Article Text


International health
Treatment gap in depression
  1. J Twynam-Perkins1*,
  2. A Pollock2,
  3. P Brilikhova2
  1. 1Medical School, University of Edinburgh, Edinburgh, UK
  2. 2School of Social and Political Science, University of Edinburgh, Edinburgh, UK


Purpose Since 2001 treatment of depression has been a main priority of the World Health Organisation (WHO) public health agenda. WHO policy reports, such as the World Health Report 2001, state that there is an unmet need of depression, referred to as the treatment gap. This report aims to explore how the treatment gap is defined and measured.

Methods WHO policy documents were searched and a literature review using key terms; treatment gap and depression, was conducted in the English speaking language with no time limits. This sought to measure the prevalence of depression alongside need or unmet need for services. A critical appraisal of these studies alongside primary data sources identified through a search of all relevant WHO policy documents was carried out.

Results 17 WHO publications referred to the treatment gap of depression and cited primary data sources. The literature review yielded 95 results. Using the inclusion criteria (measures of prevalence and service use) this was reduced to 35 primary data sources. There's no consensus in the WHO publications or wider literature over the definition or measurement of the treatment gap of depression. The primary data sources are not representative and are of variable quality with little continuity in design. The majority of primary data is drawn from the more economically developed world; only 3 studies contained data from Africa compared to 18 for Europe and only 1 low income country was represented compared to 46 high and middle income countries.

Conclusions A clear framework to define unmet need, service access and use is required to reliably measure the treatment gap.

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