Summary

Unmet need is examined from the perspectives of various stakeholders, including clinicians in primary and specialist care, depressed people and their families, fundholders and health planners, and society in general. The various perspectives lead to a number of needs which may conflict with one another, but not necessarily so. Areas of unmet need include: increasing the importance of depression in preventive programs; increasing education about the relapsing nature of depression, identifying underlying vulnerability to relapse and the importance of conveying such information in user-friendly formats; translating this information into practical programs that improve prevention, detection, and management; and identifying areas where there are unanswered questions requiring further research. Strategies aimed at increasing the quality of life and reducing risk factors for depression also improve health in general, are relatively cheap and are acceptable to the general public. Thus, they simultaneously address a number of crucial economic and social concerns.

Varying perspectives on need

Major depression is a common illness with a significant morbidity (Goering, Lin, Campbell, Boyle & Offord, 1996; Kessler, McGonagle, Schwartz, Blazer & Nelson, 1993; Regier et al., 1988). A depressive episode is associated with increased morbidity and mortality from a range of medical and other psychiatric disorders (Fawcett, 1993; Livingston Bruce, Leaf, Rozal, Florio & Hoff, 1994), and an increased functional and economic burden for depressed individuals, the health budget and society (Bushnell & Bowie, 1995; Murphy et al., 1991; Simon, Von Korff & Barlow, 1995). The significance of depression also recently received considerable public attention following the World Bank report (Murray & Lopez, 1996) that the toll, measured by disability-adjusted life years (DALYs), is currently fourth behind respiratory diseases, diarrheal diseases, and perinatal conditions.