Depression is of high public health concern because it is the
most common mental disorder and a primary cause of disease
burden, disability (1), long-term sickness, absence from work,
and premature retirement (2). Furthermore, it has been described
as the most costly brain disorder in Europe (3). In southern
European countries, prevalence rates of depression and suicide
are lower than elsewhere in Europe (4,5), and a recent study of
depression in Spain, one of the largest southern European
countries, found additional characteristics specific to this
country, such as an earlier age at onset and higher rates of
comorbidity and of chronicity (5). Health services are a crucial
resource in reducing the suffering of persons with depression;
however, studies have found large differences between countries
in rates of depression treatment, with low overall rates (6—8).
Although health care systems vary widely across the world,
certain system characteristics, such as access to services,
number of health professionals,