The burden of major depression avoidable by longer-term treatment strategies.
BACKGROUND
Major depression is the largest single cause of nonfatal disease burden in Australia. Effective drug and psychological treatments exist, yet are underused.


OBJECTIVE
To quantify the burden of disease currently averted in people seeking care for major depression and the amount of disease burden that could be averted in these people under optimal episodic and maintenance treatment strategies.


METHODS
Modeling impact of current and optimal treatment strategies based on secondary analysis of mental health survey data, studies of the natural history of major depression, and meta-analyses of effectiveness data. Monte Carlo simulation of uncertainty in the model.


METHODS
The cohort of Australian adults experiencing an episode of major depression in 2000 are modeled through "what if" scenarios of no treatment, current treatment, and optimal treatment strategies with cognitive behavioral therapy or antidepressant drug treatment.


METHODS
Disability-Adjusted Life Year.


RESULTS
Current episodic treatment averts 9% (95% uncertainty interval, 6%-12%) of the disease burden of major depression in Australian adults. Optimal episodic treatment with cognitive behavioral therapy could avert 28% (95% uncertainty interval, 19%-39%) of this disease burden, and with drugs 24% (95% uncertainty interval, 19%-30%) could be averted. During the 5 years after an episode of major depression, current episodic treatment patterns would avert 13% (95% uncertainty interval, 10%-17%) of Disability-Adjusted Life Years, whereas maintenance drug treatment could avert 50% (95% uncertainty interval, 40%-60%) and maintenance cognitive behavioral therapy could avert 52% (95% uncertainty interval, 42%-64%), even if adherence of around 60% is taken into account.


CONCLUSIONS
Longer-term maintenance drug or psychological treatment strategies are required to make significant inroads into the large disease burden associated with major depression in the Australian population.
Vos
Theo
T
Department of Human Services, Melbourne, Australia; School of Population Health, University of Queensland, Herston, Australia. t.vos@sph.uq.edu.au
Haby
Michelle M
MM
Barendregt
Jan J
JJ
Kruijshaar
Michelle
M
Corry
Justine
J
Andrews
Gavin
G
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D015928:Cognitive Behavioral Therapy; D017281:Cost of Illness; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D004185:Disability Evaluation; D017050:Episode of Care; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008134:Long-Term Care / Q000379:methods; D008297:Male; D015201:Meta-Analysis as Topic; D008962:Models, Theoretical; D009010:Monte Carlo Method; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012306:Risk; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013997:Time Factors
D000928:Antidepressive Agents