Non-communicable diseases (NCDs) increase the risk of depression by two to three times, and there is a bidirectional relationship between depression and NCDs. This can result in adverse health outcomes, increased healthcare costs, loss of earnings, and diminished quality of life. The prevalence of both depression and NCDs is rapidly increasing in low-and middle-income countries (LMICs).
The good news is that depression can be treated with relatively simple, low-cost, and culturally adaptable psychological and/or pharmacological therapies. A recent systematic review and meta-analysis conducted by Zavala and colleagues sought to evaluate the effects of psychological interventions on depression among people with NCDs including cardiovascular disease, type 2 diabetes, chronic obstructive pulmonary disorder, stroke, and cancer in South Asian countries like Bangladesh and Pakistan.
The study identified a total of 2,823 records, resulting in 5 studies for effectiveness and 14 studies analyzing barriers and facilitators, as well as 35 policy documents from Bangladesh and Pakistan. The meta-analysis showed a significant improvement in depression and anxiety symptoms with psychological therapy, though this evidence was of low quality and high heterogeneity. Barriers to intervention included language barriers, lack of patient familiarity with therapies, pessimism, stigma, and lack of staff familiarity with psychological therapies, while facilitators included community and family engagement, training for practitioners, and provision of therapies in clinical settings.
The review calls for a clear plan for implementation of healthcare for people with depression and NCDs in Bangladesh and Pakistan. More high-quality, adequately powered trials are recommended, as well as efforts to integrate depression care into the NCD care pathway and policy initiatives to support healthcare professionals in recognizing and managing depression. On the whole, the review highlights the importance of considering contextual barriers and facilitators in the development and implementation of interventions.
