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According to data published by the World Health Organization (WHO) and confirmed by various large-scale studies, depressive disorders are the second most common mental health disorders worldwide, after anxiety disorders. That’s why researchers around the world are engaged in an ongoing search for new and effective methods of depression treatment.

Here are general estimates on the worldwide prevalence of depression from a comprehensive meta-analysis that examined rates of depression from 72 peer-reviewed studies published over a twenty-year period between 2001 and 2020:

  • Percentage of world population with self-reported depression at any given point in time: 34%
  • Percentage of world population with clinically diagnosed major depressive disorder at any given point in time: 8%
  • Percentage of world population with clinically diagnosed major depressive disorder at any point during their lifetime: 19%
  • Percentage of world population with clinically diagnosed major depressive disorder during the past year: 19%

Those figures give us a good idea of the big picture. Depression is a mental health disorder that affects millions of people around the world. However, despite its widespread prevalence, the WHO reports that close to 75 percent of people with depression don’t get the professional support, care, and treatment they need.

That’s a situation that causes concern among researchers and mental health professionals around the world, because treatment for depressive disorders is available. Evidence shows that with appropriate support and care, people with depression can learn to manage their symptoms and lead a full and fulfilling life.

Depression Treatment: Barriers to Care

The things that keep people diagnosed with depression from accessing depression treatment are known as barriers to care. Barriers to care can be structural, personal, or environmental. This list contains most, but not all, of the most commonly recognized barriers to depression treatment.

Depression Treatment: Common Barriers to Care

  • Cost
  • Inadequate insurance coverage
  • Lack of awareness of treatment options
  • Lack of available treatment
  • Structural and practical barriers, such:
    • Transportation
    • Time off work
    • Childcare

This article will examine a paper published in March 2022 called “Clinical Effectiveness and Cost-Effectiveness of Supported Mindfulness-Based Cognitive Therapy Self-help Compared With Supported Cognitive Behavioral Therapy Self-help for Adults Experiencing Depression.” The paper examines two approaches to depression treatment that may reduce several of those barriers to care at once. The study examines practitioner supported mindfulness-based cognitive behavioral therapy self-help, and practitioner supported cognitive behavioral therapy self-help to determine two things: clinical effectiveness and cost-effectiveness.

Before we discuss the study in detail, we’ll review the current prevalence of mental health disorders, depression, and depressive disorders in the U.S. and discuss the most common treatment options available for people with depression. Once we understand the prevalence of depression and the most common modes of depression treatment, we’ll discuss this new paper and what it means for people who need depression treatment, but may experience barriers in accessing evidence-based treatment and care.

Mental Illness in the United States: Facts and Figures

We’ll start this section with general data on the prevalence of mental illness in the U.S., as reported by the 2021 National Survey on Drug Use and Health (2021 NSDUH). The NSDUH is a valuable tool that allows treatment professionals, policymakers, and researchers to understand the current prevalence of various health metrics on a nationwide scale. The NSDUH collects prevalence data annually from over 70,000 participants on mental health disorders, substance use disorders, treatment for mental health and substance use disorders, and various other health and mental health-related metrics.

The first set of data we’ll share is on the overall prevalence of mental illness in the U.S. This data will help give us a clear context of the depression data to follow. Here’s the latest general prevalence data on mental illness from the 2021 NSDUH. We’ll start with the percentage and number of people in the U.S. who reported a diagnosis of any mental illness.

Any Mental Illness (AMI): 2021 NSDUH

  • Adults 18+: 22.8% (57.8 million)
  • 18-25: 33.7% (11.3 million)
  • 26-49: 28.1% (28.8 million)
  • 50+: 15.0% (17.7 million)
  • 65+: 11.9% (698,000)

Those figures may surprise some people: they indicate the over 1 in 5 people in the U.S. had a mental health disorder in 2021. Since numbers and percentages can feel abstract, we’ll put this in perspective: in a room of ten people, that means at least two are likely to have a mental health disorder. In a room of 100 people, that means at least 20 are likely to have a mental health disorder. Another way to put this: on a typical trip to the grocery store – depending on the size – we may walk by/come close to between 50 and 100 people. If we pass 50 people, statistics tell us at least 10 are likely to have a mental health disorder. If we pass 100 people, then at least 20 are likely to have a mental health disorder.

That’s a reality check: mental health challenges are far more common than most of us think.

Next, we’ll look at the prevalence of people who reported a diagnosis of a serious mental illness.

Serious Mental Illness (SMI): 2021 NSDUH

  • Adults 18+: 5.5% (14.1million)
  • 18-25: 11.4% (3.8 million)
  • 26-49: 7.1% (7.3 million)
  • 50+: 2.5% (3.0 million)

Those figures are also informative. They tell us that the prevalence of serious mental illness is lower than the presence of any mental illness. However, the numbers are significant: millions of people in the U.S. have serious mental illness.

Now let’s narrow our focus to the topic of this article, and look at the latest data on rates of depression.

Depression in the United States: Facts and Figures

These are the most recent reliable statistics on the prevalence of depression in the U.S.

Depression Among Adults: 2021 NSDUH

Major Depressive Episode (MDE):

  • Adults 18+: 8.3% (21.0 million)
  • 18-25: 18.6% (6.2 million)
  • 26-49: 9.3% (9.5 million)
  • 50+: 4.5% (5.3 million)
  • 65+: 2.8% (1.5 million)

MDE With Severe Impairment:

  • Adults 18+: 5.7% (14.5 million)
  • 18-25: 13.3% (4.4 million)
  • 26-49: 6.5% (6.6 million)
  • 50+: 2.9% (3.4 million)
  • 65+: 1.3% (739,000)

Now let’s look at the rates of depression treatment among people diagnosed with depressive disorders.

Prevalence of Depression Treatment Among Adults With MDE

Adults 18+ with MDE:

  • 0% (12.6 million) received treatment for depression
  • 18-25: 51.1% (3.1 million) received treatment
  • 26-49: 63.5% (5.9 million) received treatment
  • 50+: 68.2% (3.5 million) received treatment

Adults 18+ with MDE with severe impairment:

  • 8% (9.1 million) received treatment for depression
  • 18-25: 56.7% (2.4 million) received treatment
  • 26-49: 66.6% (4.3 million) received treatment
  • 50+: 71.8% (2.3 million) received treatment

That’s all the statistics we’ll share for now. These numbers set the stage for understanding why the study we’re discussing in this article is important. While the rates of treatment for people with depression look high – across all age groups, over half of people receive treatment – the fact that we think those rates of treatment are acceptable reveal something: half, two thirds, and even three-quarters of people mean that half, one third, or one quarter of people are not receiving the treatment they need.

This paper compares two similar treatment approaches that reduce barriers to care in order to determine which is both cost-effective and clinically effective.

Mindfulness Based Cognitive Therapy Self-Help, or Cognitive Behavioral Therapy Self-Help?

Evidence shows the most effective approach to depression treatment is a combination of psychotherapy, lifestyle changes, medication (if necessary), community support, and complementary therapies. Common modes of therapy include:

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Acceptance and commitment therapy (ACT)

The study we introduce above discusses two novel variations of CBT, both of which are classified as practitioner-supported self-help versions of CBT:

  • Cognitive behavioral therapy self-help (CBT-SH)
  • Mindfulness based cognitive behavioral therapy self-help (MBCBT-SH)

These variations on standard, office-based outpatient CBT are designed for people with mild to moderate depression who, for various reasons, cannot participate in regular, in-person sessions with the consistency required for treatment progress. To meet the needs of this specific population, therapists working for the National Health Service in the United Kingdom (U.K.)developed a unique protocol. Here’s how it works:

  • Patients receive a self-help workbook based on CBT techniques
    • Workbooks contain 16 weeks of material
  • Over the six week period, patients meet with a therapist six (6) times
  • The therapist helps them work through the material and consolidate treatment gains

This is a solid idea with real potential. However, when implemented in the U.K., only half the participants completed treatment, and among those who complete treatment, close to half relapse. In other words, the treatment protocol they use does not keep patients engaged in treatment, and is not as effective as most CBT protocols are.

CBT + Mindfulness = MBCBT: A New Protocol for Self-Help CBT

Because of the lack of retention and positive treatment outcomes, clinicians added a second component to the CBT protocol: mindfulness. While CBT focuses on assessing the accuracy or validity of difficult or troubling thoughts, MBCBT focuses on non-judgmental acceptance of difficult or troubling thoughts. The two techniques have a similar, if not identical, goal: they help patients identify exactly what’s going on with their thoughts, feelings, and emotions at any given moment, and teach techniques to process those thoughts and feelings in a healthy and productive manner.

The primary difference is that CBT seeks to correct troubling, irrational, or habitual patterns of thought and replace them with realistic, productive patterns of thought, whereas MBCT places emphasis on identifying and acknowledging thoughts without judging them, rather than automatically replacing them. The idea is that when a patient can accept their thoughts without judgment, their emotional reactivity to those thoughts – often identified as the symptoms of a mental health disorder such as depression – will decrease in intensity. Over time, the combination of mindfulness and CBT will help patients manage and process disruptive thoughts and feelings, and reduce their impact on their emotional and psychological wellbeing.

In this study, researchers recruited 410 participants with depression and separated them into two groups: an MBCBT-SH group and a CBT-SH group. During the course of the study, each participant completed either a 16-week MBCBT workbook or a 16-week CBT workbook and attended six (6) in-person therapy sessions. Researchers measured depressive symptoms at the beginning of treatment, at the end of the 16-week self-help treatment protocol, and at 42 weeks post-treatment. In addition, they assessed the relative cost of each program.

Here’s what they found. Note: researchers included a secondary measure – anxiety symptoms – for which we include results below.

CBT-SH vs. MBCBT-SH: Which Works Best?

Depressive Symptoms:

  • CBT-SH:
    • 16 weeks: 6.34-point reduction in symptom severity
    • 42 weeks: 7.49-point reduction in symptom severity
  • MBCBT-SH:
    • 16 weeks: 7.35-point reduction in symptom severity
    • 42 weeks: 8.01-point reduction in symptom severity
The MBCBT-SH group showed a significantly greater reduction in symptom severity compared to the CBT-SH group, as measured by the PHQ-9, a 27-point measure of depression severity.

Anxiety Symptoms:

  • CBT-SH:
    • 16 weeks: 4.14-point reduction in symptom severity
    • 42 weeks: 4.86-point reduction in symptom severity
  • MBCBT-SH:
    • 16 weeks: 4.4-point reduction in symptom severity
    • 42 weeks: 5.2-point reduction in symptom severity
The MBCBT-SH group showed a significantly greater reduction in symptom severity compared to the CBT-SH group, as measured by the GAD-7, a 21-point measure of anxiety severity.

Cumulative Cost at 42-week Follow-Up:

  • CBT-SH: $1,954 USD
  • MBCBT-SH: $1,174 USD
The CBT-SH protocol cost 66% more than the MNCBT-SH protocol, on average, per participant.

We’ll discuss these results below.

Mindfulness-Based CBT or CBT? How This Research Helps us Treat Patients With Depression

We spend significant time and energy working with patients who have treatment-resistant depression who require immersive or intensive approaches to treatment. It’s important work and the treatment we offer can be lifechanging. However, it’s equally important to understand how to support people with mild to moderate depression who may respond well to treatment.

In many cases, people with depression – whether mild, moderate, or severe – cannot make the commitment to engage in full time therapy and support. Barriers to care vary by person. For some, it’s scheduling. For others, it’s financial resources. And for others, it’s both.

What this study teaches us is that a self-directed CBT protocol that includes mindfulness – MBCBT-SH – can effectively reduce the symptoms of both anxiety and depression – and it’s more affordable than a standard CBT-SH protocol.

This is good news for many people who have mild to moderate depression, but avoid treatment – and tolerate uncomfortable symptoms – because of the barriers to care present in their lives. This new protocol can offer symptom relief that’s both cost- and time-effective. This can change the outlook and prognosis for millions of people with depression, who may avoid seeking treatment because they think they don’t have time and/or the resources: they can now engage in treatment that meets their individual needs, and reduces the barriers to care that may have previously prevented them from seeking treatment.