Estimating the global treatment rates for depression: A systematic review and meta-analysis

Background: Depression is considered a global crisis due to its high prevalence and associated disabilities. The burden posed by depression could be reduced by increasing access to timely treatment. Limited information is available on treatment rates of depression, particularly in low- and middle-income countries. This study aimed to estimate the treatment rates for depression in the general adult population by World Bank income classification. Methods: We searched PubMed, EMBASE, PsycINFO, and CINAHL, supplemented with hand-search of reference lists to identify community-based studies. The overall treatment rate for depression was estimated from studies that reported any treatment (behavioral or pharmacological treatments) in healthcare or informal non-healthcare settings. Data were pooled using a random-effects meta-analysis model. Subgroup analyses by income classification were completed. Meta-regression was conducted by study characteristics. The protocol was pre-registered at PROSPERO (CRD42020161683). Results: We included 65 studies comprising 1.1 million participants from 79 countries and territories. The global 12-month/lifetime pooled treatment rate was 34.8% (95% confidence interval: 29.9, 39.9%). The treatment rates were 48.3% (43.0, 53.6%) in high-income countries, 21.4% (15.1, 27.7%) in middle-income countries, and 16.8% (11.3, 23.0%) in low-income countries. Among the treated samples, 12-month minimally adequate treatment was estimated to be 40%. Limitation: We reported a substantial level of between-study heterogeneity, which was partially explained by study characteristics in the meta-regression. Conclusion: Globally, approximately one-third of people with depression receive treatment. Three in five treated people with depression did not receive minimally adequate treatment. Depression treatment rates are considerably lower in low-and middle-income countries.