Inequities in access to depression treatment: results of the Brazilian National Health Survey – PNS

Abstract

BackgroundDespite depression being one of the most prevalent mental disorders in the world, access to treatment is still insufficient, especially in low- and middle-income countries. The aim of this study is to investigate differences in access to treatment for depression according to socio-demographic characteristics, geographical area and multi-morbidity in a nationally representative sample of individuals with depression.MethodsThis study analyses data from the National Health Survey (Pesquisa Nacional de Saúde – PNS), a Brazilian household-based nationwide survey, which comprises 60,202 adults (aged 18 years or older). Depression was evaluated through the Patient Health Questionnaire-9 (PHQ-9). Prevalence Ratios and corresponding 95 % confidence intervals (95%CI) were calculated using Poisson regression.ResultsThe general prevalence of depression was 7.9 % (95 % CI 7.5 to 8.3). Among those with depression, 78.8 % did not receive any treatment, and 14.1 % received only pharmacotherapy. Multivariable analyses showed that being female, white, aged between 30 and 69 years, living in regions other than the North, having higher education and having multi-morbidities were independently associated with higher likelihood of access to any treatment.ConclusionsMost Brazilians with clinically relevant depressive symptoms are not receiving any treatment. Access to care is unequal, with the poor and those living in low resource areas having higher difficulties to access mental health care. Understanding these disparities is important for the provision of effective interventions aimed at reducing the prevalence of depression and inequities in access to mental health care.

A panorama of health inequalities in Brazil

“…Boccolini et al [14] identify characteristics of the more than 20 million people who still underutilize the Brazilian health system and Dourado et al [15] demonstrate the importance of the Family Health Strategy in providing a usual source of healthcare as well as remaining regional disparities in its distribution. The article by Lopes et al [16] highlights individual and regional factors associated with disparities in the prevalence of depression and in access to effective treatment and Theme-Filha et al [17] document inequalities in preventive cancer screening for women, regional disparities and correlation with other health behaviors. Finally, Lima-Costa et al [18] demonstrate a distinct gap in access to and use of needed informal and formal care for older Brazilians with functional limitations.…”

Measuring and improving the quality of mental health care: a global perspective

“…Severe mental illness (e.g., schizophrenia and bipolar disorder) is emerging as a prominent health disparity category, given estimates that persons in this group die 8-25 years younger than the general population 10,11 . Despite the contribution of mental disorders to the global burden of disease, the quality of care for these disorders remains suboptimal, and there are persistent gaps in access to and receipt of mental health services worldwide [12][13][14][15][16][17][18] .…”

A carga dos transtornos mentais e decorrentes do uso de substâncias psicoativas no Brasil: Estudo de Carga Global de Doença, 1990 e 2015

“…The Brazilian territory is special because it is marked by important differences in the availability of mental health services depending on the region of the country. The national population-based survey (PNS) conducted in 2013, reported estimates of access to treatment for depression, and found that in the north region there is the largest proportion of untreated individuals (90.2%) whereas in the south region the lowest proportion of untreated individuals (67.5%) 6 . Nevertheless, the results of the GBD 2015 for Brazilian FUs were practically homogeneous.…”

“…In Brazil, data from the National Health Survey (acronym in Portuguese -PNS) demonstrated inequities in access to mental health care. In addition, it was found that the majority of Brazilians with clinically relevant depressive symptoms (78.8%) did not undergo any type of treatment 6 .…”