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Neglected Diseases

Packages of Care for Depression in Low- and Middle-Income Countries

  • Vikram Patel,

    Affiliations: London School of Hygiene & Tropical Medicine, London, United Kingdom, Sangath, Alto-Porvorim, Goa, India

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  • Gregory Simon,

    Affiliation: Group Health Center for Health Studies, Seattle, Washington, United States of America

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  • Neerja Chowdhary mail,

    neerjachowdhary@hotmail.com

    Affiliation: Sangath, Alto-Porvorim, Goa, India

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  • Sylvia Kaaya,

    Affiliation: Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

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  • Ricardo Araya

    Affiliation: Academic Unit of Psychiatry, University of Bristol, United Kingdom

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  • Published: October 06, 2009
  • DOI: 10.1371/journal.pmed.1000159
  • Published in PLOS Medicine

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Solving Treatment Gaps in Mental Illness

Posted by Vensel on 24 Oct 2009 at 15:12 GMT

In their October PloS Medicine review, Vikram Patel et al. describe effective depression screening and treatment in low- and middle-income countries based on adaptation of evidence-based methods from high-income countries [1]. These interventions begin to address the enormous global burden of untreated mental illnesses and the substantial barriers to care [2]. Many barriers are not financial, but rather related to stigma, false beliefs, and lack of awareness about depression.

Our organization, Tiyatien Health (TH), is a community-based social justice NGO based in Zwedru, Liberia that provides healthcare to the rural poor. In heavily forested southeastern Liberia, access to care is limited and the treatment gap for mental health approaches 100%. Partnering with the Liberian government and a team of local health workers, we are currently implementing the country’s first chronic disease program. In 2008, a random nationwide survey of Liberian adults found that 40% met criteria for major depressive disorder [3]. The best available estimates suggest epilepsy affects approximately 5% of the population [4]. Responding to this substantial local need, our program focuses initially on mental health and epilepsy. We deploy simplified, evidence-based protocols in a task-shifted, decentralized, community-based model of care. These efforts are in keeping with those described by Patel.

It is critical to rigorously assess the effectiveness of the algorithms used by community health workers and share the results widely. We will publish our validated protocols and methods on an open source forum, and call on others addressing mental health in low-income settings to do the same. We applaud ongoing collaborations across like-minded organizations to coordinate evaluative efforts and build the evidence base for treatment of depression and other mental health problems in resource-poor areas. The time has come to tackle mental health in impoverished and post-conflict settings.

Vensel L, Weil A, Schaaf M, Kraemer J, Raja A, Lee PT.



1. Patel V, Simon G, Chowdhary N, Kaaya S, Araya R (2009) Packages of care for depression in low- and middle-income countries. PLoS Med 6: e1000159.
2. The Global Burden Of Disease, World Health Organization 2004 Update. (2008) WHO Library Cataloguing-in-Publication Data.
3. Johnson K, Asher J, Rosborough S, Raja A, Panjabi R, et al. (2008) Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia. JAMA 300: 676-690.
4. Scott RA, Lhatoo SD, Sander JW (2001) The treatment of epilepsy in developing countries: where do we go from here? Bull World Health Organ 79: 344-351.


No competing interests declared.