In July 2021, following months of field research and stemming from a similar report we conducted for the wider Asia-Pacific region (link here), KPMG, in collaboration with Johnson & Johnson, are proud to release our call-to-action for Southeast Asia policy leaders on the topic of Major Depressive Disorder (MDD). MDD is one of the leading causes of disability in the region, yet receives a disproportionately small share of resource attention. Rather than addressing MDD as a monolithic challenge, we suggest to Southeast Asia policy leaders to seek to better understand the “spectrum” of sub-type conditions that drive the rapidly rising rate of people suffering a form of MDD. Such a topic is even more relevant during the pandemic, during which we’ve observed calls to help hotline grow exponentially.
We provide key excerpts of the research on this webpage, with the full document and set of analyses available for download too. We hope the report fosters proactive public-private dialogue about MDD in Southeast Asia, and we remain available for any questions or queries on the same. Let us re-imagine a future of our people freed from MDD, leaving no one behind.
About the report and its call-to-action
The impetus for the research stems from the rising prevalence and cost of MDD in Southeast Asia. Despite heightened awareness of the mental health topic, broadly-speaking, and an increase in depression-related policies, our populations continue to suffer due in large part because MDD is viewed as a homogenous disorder. Rather, MDD is a collection of symptoms, which vary at an individual level. Recognition of this reality, and appropriate response therein, would be a great start.
In particular for Southeast Asia policy leaders, we draw attention to two MDD sub-types of pressing need to be better understood and addressed with a more nuanced effort:
- Treatment Resistant Depression (TRD), defined as a failure of two drug treatments of adequate doses, for 4-8 weeks in duration with adequate adherence, during a major depressive episode; and
- MDD with Suicidal Ideation (MDSI), defined as a more serious manifestation that involves active plans to kill oneself or passive thoughts about wanting to die.
The MDD policy barriers for Southeast Asia, including for TRD and MDSI, outlined in the report pertain to the lack of basic infrastructure (such as trained psychiatrists), delays in appropriate interventions being taken (for example due to lingering stigmas), and the impact to a generation of youths due to high suicide rates that cause tremendous social and economic harm to the countries in the region.
A window of opportunity – policy recommendations to take forward
The good news for policy leaders in Southeast Asia is that we have something to teach, and something to learn from the existing good practices occurring in the region and globally. It’s a matter of doubling down and being more targeted in the effort. The report summarizes the solution concepts at macro and micro levels, leveraging inputs from government, practitioner, and patient stakeholders.
The policy recommendations are primarily along the following three themes:
- Evidence-based guidelines for the MDD spectrum, especially regarding the modernization of Mental Health Acts to include TRD and MDSI, as well as to incorporate the latest therapeutic interventions in the essential medicines’ lists.
- New models of care to overcome inherent inequities in the Southeast Asia health systems, such as by adopting a tiered approach to community-based triage with strong referral networks for the more severe cases, and by deploying digital tools backed by sufficient workforce support.
- Holistic campaign and coverage investment, utilizing influencers to drive the messaging and taking note from countries like Australia in terms of budget allocation and psychiatric capacity allocated to the MDD cause.
The report concludes by proposing two possible futures – one staying the existing course and failing to achieve our population socioeconomic development ambitions due to the lingering burden of MDD; versus another incorporating the policy recommendations and creative solution concepts, upon which populations become freed from MDD. Certainly, we must aim for the latter, which necessitates a greater understanding and bias for action toward addressing MDD as a spectrum.
Country-specific snapshots and bespoke policy recommendations can also be found in the report.