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

Abstract：

BACKGROUND:The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. METHODS:We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. RESULTS:The sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, country-level factors explained 27.6% of the variance in access to diagnosis and 24.1% in access to treatment. Access to treatment for depression improved with increasing country income. Female gender, better education, the presence of physical co-morbidity, more material assets, and living in urban areas were individual level determinants of better access. LIMITATIONS:Data on other contextual factors was not available. Unmet need was likely underestimated, since only lifetime treatment data was available. CONCLUSION:This study highlights major inequalities in access to a diagnosis and treatment of depression. Unlike the prevalence of depression, where contextual factors have shown to have less importance, a significant proportion of the variance in access to depression care was explained by country-level income.

journal_name

J Affect Disord

journal_title

Journal of affective disorders

authors

Araya R,Zitko P,Markkula N,Rai D,Jones K

doi

10.1016/j.jad.2018.02.092

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

80-88

eissn

0165-0327

issn

1573-2517

pii

S0165-0327(17)31399-X

journal_volume

234

pub_type

杂志文章

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