World Mental Health Day: Preventing Depression in Developing Countries

By Charles F. Reynolds III, M.D.

Today is World Mental Health Day, when the World Health Organization works to raise awareness of mental health issues around the globe. Recent developments are helping us better understand how to treat depression and anxiety disorders in developing countries, but much work remains.

Depression and anxiety disorders are a significant public health concern in developing countries, also referred to as low and middle income countries (LMICs).  

Late-life depression and anxiety are of particular concern in LMICs. This is due to rapid demographic transition and aging in countries such as India, increased prevalence of social conditions that are recognized as risk factors - such as living alone or living with a chronic disabling condition - and the inability of health systems to address the physical and mental health needs of the elderly due to a lack of mental health resources.

Because of a lack of mental health specialists, there is a large need to focus on prevention interventions that can be delivered by non-specialists and lay health workers in non-health care or primary-care settings. In other words, mental health care services can be provided by caregivers other than mental health experts such as psychiatrists and psychologists.

By equipping lay and non-specialist workers with the skills needed to help individuals in countries with few mental health resources, we can work towards a long-term goal of scalable depression prevention in LMICs. These skills include the use of learning-based psychotherapies, such as problem-solving therapy for primary care and brief behavioral treatment for insomnia, which in the West have shown to reduce depressive and anxiety disorders by 25 percent over one to two years compared to usual care. Such therapies can help individuals cope with stressful relationships and situations that may trigger depressive episodes, and teach more constructive thought patterns to replace thinking habits that magnify feelings of worthlessness and hopelessness.

A recent study conducted in Goa, India, demonstrated that the use of lay health counselors increased recovery rates from common mental disorders - anxiety and depression - in a sample of patients of all ages.

Now, a new study funded by the National Institute of Mental Healthis working to investigate the use of non-specialists in an effort to prevent late-life depression and anxiety in LMICs, specifically in Goa, India.

Researchers  will develop best practices for depression and anxiety depression, and teach learning-based psychotherapies as well. Other tactics will include education about symptoms of depression and anxiety, instruction in breathing exercises and relaxation to manage symptoms of anxiety, and scheduling of activities to manage symptoms of depression.

Charles F. Reynolds III, M.D., is the UPMC Endowed Professor in Geriatric Psychiatry and Director of the Aging Institute of UPMC and the University of Pittsburgh.