Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.
Researchers say that even in places with very poor people, the ailments require urgent attention. Severe depression can be as disabling as physical diseases like malaria, the researchers say, and can have serious economic effects. If a subsistence farmer is so depressed that he cannot get out of bed, neither he nor his children are likely to eat.
In India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated. With a population of more than one billion, India has fewer than 4,000 psychiatrists, one-tenth the United States total. Because most psychiatrists are clustered in a few urban areas, the problem is much worse elsewhere.
As a result, most Indians with mental illness go untreated, especially in poor and rural areas. “There is a huge treatment gap for people with depression,” said Dr. Vikram Patel of the London School of Hygiene and Tropical Medicine, the psychiatrist who began the Siolim project. “In most places in the developing world, 80 percent to 90 percent of people with severe depression don’t receive adequate treatment.”
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After completing training, he spent two years in Zimbabwe as a researcher. He hoped to prove that Western concepts of mental illness did not apply in the developing world. Instead, he came to the opposite conclusion, that the ailments were in fact just as common and just as treatable as in the West.
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ven clinicians who look for depression may miss it. For reasons that no one fully understands, depressed patients in the developing world often complain of physical symptoms like fatigue, headache and insomnia rather than emotional problems like sadness or regret.
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