Depression and physical noncommunicable diseases: the need for an integrated approach

ABSTRACT

Depression is globally the third-leading cause of disability in terms of disability-adjusted life-years. Depressionin patients with diseases such as cancer, diabetes mellitus, stroke or cardiovascular disease is 2–4-foldmore prevalent than in people who do not have physical noncommunicable diseases, and may have amore prolonged course. The significant burden due to depression that is comorbid with chronic physicaldisease, coupled with limited resources, makes it a major public health challenge for low- and middle-incomecountries. Given the bidirectional relation between depression and chronic physical disease, the clear wayforward in managing this population of patients is via a system in which mental health care is integratedwith primary care. Central to this integrated approach is the Collaborative Care Model, adapted to the localsociocultural context. In this model, care is jointly led by the primary care physician, supported by a casemanager and a mental health professional. Various successful initiatives in low- and middle-income countriesmay be used as templates for collaborative care in other low-resource settings. The model involves a rangeof interwoven components, such as capacity-building, task-sharing, task-shifting, developing good referraland linkage systems, anti-stigma initiatives and lifestyle modifications. Policies based on adoption of thisapproach would not only directly address depression that is comorbid with physical noncommunicabledisease but also facilitate achievement of Sustainable Development Goal 3, to “ensure healthy lives andpromote well-being for all at all ages”.