The world’s poor, whether they live in dangerous urban slums or in the remote countryside, are often in dire need of food, clean water, and basic medications. So it might appear misguided to argue that mental health should be a primary rather than secondary concern in developing countries. But the reality is that mental health is not just a First World problem: disorders such as depression are pervasive in developing countries. Depression of course exacts a heavy psychological toll, but it also has economic costs because it impairs individuals’ ability to function in everyday life. Accordingly, treating depression in developing countries has been shown to boost economic productivity, particularly among the most disadvantaged. A study in Uganda, for example, found that interpersonal group therapy for women with depression improved their ability to undertake economic activities, while treatment in India increased the number of productive workdays for patients.
Depression, which the World Health Organization calls “the leading cause of disability worldwide,” affects 350 million, but it strikes the poor the hardest. A meta-analysis of 56 epidemiologic studies by researchers at the Catholic University of Louvain in Belgium found that those who fell in the lowest socioeconomic group within any given population were several times more likely to suffer from major depression than those in the highest group. In developing countries, depression and mental illness are exacerbated by conflict, extreme poverty, and other calamities. For example, in Uganda, a country disproportionately affected by civil unrest and the HIV epidemic, rates of depression hover between 21 percent and 25 percent. Globally, depression affects 10 percent of the population.
Sadly, the vast majority of the mentally ill do not receive any care—over 80 percent are left untreated in developing countries. There are two problems when it comes to treatment. First, mental illness manifests itself differently across cultures, which means that addressing it will require a different methodology 10.5 psychiatrists per 100,000 people; the average among low-income countries is 0.06. Rwanda, for example, has only six psychiatrists throughout the entire country (for a population of almost 12 million), and Ghana has only 12 nationwide (for a population of almost 26 million). Even fewer psychiatrists work in the public sector or in rural areas.
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