Hostname: page-component-5d84bcc8dc-k2fgz Total loading time: 0 Render date: 2026-08-16T09:36:11.504Z Has data issue: false hasContentIssue false
  • English
  • Français

Antidepressant use in low- middle- and high-income countries: a World Mental Health Surveys report

Published online by Cambridge University Press:  23 September 2021

Alan E. Kazdin Open the ORCID record for Alan E. Kazdin [Opens in a new window] ,
Chi-Shin Wu ,
Irving Hwang ,
Victor Puac-Polanco ,
Nancy A. Sampson ,
Ali Al-Hamzawi ,
Jordi Alonso ,
Laura Helena Andrade ,
Corina Benjet  and
José-Miguel Caldas-de-Almeida
...Show all authors
Alan E. Kazdin
Affiliation:
Department of Psychology, Yale University, New Haven, CT, USA
Chi-Shin Wu
Affiliation:
Department of Psychiatry, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
Irving Hwang
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Victor Puac-Polanco
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Nancy A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Ali Al-Hamzawi
Affiliation:
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Al Diwaniyah, Iraq
Jordi Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain Pompeu Fabra University (UPF), Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Laura Helena Andrade
Affiliation:
Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
Corina Benjet
Affiliation:
Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
José-Miguel Caldas-de-Almeida
Affiliation:
Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
Giovanni de Girolamo
Affiliation:
IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
Peter de Jonge
Affiliation:
Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, The Netherlands
Silvia Florescu
Affiliation:
National School of Public Health, Management and Development, Bucharest, Romania
Oye Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Josep M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
Meredith G. Harris
Affiliation:
School of Public Health, The University of Queensland, Herston, QLD 4006, Australia Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol QLD 4072, Australia
Elie G. Karam
Affiliation:
Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Georges Karam
Affiliation:
Faculty of Medicine, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Viviane Kovess-Masfety
Affiliation:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
Sing Lee
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
John J. McGrath
Affiliation:
Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol QLD 4072, Australia Queensland Brain Institute, The University of Queensland, St Lucia QLD 4065, Australia National Centre for Register-based Research, Aarhus University, Aarhus V 8000, Denmark
Fernando Navarro-Mateu
Affiliation:
UDIF-SM, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia, Región de Murcia, Spain
Daisuke Nishi
Affiliation:
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan National Center of Neurology and Psychiatry, Tokyo, Japan
Bibilola D. Oladeji
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
José Posada-Villa
Affiliation:
Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
Dan J. Stein
Affiliation:
Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa Groote Schuur Hospital, Cape Town, South Africa
T. Bedirhan Üstün
Affiliation:
Department of Psychiatry, Koç University, Istanbul, Turkey
Daniel V. Vigo
Affiliation:
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
Zahari Zarkov
Affiliation:
Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
Alan M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Ronald C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.

Methods

Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.

Results

3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.

Conclusion

ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.

Keywords

Antidepressant medicationsperceived effectivenessreasons for use

Information

Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 4 , March 2023 , pp. 1583 - 1591
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Abbing-Karahagopian, V., Huerta, C., Souverein, P., De Abajo, F., Leufkens, H., Slattery, J., … Oliva, B. (2014). Antidepressant prescribing in five European countries: Application of common definitions to assess the prevalence, clinical observations, and methodological implications. European Journal of Clinical Pharmacology, 70, 849–857. doi: 10.1007/s00228-014-1676-zCrossRefGoogle ScholarPubMed
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in Clinical Neuroscience, 19, 93–107. doi: 10.31887/DCNS.2017.19.2/bbandelowCrossRefGoogle ScholarPubMed
Barth, J., Munder, T., Gerger, H., Nüesch, E., Trelle, S., Znoj, H., … Cuijpers, P. (2016). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis. Focus, 14, 229–243. doi: 10.1176/appi.focus.140201CrossRefGoogle ScholarPubMed
Brody, D. J., & Gu, Q. (2020). Antidepressant use among adults: United States, 2015–2018. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db377.htm.Google Scholar
Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: A global return on investment analysis. The Lancet Psychiatry, 3, 415–424. doi: 10.1016/S2215-0366(16)30024-4CrossRefGoogle ScholarPubMed
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., … Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet Psychiatry, 391, 1357–1366. doi: 10.1016/s0140-6736(17)32802-7CrossRefGoogle ScholarPubMed
Cooper, C. (2018). Global, regional, and national Disability-Adjusted Life-Years (DALY) for 359 diseases and injuries and Health Life Expectancy (HALE) for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Psychiatry, 392, 1859–1922. doi: 10.1016/S0140-6736(18)32335-3Google Scholar
Fava, M., Rush, A. J., Alpert, J. E., Balasubramani, G., Wisniewski, S. R., Carmin, C. N., … Howland, R. (2008). Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR* D report. American Journal of Psychiatry, 165, 342–351. doi: 10.1176/appi.ajp.2007.06111868CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, Non-patient edition. (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Goldstein, B. I., Baune, B. T., Bond, D. J., Chen, P. H., Eyler, L., Fagiolini, A., … McElroy, S. L. (2020). Call to action regarding the vascular-bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders. Bipolar Disorders, 22, 440–460. doi: 10.1111/bdi.12921CrossRefGoogle Scholar
Harkness, J., Pennell, B., Villar, A., Gebler, N., Aguilar-Gaxiola, S., & Bilgen, I. (2008). Translation procedures and translation assessment in the world mental health survey initiative. In Kessler, R. & Üstün, T. (Eds.), The WHO world mental health surveys: Global perspectives on the epidemiology of mental disorders (pp. 91–113). New York, NY: Cambridge University Press.Google Scholar
Haro, J. M., Arbabzadeh-Bouchez, S., Brugha, T. S., De Girolamo, G., Guyer, M. E., Jin, R., … Vilagut, G. (2006). Concordance of the Composite International Diagnostic Interview version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research, 15, 167–180. doi: 10.1002/mpr.196CrossRefGoogle ScholarPubMed
Harris, M. G., Kazdin, A. E., Chiu, W. T., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., … Kessler, R. C. (2020). Findings from World Mental Health Surveys of the perceived helpfulness of treatment for patients with major depressive disorder. JAMA Psychiatry, 77, 830–841. doi: 10.1001/jamapsychiatry.2020.1107CrossRefGoogle ScholarPubMed
Heeringa, S., Wells, J., Hubbard, F., Mneimneh, Z., Chiu, W., Sampson, N., & Berglund, P. (2008). Sample designs and sampling procedures. New York, NY: Cambridge University Press.Google Scholar
Herrman, H., Kieling, C., McGorry, P., Horton, R., Sargent, J., & Patel, V. (2019). Reducing the global burden of depression: A Lancet–World Psychiatric Association commission. The Lancet Psychiatry, 393, e42–e43. doi: 10.1016/S0140-6736(18)32408-5CrossRefGoogle ScholarPubMed
Kessler, R. C., & Üstün, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121. doi: 10.1002/mpr.168CrossRefGoogle ScholarPubMed
Lewer, D., O'Reilly, C., Mojtabai, R., & Evans-Lacko, S. (2015). Antidepressant use in 27 European countries: Associations with sociodemographic, cultural and economic factors. The British Journal of Psychiatry, 207, 221–226. doi: 10.1192/bjp.bp.114.156786CrossRefGoogle ScholarPubMed
Maslej, M. M., Furukawa, T. A., Cipriani, A., Andrews, P. W., Sanches, M., Tomlinson, A., … Mulsant, B. H. (2021). Individual differences in response to antidepressants: A meta-analysis of placebo-controlled randomized clinical trials. JAMA Psychiatry, 78, 490–497. doi: 10.1001/jamapsychiatry.2020.4564CrossRefGoogle ScholarPubMed
Olfson, M., & Marcus, S. C. (2009). National patterns in antidepressant medication treatment. Archives of General Psychiatry, 66(8), 848–856. doi: 10.1001/archgenpsychiatry.2009.81CrossRefGoogle ScholarPubMed
Prukkanone, B., Vos, T., Bertram, M., & Lim, S. (2012). Cost-effectiveness analysis for antidepressants and cognitive behavioral therapy for major depression in Thailand. Value in Health, 15, S3–S8. doi: 10.1016/j.jval.2011.11.009CrossRefGoogle ScholarPubMed
Rajaratnam, K., Xiang, Y.-T., Tripathi, A., Chiu, H. F. K., Si, T.-M., Chee, K.-Y., … Kuga, H. (2016). Factors associated with antidepressant dosing in Asia: Findings from the research on Asian psychotropic prescription study. Journal of Clinical Psychopharmacology, 36, 716–719. doi: 10.1097/JCP.0000000000000591CrossRefGoogle ScholarPubMed
SAS Institute Inc. (2016). SAS Software Version 9.4.Google Scholar
Shefer, G., Henderson, C., Howard, L. M., Murray, J., & Thornicroft, G. (2014). Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms – a qualitative study. PLoS One, 9, e111682. doi: 10.1371/journal.pone.0111682CrossRefGoogle ScholarPubMed
Souery, D., Oswald, P., Massat, I., Bailer, U., Bollen, J., Demyttenaere, K., … Serretti, A. (2007). Clinical factors associated with treatment resistance in major depressive disorder: Results from a European multicenter study. Journal of Clinical Psychiatry, 68, 1062–1070. doi: 10.4088/jcp.v68n0713CrossRefGoogle ScholarPubMed
Wang, Y.-H., Li, J.-Q., Shi, J.-F., Que, J.-Y., Liu, J.-J., Lappin, J. M., … Qiao, Y.-L. (2020). Depression and anxiety in relation to cancer incidence and mortality: A systematic review and meta-analysis of cohort studies. Molecular Psychiatry, 25, 1487–1499. doi: 10.1038/s41380-019-0595-xCrossRefGoogle ScholarPubMed
Wiles, N. J., Thomas, L., Turner, N., Garfield, K., Kounali, D., Campbell, J., … Morrison, J. (2016). Long-term effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: Follow-up of the CoBalT randomised controlled trial. The Lancet Psychiatry, 3, 137–144. doi: 10.1016/S2215-0366(15)00495-2CrossRefGoogle ScholarPubMed
Wolter, K. M. (1985). Introduction to variance estimation. New York, NY: Springer-Verlag. doi: 10.1007/978-0-387-35099-8Google Scholar
World Health Organization (2017). Depression and other common mental disorders: global health estimates. Retrieved from https://apps.who.int/iris/handle/10665/254610.Google Scholar
Wu, C.-S., Shau, W.-Y., Chan, H.-Y., Lee, Y.-C., Lai, Y.-J., & Lai, M.-S. (2012). Utilization of antidepressants in Taiwan: A nationwide population-based survey from 2000 to 2009. Pharmacoepidemiology and Drug Safety, 21, 980–988. doi: 10.1002/pds.3255CrossRefGoogle ScholarPubMed
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., … Berk, M. (2018). Canadian Network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20, 97–170. doi: 10.1111/bdi.12609CrossRefGoogle Scholar
Zhang, Y., Yang, H., Yang, S., Liang, W., Dai, P., Wang, C., & Zhang, Y. (2013). Antidepressants for bipolar disorder: A meta-analysis of randomized, double-blind, controlled trials. Neural Regeneration Research, 8, 2962. doi: 10.3969/j.issn.1673-5374.2013.31.009Google ScholarPubMed
Zimmerman, M., McGlinchey, J. B., Posternak, M. A., Friedman, M., Attiullah, N., & Boerescu, D. (2006). How should remission from depression be defined? The depressed patient's perspective. American Journal of Psychiatry, 163, 148–150. doi: 10.1176/appi.ajp.163.1.148CrossRefGoogle ScholarPubMed
Supplementary material: File

Kazdin et al. supplementary material

Kazdin et al. supplementary material

Download Kazdin et al. supplementary material(File)
File 91.2 KB