Depression intervention in resource-poor regions

Depression is recognised as a common problem in developing countries and it is one of the most important causes of morbidity and mortality (Patel et al, 2001). Lack of trained personnel and the scarcity of newer antidepressants in the public sector makes the use of evidence-based treatment methods impractical in developing countries. However, as Dr Crawford (2004) points out, this does not mean that the likelihood of recovery from depression is worse than in resource-rich regions.

Even though there is limited access to specialised mental health services and newer antidepressant medication, many developing countries have evolved innovative techniques to overcome these apparent hurdles (Swartz & Rollman, 2003). The majority of patients are treated effectively using older and cheaper antidepressants. Electroconvulsive therapy is used widely in a more liberal manner than in the West; one reason being the need for a quick cure to decrease the patient load, which is far greater than the number of beds available. Cognitive–behavioural therapy is an affordable form of psychotherapy that is used. Even in the absence of formal psychological interventions, the closely knit extended families and networks of friends provide supportive therapy in an informal manner.

In addition, the available primary health care facilities are used in an effective manner to combat the difficulties created by inadequate resources. One such example is the Chinese model of village health workers functioning at a local level to identify patients in need and referring to medical personnel in local clinics (Swartz & Rollman, 2003).

In Iran the concept of health houses has been reported, where local inhabitants are screened for mental and physical illnesses by health workers, and patients presenting with more complex problems are referred on for more intensive care (Swartz & Rollman, 2003).

These models employed in some developing countries in response to the scarcity of resources should be commended. Instead of letting what we do not have incapacitate us, it is time we made use of our existing resources to provide better care for people with mental illnesses.