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16 February 2022

Overlooked and underfunded - a new Lancet Commission calls for united action to reduce the global burden of depression

A new Lancet–World Psychiatric Association Commission, with contributions from King’s IoPPN’s Professor Louise Howard, has called for worldwide efforts to tackle the persisting and increasingly serious crisis of depression


The Commisssion, ‘Time for united action on depression’ calls for concerted and collaborative efforts by governments, healthcare providers, researchers, people living with depression, and their families to improve care and prevention, fill knowledge gaps, and increase awareness to tackle one of the leading causes of avoidable suffering and premature death worldwide. It is authored by 25 experts from 11 countries spanning disciplines from neuroscience to global health and advised by people with experience of depression.

Depression is a common condition worldwide, yet despite this, many myths continue to surround it, perpetuating inaction. These include common misconceptions that depression is simply sadness, a sign of weakness, or restricted to certain cultural groups. The authors stress that depression is a distinct health condition characterised by its persistence, substantial effect on daily functioning, and long-term health consequences. It can affect anyone, regardless of gender, background, social class, or age, there is variability in types and prevalence of depressive symptoms and signs among cultures and populations. The risk of depression rises in settings of adversity including poverty, violence, displacement and gender, racial and other forms of discrimination.

The authors stress that the current system of classifying people with symptoms of depression in to just two categories—either they have clinical depression or not—is too simplistic. They argue that depression is a complex condition with a diversity of signs and symptoms, severity levels, and duration across cultures and the life course. The Commission supports a personalised, staged approach to depression care that recognises the chronology and intensity of symptoms and recommends interventions tailored to the specific needs of the individual and severity of the condition, ranging from self-help and lifestyle changes to psychological therapies and antidepressants to more intensive and specialised treatments such as electroconvulsive therapy (ECT) for severe, refractory forms of the illness.

At the same time, the Commission proposes that collaborative care strategies are adopted to scale up evidence-based interventions in routine care. They argue that using locally recruited, widely available and low-cost non-specialists such as community health workers and lay counsellors, not only addresses the acute shortage of skilled providers and financial barriers, but will also help reduce stigma and cultural barriers, while providing holistic care to patients and their families. While this is most important in low-income countries it is also relevant and useful universally as nowhere in the world is depression care adequate. Ultimately, greater investment is needed to ensure that people receive the care they need where and when they need it, and the Commission underscores the importance of whole-of-government actions to reduce the damaging effects of poverty, gender inequity, and other social inequities on mental health.

"I am very proud to have been part of this important Lancet Depression Commission. Depression disproportionately affects women, partly due to gendered disadvantages faced by women and girls, including intimate partner violence and sexual abuse, and this can lead to further gender inequalities in education, health, and income. The Commission includes highlighting the contribution of the social determinants of depression, and emphasises their relevance to government policy, public health interventions, clinical formulations and personalised treatment. The focus on depression across the life course including across the generations is also vital, and enables us to lay the groundwork to ensure that future generations are less at risk of developing what can be a life changing illness.”

Professor Louise Howard, Professor in Women’s Mental Health at King’s IoPPN

Commission Chair Professor Helen Herrman, of the National Centre for Excellence in Youth Mental Health and The University of Melbourne said, “Depression is a global health crisis that demands responses at multiple levels. This Commission offers an important opportunity for united action to transform approaches to mental health care and prevention globally. Investing in reducing the burden of depression will give millions of people the chance to become healthier, happier and more productive members of society, help to strengthen national economies, and advance the United Nation’s Sustainable Development Goals for 2030”


A full copy of Time for united action on depression: a Lancet–World Psychiatric Association Commission can be found here.

For more information, please contact Patrick O’Brien (Senior Media Officer).

In this story

Professor Emerita Louise Howard

Emeritus Professor, Women's Mental Health