6.4% of the European population suffers from depression, according to a study published in The Lancet Public Health. The work was led by researchers from King’s College London, the Hospital del Mar Medical Research Institute (IMIM), the Parc de Recerca Sant Joan de Déu-Institut de Recerca Sant Joan de Déu, the Institute of Biomedicine at the University of León (IBIOMED), and the CIBER on Epidemiology and Public Health (CIBERESP). This figure is higher than that estimated by the World Health Organisation (WHO), which calculated the prevalence of this pathology in the European region at 4.2%. Depression is considered to be one of the leading causes of disability around the world, increasing the risk of premature death, decreasing quality of life and being a heavy burden on health systems. In fact, it is estimated that it may affect more than 300 million people worldwide.
The researchers analysed data from the second wave of the European Health Interview Survey, collected between 2013 and 2015. In total, they were able to utilise the responses from 258,888 people from 27 European countries, excluding Spain, Belgium and the Netherlands, for methodological reasons. Nevertheless, a previous study did make use of the Spanish data from the survey, which showed that depression had an overall prevalence of 6.1%, 8% among women and 4.1% among men (the study can be consulted at https://bit.ly/2RL5fsl).
Large differences between countries
Depression prevalence was calculated using an eight-item scale (PHQ-8) that assesses the presence and intensity of depressive symptoms, excluding thoughts of death or suicide, and which is used to diagnose this disorder. Of the total population surveyed, 6.4% presented a probable depressive disorder. In women, who represented 52.2% of the sample, the prevalence of this pathology was 7.7%, much higher than that registered for men, at 4.9%. This marked difference between the sexes is found in almost all countries, with the exception of Finland and Croatia.
One of the facts that has surprised researchers the most are the major differences between countries, with prevalence rates being up to four times higher in more economically developed nations. “The overall prevalence is high, with the average for all the countries included being over 6%. But it is surprising that countries with greater economic development and therefore, supposedly, better health and care resources, which should reduce prevalence rates, have a higher incidence than other countries that are less economically developed”, explains Dr. Jorge Arias-de Torre, from the Medical Psychology department at King’s College London and one of the main authors of the paper.
“This data establishes depression as a very frequent problem and, therefore, having this information helps us estimate possible care needs”, says Dr. Jordi Alonso, another author of the study, director of the Epidemiology and Public Health Programme at IMIM-Hospital del Mar and the scientific co-director of CIBERESP. “The results will allow us to monitor how the prevalence of depression evolves, and this is especially important for assessing the impact of the COVID-19 pandemic. We have data from many European countries gathered using the same instrument, which will allow us to monitor this closely.”
The countries with the highest prevalence are Iceland (10.3% of the population), Luxembourg (9.7%), Germany (9.2%) and Portugal (9.2%). Those with the lowest rates are the Czech Republic (2.6%), Slovakia (2.6%), Lithuania (3%), and Croatia (3.2%). By sex, the countries with the highest proportion of men suffering a depressive disorder are Germany and Ireland, and the lowest are the Czech Republic and Slovakia. For women, the countries with the highest rates are Germany and Luxembourg, while the lowest are Slovakia and the Czech Republic.
These results suggest that demographic, cultural and socio-political factors, such as access to health services, job insecurity or the rising cost of living, may be determining factors in the observed differences. In terms of population groups, those most affected by depression are older people, not born in the European Union, living in densely populated areas, with chronic illnesses and little physical activity, and with lower levels of education and income. The findings of the study also indicate that Western European countries have higher rates of depression compared to Eastern European countries.
“This study is one of the largest samples analysed in Europe to date and reflects variations in prevalence between countries that should be used to plan healthcare services and monitor the phenomenon over time”, explains Dr. Antoni Serrano, deputy director of Mental Health at the Parc Sanitari Sant Joan de Déu, researcher at the Institut de Recerca de Sant Joan de Déu and author of the study. “We should look at whether population-screening strategies could be advantageous in the detection and treatment of these individuals, to reduce the costs associated with the disease and the burden on the health and social care systems”, he says.