As the world undergoes varying degrees of disease transitions, non-communicable diseases (NCDs) lead in the global burden of diseases (GBD) and in disability. A high degree of co morbidity prevails among many of the NCDs including cardiovascular disorders, diabetes, depression, cancer, and others. Cardiovascular disorders and mental disorders lead among them. Mental disorders alone represent 14% of the GBD and 30-45% of the global burden of disability affecting hundreds of millions of people worldwide as well as the economies of low-, middle- and high-income countries.2
The global cost of mental disorders was estimated to be approximately US$2.5 trillion in 2010. It is projected to increase by 240% by 2030, to US$6.0 trillion. In 2010, 54% of that burden was attributable to low- and middle-income countries (LMICs). This LMIC burden is projected to increase to 58% by 2030. Due to insufficient investment and challenges in accessing treatment, mental disorders have serious economic consequences as well. The lost economic output to depression alone was estimated to have cost at least $800 billion in 2010, a sum expected to double to 2030. High-income countries are estimated to spend 2.4 % to 4% of GDP on mental disease burden. It is essential to generate evidence on costs attributable to mental health in LMICs, to fully understand its impact on GDP. 1-3
Total Health Screening
Most non-communicable diseases are first seen in primary care, depression included. Depression, one of leading conditions in the global burden of disease and of disability is frequently misdiagnosed, underdiagnosed and undertreated, especially in low- and middle-income countries. Depression often presents as a co-morbid condition with other non-communicable disease, especially cardiovascular disease and diabetes. Therefore, it is important to screen for mental health, including co-morbidities, in patients,at the first point of contact with the healthcare system, i.e. primary health care centers. This study of depression and co morbidity in primary care in China, India, Iran and Romania screens patients for depression at the primary care centers; using the PHQ-9 instrument, a reliable, internationally validated questionnaire, that takes 3-5 minutes to complete, and can be administered by non-clinical personnel.