Treating Depression in the Developing World

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PROVIDENCE, Rhode Island — One of the most debilitating diseases in the world is depression. It represents the biggest risk factor for suicide, which is responsible for over 800,000 deaths every year. While the mortality rate of depression can’t compare to that of HIV or malaria, depression is the leading cause of disability worldwide.

Even in the developed world, the effects of depression are palpable and widespread. But in the developing world where mothers mourn the deaths of their newborn children and fathers struggle to provide food and shelter for their families, depression is more than just a burden, it is a terrifying and crushing weight. The lack of resources in the developing world means that weight cannot be lifted with Prozac and professional counseling.

The fact of the matter is that depression is a disease that is by no means limited to the rich. In reality, the developing world is a hotbed for depression and a bevy of other mental health issues. Nearly three-quarters of the world’s neuropsychiatric disorders exist in low-income countries.

The developing world’s profound lack of mental health care professionals only compounds the problem. High-income countries have approximately 210 times as many psychiatrists, 350 times as many psychologists and nearly 400 times as many social workers as low-income countries.

As such, treatment for depression in the developing world must take a different tack. Due to the lack of resources, developing countries cannot rely so heavily on antidepressant drugs and professional health care. Fortunately, an alternative exists.

This alternative is not some newfangled technology or a breakthrough psychological treatment method. Rather, this treatment is the age-old strategy of task shifting.

Task shifting means training other people for the roles that their communities need the most. The strategy has had a great deal of success for physical ailments. When task shifting is done correctly, professional doctors only treat the most severe cases, and spend the rest of their time training locals.

With a global shift toward a focus on mental health issues, task shifting has proven immensely successful in treating depression.

A study done in Uganda showed that interpersonal therapy sessions can be instrumental in treating depression. The study was done by training just a handful of locals to lead these therapy sessions. After six months, merely six percent of those treated still had major depression.

The Uganda study proved that task shifting can work in rural and underdeveloped areas just as effectively — if not more so — than in the developed world.

A number of similar studies backed up those results. For instance, using only newly trained community health workers from Pakistan, mothers suffering from postpartum depression were twice as likely to still be depressed after six months in the control group as those in the therapy group. Similarly, a study in Goa, India showed that after an eight-week course in psychotherapy, local community members were able to treat depression just as well as doctors in private clinics.

Some studies have even shown positive results after a short two-day long training period.

Still, some may say that since the mortality rate of depression is less than more deadly diseases such as HIV/AIDS, we should forgo treatment for mental health and instead focus on what they deem to be more pressing issues.

However, community-based treatment for depression is surprisingly simple and, when done correctly, can be cheaper and just as effective as first world treatments. By investing relatively small amounts of time and energy to train the local populace, depression in the developing world can be treated without taking resources away from fighting other epidemics.

Sam Hillestad

Sources: New York Times, PsychCentral, PRB
Photo: The Star

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