Determinants of access to health care for depression in 49 countries: A multilevel analysis

Araya, Ricardo; Zitko, Pedro; Markkula, Niina; Rai, Dheeraj; Jones, Kelvyn

doi:10.1016/j.jad.2018.02.092

Cited by 48 publications

(38 citation statements)

References 31 publications

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“…13,57 A study by Pomerantz et al, 13 based on administrative data of a health maintenance organization in the United States linked to a physicians' survey, showed that specialist practitioners (ie, psychiatrists) prescribed more prolonged courses of antidepressant treatment, with their patients being more prone to follow their recommendations. Although some studies reported a higher prevalence of diagnosed depression in urban vs rural living areas, 47,58 we did not find any association between the area and duration of antidepressant treatment. This finding may indicate that in our population, patients have equitable access to mental health resources, irrespective of residence, access that is assured by the diffused presence of family physicians and LHAs of the Italian healthcare system integrated with a specific collaboration program started in 1999.…”

Section: Determinants Of Long-term and Chronic Usecontrasting

confidence: 93%

<p>Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study</p>

Lunghi¹,

Antonazzo²,

Burato³

et al. 2020

NDT

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Purpose: Antidepressant consumption has risen in recent years, driven by longer treatment duration. The objective of this study was to measure the prevalence of antidepressant longterm and chronic use in the Bologna area, Italy, and to identify their main determinants. Materials and Methods: We conducted a retrospective claims-based cohort study by using the Bologna Local Health Authority data. A cohort of 18,307 incident users of antidepressant drugs in 2013 was selected, and subjects were followed for three years. A long-term utilization was defined as having at least one prescription claimed during each year of follow-up, while chronic utilization was defined as claiming at least 180 defined daily doses per year. Factors associated with chronic and long-term use were identified by univariate and multivariate logistic regressions. Results: In our cohort, 5448 (29.8%) and 1817 (9.9%) subjects were dispensed antidepressants for a long-term course and in a chronically way, respectively. Older age, antidepressant polytherapy, polypharmacy, and being prescribed the first antidepressant by a hospital physician were all factors independently associated with chronic and long-term prescriptions of antidepressant drugs. Results were reported separately for men and women. Conclusion: Antidepressant long-term and chronic prescriptions are common in the Bologna area. Because longer treatment should be clinically motivated, these results strongly prompt the need to evaluate the actual relevance, as they may indicate potentially inappropriate prescription patterns.

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Section: Determinants Of Long-term and Chronic Usecontrasting

confidence: 93%

<p>Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study</p>

Lunghi¹,

Antonazzo²,

Burato³

et al. 2020

NDT

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“…A striking imbalance exists between government spending on mental health and the related disease burden (2), and the treatment gap for mental disorders in Latin America is huge with ∼80% of those suffering from depression receiving no help at all (1). This is even more marked among socioeconomically disadvantaged groups (3, 4).…”

Section: Introductionmentioning

confidence: 97%

Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review

et al. 2019

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Background: There is a huge gap in the treatment of mental disorders in Latin America, especially among socioeconomically disadvantaged groups. Given the sharp increase in Internet access and the rapid penetration of smartphones in the region, the use of Internet-based technologies might potentially contribute to overcoming this gap and to provide more widely distributed and low-cost mental health care in a variety of contexts. Methods: We conducted a scoping review of the literature in order to systematically map the existing evidence on use of Internet-based interventions for prevention, treatment, and management of mental disorders across Latin American countries, as well as to identify existing gaps in knowledge. Six electronic databases were searched for published papers (PubMed, Embase, CINAHL, Web of Science, SciELO, and CENTRAL). Results: After the eligibility assessment, we identified 22 Internet-based studies carried out in Latin America for prevention, treatment, education, or facilitating self-management of mental disorders. Included studies mainly targeted depression (n = 11), substance misuse (n = 6), anxiety (n = 3), and mental health literacy for education and health professionals (n = 2). Most studies were undertaken in Brazil (n = 6), Mexico (n = 5), and Chile (n = 4). Only 3 studies were randomized controlled trials (RCTs), 4 were pilot RCTs, and 15 were naturalistic, acceptability, or feasibility studies. The three RCTs identified showed disparate results, but overall, there are challenges to face. Better results are seen in the short-term (postintervention or after 3 months), but most studies do not explore outcomes for long enough (follow-up after 6 or 12 months). Most of the feasibility and pilot studies showed reasonably good acceptability for a wide range of strategies but difficulties to engage and retain participants for long enough or adhering to established protocols. Conclusion: This study shows that Internet-based interventions for the prevention and treatment of mental disorders are growing rapidly in Latin America, but there are few studies on effectiveness and cost effectiveness, making it difficult to provide the evidence needed to justify scaling up these interventions.

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“…There is a vast treatment gap in mental disorders globally: approximately one in four persons with common mental disorders has received treatment (Alonso et al ., 2018; Araya et al ., 2018). The gap is wider in developing countries, where human resources for mental health are extremely scarce (Chisholm et al ., 2016 b ; De Silva et al ., 2014; Kakuma, 2011).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal

et al. 2019

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Background. An essential strategy to increase coverage of psychosocial treatments globally is task shifting to non-medical counsellors, but evidence on its effectiveness is still scarce. This study evaluates the effectiveness of lay psychosocial counselling among persons with psychological distress in a primary health care setting in rural Nepal. Methods. A parallel randomized controlled trial in Dang, rural Nepal (NCT03544450). Persons aged 16 and older attending primary care and with a General Health Questionnaire (GHQ-12) score of 6 or more were randomized (1:1) to receive either non-medical psychosocial counselling (PSY) or enhanced usual care (EUC). PSY was provided by lay persons with a 6-month training and consisted of 5-weekly counselling sessions of 35–60 min with a culturally adapted solution-focused approach. EUC was provided by trained primary health workers. Participants were followed up at 1 (T1) and 6 months (T2). The primary outcome, response to treatment, was the reduction of minimum 50% in the Beck Depression Inventory (BDI) score. Results. A total of 141 participants, predominantly socially disadvantaged women, were randomized to receive PSY and 146 to EUC. In the PSY, 123 participants and 134 in the EUC were analysed. In PSY, 101 participants (81.4%) had a response compared with 57 participants (42.5%) in EUC [percentage difference 39.4% (95% CI 28.4–50.4)]. The difference in BDI scores at T2 between PSY and EUC was −7.43 (95% CI −9.71 to −5.14). Conclusions. Non-medical (lay) psychosocial counselling appears effective in reducing depressive symptoms, and its inclusion in mental health care should be considered in low-resource settings.

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Determinants of access to health care for depression in 49 countries: A multilevel analysis

Cited by 48 publications

References 31 publications

<p>Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study</p>

<p>Prevalence and Determinants of Long-Term Utilization of Antidepressant Drugs: A Retrospective Cohort Study</p>

Internet-Based Interventions for the Prevention and Treatment of Mental Disorders in Latin America: A Scoping Review

Effectiveness of non-medical health worker-led counselling on psychological distress: a randomized controlled trial in rural Nepal

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