Major depressive disorder in Africa and the Middle East: a systematic literature review

Abstract

With major depressive disorder (MDD) associated with significant clinical, economic and health-related quality of life impact, we sought to systematically review and synthesize information relevant to the burden of MDD in Africa and the Middle East, from which published evidence is slim. Our literature search identified 54 publications assessing epidemiological (43), humanistic (5), clinical/treatment (7) or economic outcomes (2). General population MDD prevalence and that among chronic disease populations were similar in Africa and the Middle East. No MDD-related economic literature specific to Africa or the Middle East was identified. Five studies of humanistic outcomes were identified; four African studies documented significant reduction of health-related quality of life related to MDD. The frequency of certain risk factors for MDD, such as disease, trauma and associated stress, as well as patterns of MDD treatment, suggest the potential for a higher burden of disease in Africa and the Middle East than in western countries.

Keywords::

• Africa
• burden of illness
• economic impact
• health-related quality of life
• major depressive disorder
• review
• the Middle East

Financial & competing interests disclosure

KU Travers, TD Pokora and SM Cadarette are employees of Evidera, who were paid consultants to Pfizer in connection with the development of this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • The high frequency of certain risk factors for major depressive disorder (MDD), such as poverty and chronic disease, suggests the potential for a higher burden of disease in Africa and the Middle East compared with other areas of the world.

• • The current patterns of MDD treatment and resource use suggest the potential for a higher burden of disease in Africa and the Middle East compared with other areas of the world.

• • Age, gender, poverty and chronic disease are highly associated with MDD in these areas.

• • In contrast to age, gender, poverty and chronic disease, adverse life events appear to be less strongly associated with depression in this region. However, post-traumatic stress disorder (PTSD) and the loss of personal resources are certainly associated with MDD.

• • Treatment guidelines have not been established in this area of the world. Their establishment and concomitant professional training will be key to the objective of more effective treatment patterns. There are few data on the economic impact of MDD in these areas, but much indirect evidence based on MDD's impact on patient-centered outcomes such as health-related quality of life and function.