Depression and Anxiety Disorder Management in Indonesia:

Challenges and Opportunities

Hervita Diatri
Departmen of Psychiatry FMUI/RSCM
People with Common Mental Disorder
People with Common Mental Disorder
 Risk Factors
Variable High Prevalence
Genetic Family history – chronic physical and/or mental health problems
Sex Female – related to reproduction, role empowerment, high work burden
Marital Status Unmarried, divorce, widowed  difficulties in relationship
initiating/maintaining
Occupational Unemployed, housewife/husband. Among the workers: hazardous work,
greater job insecurity, high work pace, long and irregular work hours, low
income, low decision latitude, and high effort-reward imbalance
Education Low level of education
Financial Situation Low income, poverty
Behavior Impulsive and disinhibition
Life Event Violence, parent loss, parent rejection vs overprotection, migration, lack of
social capital
Spiritual and Religion Lack of spiritual belief
Depression Disorder
People with Depression Disorder
People with Depression Disorder

12 months prevalence
3 – 6%
People with Depression Disorder
Anxiety Disorder
People with Anxiety Disorder
People with Anxiety Disorder

12 months prevalence
5,6 – 19,3%
12 Months Prevalence Anxiety Disorder
5,6 – 19,3%

1,8 – 11,1%

1,2 – 7,9%

0,7 – 8,4%

0,5 – 3,1%

0,5 – 1,0%

0,4 – 3,1%

0,2 – 3,1%

Michael T, Zetsche U, Margraf J. Epidemiology

of Anxiety Disorders. Psychiatry 6;4, 2007
 People with Anxiety Disorder

Comorbidty
Specific, social 74 - 86%
GAD, panic disorder,
phobia, OCD
agoraphobia
GAD
 Anxiety Disorder Comorbidity Rate
ANXIETY DISORDER 74,1

PTSD 81

SOCIAL PHOBIA 81

SPECIFIC PHOBIA 83,4

AGORAFOBIA 87,3

GAD 91,3

PANIC DISORDER 92,2

Michael T, Zetsche U, Margraf J. Epidemiology 0 10 20 30 40 50 60 70 80 90 100

of Anxiety Disorders. Psychiatry 6;4, 2007
 Anxiety Disorder Comorbidity Rate

Other mental disorder comorbidities:

Michael T, Zetsche U, Margraf J. Epidemiology
of Anxiety Disorders. Psychiatry 6;4, 2007
a. Affective disorder – 76 – 83% - anxiety as primary diagnosis >84%.
Depression – 6,4 – 17,1%
b. Substance abused (6,2 – 13,8%) and alcohol abused (11,9 – 23,5%)
c. Antisosial personality – 2,6 – 3,5%
d. Schizophrenia - 0,7 – 1,5%
Suicide
Suicide Rate
Suicide Rate
 Suicide and Other Risks
• Approximately 39% people with depression disorder in South East Asia
Region – suicide risks - WHO SEA 2017 report

• Indonesian (WHO SEA 2017 report) – suicide cases (13 – 87 y.o) – 51,7%
have depression disorder – the highest among South East Asia Countries

• More than 70% - physical comorbidity

Common Mental Disorder and Disabilities
Depression Disorder and Disabilities
Anxiety Disorder and Disabilities
 Anxiety and Depression Management in
Indonesia: Challenges and Opportunities
 Anxiety and Depression Disorder

High Volume High Risks High Cost

Bad Performance – Less Literacy

Community literacy

Self assessment – SRQ 20

Self help group and

consumer organisation
 Anxiety and Depression Disorder

High Volume High Risks High Cost

Bad Performance – Low Coverage

Most people who commit suicide have

seen their GP in the recent past Screening Questions

Medically unexplained symptoms are

involved in 15 – 30% of all primary Health and Mental Health
care consultations Professional Training
NICE Guideline
 Screening Questions
• Depression Disorder:
a. Sadness, hopelessness
b. Lost of interest
 2 weeks
• Anxiety Disorder:
a. Excessive stress, worry, anxiety
– topics
b. Ability to control
c. Symptoms
d.Withdrawal and avoidance
e.Impact to works, relationships,
and activities
 2 weeks – 1 months

Assessment
 Anxiety and Depression Disorder

High Volume High Risks High Cost

Bad Performance – Low Coverage

Assessment Tools

Universal Coverage  (-) physical and mental

comorbidity, tentamen suicide, and substance abuse)
Treatment gaps >90%
Better Medication – National Formulary 2015

Service Provider: Primary – Secondary - Tertiary

Wrap Up Message
• Anxiety and depression disorder are too important to wait to
be our priority attention  high volume, high risks, high
costs, bad performance
• Regulation and resources have been provided  literacy,
distribution, and sustainability problems
• Ability to identify, to diagnose, and to manage  skills for
every health providers  to advocate and to provide
services  better productivity and quality of life
hervita94@yahoo.com
08567942962