Gaps in accessing treatment for anxiety and depression: Challenges for the delivery of care

Abstract

Epidemiological studies have identified high prevalence rates of anxiety and depression in North America [e.g., J. of Nerv. Ment. Dis. 182 (1994) 290]. However, only a small percentage of these individuals access effective treatment. The undertreatment of anxiety and depression is a major public health issue and is associated with significant personal, social, and economic burden. This article describes the existing discrepancy between prevalence of anxiety and depression and access to effective treatment for adults and children, the contributors to this discrepancy, and suggests various means through which access to effective treatment may be enhanced. We begin with a brief overview of the prevalence and associated personal, societal, and systemic burdens of anxiety and depression. This is followed by a review of current rates of access to treatment and possible individual, provider, and systemic barriers to accessing treatment. Recommendations for bridging the gap between the high rates of these disorders and limited accessibility of effective care are then presented.

Introduction

Epidemiological studies have identified that anxiety and depression are highly prevalent in North American society (e.g., Blazer et al., 1994, Kessler et al., 1994, Regier et al., 1993) and associated with a significant burden personally, socially, and economically Greenberg et al., 1999, Katzelnick & Greist, 2001. In fact, it is expected that depression will become the second leading cause of disability worldwide over the next decade (Murray & Lopez, 1996) and rank second as the most costly of all illnesses by 2010 (World Health Organization, 1990). Anxiety disorders are the most prevalent of all mental health problems and are estimated to affect 25% of the population over a lifetime Blazer et al., 1994, Kessler et al., 1994. Despite the scope and severity of these problems, the vast majority of adults and children with anxiety and/or depression do not access effective treatment. Dissemination of and access to effective treatments for adults and children with these disorders is imperative, within the present health care system, for improving the quality of life for individual sufferers, as well as reducing the societal costs and economic burden incurred by these disorders.

The purpose of the article is to review rates of access to effective treatment among those individuals with anxiety and depression and to highlight the many barriers regarding accessibility of treatment. Our evaluation is limited to studies of depression and anxiety disorders in light of the high prevalence of these disorders in our society. However, it is important to note that many of the issues identified likely apply to the treatment of other mental health disorders. From this review, we suggest multiple directions that can be pursued to bridge the gap between disorder and effective treatment. To contextualize these issues, prevalence of anxiety and depression in adults and children is detailed briefly to draw attention to the severity and breadth of this public health issue.