Gaps in accessing treatment for anxiety and depression: challenges for the delivery of care

Clin Psychol Rev. 2004 Sep;24(5):583-616. doi: 10.1016/j.cpr.2004.06.001.


Epidemiological studies have identified high prevalence rates of anxiety and depression in North America [e.g., J. of Nerv. Ment. Dis. 182 (1994) 290]. However, only a small percentage of these individuals access effective treatment. The undertreatment of anxiety and depression is a major public health issue and is associated with significant personal, social, and economic burden. This article describes the existing discrepancy between prevalence of anxiety and depression and access to effective treatment for adults and children, the contributors to this discrepancy, and suggests various means through which access to effective treatment may be enhanced. We begin with a brief overview of the prevalence and associated personal, societal, and systemic burdens of anxiety and depression. This is followed by a review of current rates of access to treatment and possible individual, provider, and systemic barriers to accessing treatment. Recommendations for bridging the gap between the high rates of these disorders and limited accessibility of effective care are then presented.

Publication types

  • Review

MeSH terms

  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / therapy*
  • Cost of Illness
  • Cross-Sectional Studies
  • Delivery of Health Care / statistics & numerical data*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / therapy*
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Needs and Demand / statistics & numerical data
  • Humans
  • Patient Acceptance of Health Care / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Treatment Outcome
  • United States