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      Undertreatment of people with major depressive disorder in 21 countries.

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          Abstract

          Major depressive disorder (MDD) is a leading cause of disability worldwide.

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          Most cited references7

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          The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

          This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH‐CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio‐demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12‐month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer‐assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper‐and‐pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD‐10 and DSM‐IV criteria. Elaborate CD‐ROM‐based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection. Copyright © 2004 Whurr Publishers Ltd.
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            The costs of depression.

            The data reported herein show clearly that major depression is a commonly occurring and burdensome disorder. The high prevalence, early age of onset, and high persistence of MDD in the many different countries where epidemiologic surveys have been administered confirm the high worldwide importance of depression. Although evidence is not definitive that MDD plays a causal role in its associations with the many adverse outcomes reviewed here, there is clear evidence that depression has causal effects on a number of important mediators, making it difficult to assume anything other than that depression has strong causal effects on many dimensions of burden. These results have been used to argue for the likely cost -effectiveness of expanded depression treatment from a societal perspective. Two separate, large-scale, randomized, workplace depression treatment effectiveness trials have been carried out in the United States to evaluate the cost effectiveness of expanded treatment from an employer perspective. Both trials had positive returns on investment to employers. A substantial expansion of worksite depression care management programs has occurred in the United States subsequent to the publication of these trials. However, the proportion of people with depression who receive treatment remains low in the United States and even lower in other parts of the world. A recent US study found that only about half of workers with MDD received treatment in the year of interview and that fewer than half of treated workers received treatment consistent with published treatment guidelines. Although the treatment rate was higher for more severe cases, even some with severe MDD often failed to receive treatment. The WMH surveys show that treatment rates are even lower in many other developed countries and consistently much lower in developing countries. Less information is available on rates of depression treatment among patients with chronic physical disorders, but available evidence suggests that expanded treatment could be of considerable value. Randomized, controlled trials are needed to expand our understanding of the effects of detection and treatment of depression among people in treatment for chronic physical disorders. In addition, controlled effectiveness trials with long-term follow-ups are needed to increase our understanding of the effects of early MDD treatment interventions on changes in life course role trajectories, role performance, and onset of secondary physical disorders.
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              Global pattern of experienced and anticipated discrimination reported by people with major depressive disorder: a cross-sectional survey.

              Depression is the third leading contributor to the worldwide burden of disease. We assessed the nature and severity of experienced and anticipated discrimination reported by adults with major depressive disorder worldwide. Moreover, we investigated whether experienced discrimination is related to clinical history, provision of health care, and disclosure of diagnosis and whether anticipated discrimination is associated with disclosure and previous experiences of discrimination. In a cross-sectional survey, people with a diagnosis of major depressive disorder were interviewed in 39 sites (35 countries) worldwide with the discrimination and stigma scale (version 12; DISC-12). Other inclusion criteria were ability to understand and speak the main local language and age 18 years or older. The DISC-12 subscores assessed were reported discrimination and anticipated discrimination. Multivariable regression was used to analyse the data. 1082 people with depression completed the DISC-12. Of these, 855 (79%) reported experiencing discrimination in at least one life domain. 405 (37%) participants had stopped themselves from initiating a close personal relationship, 271 (25%) from applying for work, and 218 (20%) from applying for education or training. We noted that higher levels of experienced discrimination were associated with several lifetime depressive episodes (negative binomial regression coefficient 0·20 [95% CI 0·09-0·32], p=0·001); at least one lifetime psychiatric hospital admission (0·29 [0·15-0·42], p=0·001); poorer levels of social functioning (widowed, separated, or divorced 0·10 [0·01-0·19], p=0·032; unpaid employed 0·34 [0·09-0·60], p=0·007; looking for a job 0·26 [0·09-0·43], p=0·002; and unemployed 0·22 [0·03-0·41], p=0·022). Experienced discrimination was also associated with lower willingness to disclose a diagnosis of depression (mean discrimination score 4·18 [SD 3·68] for concealing depression vs 2·25 [2·65] for disclosing depression; p<0·0001). Anticipated discrimination is not necessarily associated with experienced discrimination because 147 (47%) of 316 participants who anticipated discrimination in finding or keeping a job and 160 (45%) of 353 in their intimate relationships had not experienced discrimination. Discrimination related to depression acts as a barrier to social participation and successful vocational integration. Non-disclosure of depression is itself a further barrier to seeking help and to receiving effective treatment. This finding suggests that new and sustained approaches are needed to prevent stigmatisation of people with depression and reduce the effects of stigma when it is already established. European Commission, Directorate General for Health and Consumers, Public Health Executive Agency. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Br J Psychiatry
                The British journal of psychiatry : the journal of mental science
                Royal College of Psychiatrists
                1472-1465
                0007-1250
                Feb 2017
                : 210
                : 2
                Affiliations
                [1 ] Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA graham.thornicroft@kcl.ac.uk.
                [2 ] Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
                Article
                bjp.bp.116.188078
                10.1192/bjp.bp.116.188078
                5288082
                27908899
                4a46a4c9-9da4-4aa7-b741-ed062ddcf4ed
                History

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