder can be quantified, to monitor and inform action by governments and international partners.

Funding

Queensland Health and the Bill & Melinda Gates Foundation.

中文翻译：

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重度抑郁症的服务覆盖率：2021 年估计 204 个国家和地区的最低限度充分治疗率

 背景

重度抑郁症获得有效治疗的机会仍然有限，并且难以跨地点和时间进行追踪。我们分析了全球重度抑郁症最低限度充分治疗 （MAT） 的现有数据，旨在提供一个有用的指标，以监测国家对重度抑郁症造成的日益增长的公共卫生负担的反应。

 方法

MAT 被定义为药物治疗 （1 个月的药物治疗，加上 4 次看医生） 或心理治疗 （8 次去看任何专业人士）。从现有的综述中，我们确定了心理健康调查，这些调查评估了普通人群中的重度抑郁症以及重度抑郁症患者的卫生服务接受情况。没有按种族划分的数据。提取了 MAT、抗抑郁药使用或任何心理健康服务的使用情况的估计值。通过网络荟萃分析对后两个估计值进行了调整，以反映可能的 MAT 率。使用疾病建模元回归 （DisMod-MR 2.1） 工具通过贝叶斯元回归分析调整后的 MAT 估计值。该分析按年龄、性别、地点和年份估计了重度抑郁症患者的 MAT 覆盖率。最终的 MAT 估计值根据全球重度抑郁症患者的现有年龄和性别分布，按年龄和性别进行标准化。具有生活经验的人参与了这份手稿的设计、准备、解释和写作。

 发现

分析的数据集包括来自 32 项研究的 145 个估计值，涵盖 31 个国家、14 个地区和 6 个超级地区。2021 年全球接受 MAT 的重度抑郁症患者比例为 9·1%（95% 不确定性区间 7·2-11·6），其中 10·2% （8·2-13·1） 的女性和 7·2% （5·7-9·3） 的重度抑郁症男性接受 MAT。MAT 覆盖率在高收入地区最高 （27·0% [21·7–34·4]）， 其中澳大拉西亚的比率最高 （29·2% [21·4–40·8]）。撒哈拉以南非洲的 MAT 覆盖率最低 （2·0% [1·5–2·6]），其中撒哈拉以南非洲西部 （1·8% [1·4–2·5]）的覆盖率最低。据估计，7 个国家/地区（澳大利亚、比利时、加拿大、德国、荷兰、韩国和瑞典）的 MAT 覆盖率超过 30%，而 90 个国家/地区的覆盖率估计低于 5%。

 解释

尽管现有数据存在许多差距，但估计显示，在全球范围内，大多数重度抑郁症患者没有接受 MAT。必须改进服务，以达到全球覆盖面，更好地满足重度抑郁症患者的心理健康需求。应紧急关注扩大有效的干预策略，特别是在低收入和中等收入国家，并进一步研究更高质量的重度抑郁症治疗方案。我们提出了一种可以量化重度抑郁症 MAT 差距的方法，以监测政府和国际合作伙伴的行动并为行动提供信息。

 资金

昆士兰卫生部和比尔&梅琳达·盖茨基金会。