Moitra Modhurima, Santomauro Damian, Collins Pamela Y, Vos Theo, Whiteford Harvey, Saxena Shekhar, Ferrari Alize J
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Department of Global Health, University of Washington, Seattle, Washington, United States of America.
PLoS Med. 2022 Feb 15;19(2):e1003901. doi: 10.1371/journal.pmed.1003901. eCollection 2022 Feb.
The treatment coverage for major depressive disorder (MDD) is low in many parts of the world despite MDD being a major contributor to disability globally. Most existing reviews of MDD treatment coverage do not account for potential sources of study-level heterogeneity that contribute to variation in reported treatment rates. This study aims to provide a comprehensive review of the evidence and analytically quantify sources of heterogeneity to report updated estimates of MDD treatment coverage and gaps by location and treatment type between 2000 and 2019.
A systematic review of the literature was conducted to identify relevant studies that provided data on treatment rates for MDD between January 1, 2000, and November 26, 2021, from 2 online scholarly databases PubMed and Embase. Cohort and cross-sectional studies were included if treatment rates pertaining to the last 12 months or less were reported directly or if sufficient information was available to calculate this along with 95% uncertainty intervals (UIs). Studies were included if they made use of population-based surveys that were representative of communities, countries, or regions under study. Studies were included if they used established diagnostic criteria to diagnose cases of MDD. Sample and methodological characteristics were extracted from selected studies. Treatment rates were modeled using a Bayesian meta-regression approach and adjusted for select covariates that quantified heterogeneity in the data. These covariates included age, sex, treatment type, location, and choice of MDD assessment tool. A total of 149 studies were included for quantitative analysis. Treatment coverage for health service use ranged from 51% [95% UI 20%, 82%] in high-income locations to 20% [95% UI 1%, 53%] in low- and lower middle-income locations. Treatment coverage for mental health service use ranged from 33% [95% UI 8%, 66%] in high-income locations to 8% [95% UI <1%, 36%] in low- and lower middle-income countries. Minimally adequate treatment (MAT) rates ranged from 23% [95% UI 2%, 55%] in high-income countries to 3% [95% UI <1%, 25%]) in low- and lower middle-income countries. A primary methodological limitation was the lack of sufficient data from low- and lower middle-income countries, which precluded our ability to provide more detailed treatment rate estimates.
In this study, we observed that the treatment coverage for MDD continues to be low in many parts of the world and in particular in low- and lower middle-income countries. There is a continued need for routine data collection that will help obtain more accurate estimates of treatment coverage globally.
尽管重度抑郁症（MDD）是全球残疾的主要原因之一，但在世界许多地区，MDD的治疗覆盖率较低。现有的大多数关于MDD治疗覆盖率的综述没有考虑到研究水平异质性的潜在来源，这些来源导致了报告的治疗率存在差异。本研究旨在对证据进行全面综述，并通过分析量化异质性来源，以报告2000年至2019年期间按地点和治疗类型划分的MDD治疗覆盖率及差距的最新估计值。
对文献进行了系统综述，以确定2000年1月1日至2021年11月26日期间，从两个在线学术数据库PubMed和Embase中提供MDD治疗率数据的相关研究。如果直接报告了过去12个月或更短时间内的治疗率，或者有足够的信息来计算该治疗率以及95%的不确定性区间（UI），则纳入队列研究和横断面研究。如果研究使用了代表所研究社区、国家或地区的基于人群的调查，则纳入该研究。如果研究使用既定的诊断标准来诊断MDD病例，则纳入该研究。从选定的研究中提取样本和方法学特征。使用贝叶斯元回归方法对治疗率进行建模，并针对量化数据异质性的选定协变量进行调整。这些协变量包括年龄、性别、治疗类型、地点和MDD评估工具的选择。共有149项研究纳入定量分析。卫生服务使用的治疗覆盖率在高收入地区为51%[95%UI 20%，82%]，在低收入和中低收入地区为20%[95%UI 1%，53%]。心理健康服务使用的治疗覆盖率在高收入地区为33%[95%UI 8%，66%]，在低收入和中低收入国家为8%[95%UI <1%，36%]。最低充分治疗（MAT）率在高收入国家为23%[95%UI 2%，55%]，在低收入和中低收入国家为3%[95%UI <1%，25%]。一个主要的方法学局限性是缺乏来自低收入和中低收入国家的足够数据，这使得我们无法提供更详细的治疗率估计。
在本研究中，我们观察到MDD的治疗覆盖率在世界许多地区，特别是在低收入和中低收入国家仍然很低。持续需要进行常规数据收集，这将有助于获得全球治疗覆盖率更准确的估计值。
