Poor access to health services for depression treatment in Brazil

Bezerra, Héllyda de Souza; Barbosa, Isabelle Ribeiro

doi:10.11606/s1518-8787.2023057004654

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Brasil

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Sumário

Original Article • Rev. Saúde Pública 57 • 2023 • https://doi.org/10.11606/s1518-8787.2023057004654 copy

Poor access to health services for depression treatment in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the factors associated with poor access to health services for the depression treatment in Brazil.

METHODS

This study used data from the Brazilian National Survey of Health, conducted in the years 2019 and 2020. The sample consisted of 8,332 individuals with a self-reported diagnosis of depression, and poor access to healthcare was identified from the question “what is the main reason for you to not visit the physician/health service regularly for your depression?” From which poor access was identified by the affirmative answer reporting distance of health services or difficulties with transportation; waiting time at the health service; financial difficulties; opening hours of the health service; Not being able to schedule a consultation via health insurance; does not know who to look for or where to go, among others. Sociodemographic aspects and health conditions were analyzed. Bivariate and multivariate analysis was performed using Poisson Regression.

RESULTS

The prevalence of poor access to health services for depression treatment was 14.9% (95%CI: 13.6–16.2), relating to individuals aged 15–29 years (PR = 1.52) and 30-59 years old (PR = 1.22), without education (PR = 1.43), who rate their health as regular/poor/very poor (PR = 1.26), who have some limitation in their usual activities (PR = 2.71), who had the last consultation within 6 months of less than 2 years (PR = 2.63) and for more than 2 years (PR = 2.25) and who do not undergo psychotherapy (PR = 4.28).

CONCLUSION

Poor access to health services for depression treatment was associated with individual factors and health conditions.

Depression; Health Services Accessibility; Health Status Disparities; Health Surveys

Variables	Descriptive

	Prevalence (%)	95%CI	P-value
Gender
Man	14.11	11.86–16.72	0.483
Woman	15.09	13.97–16.28	0.483
Age (year)
15–29	16.71	13.5–20.5	0.197
30–59 year	14.98	13.65–16.42
60 or more	13.43	11.89–15.14
Race or skin color
White	14.06	12.61–15.64	0.515
Black	15.76	14.31–17.32
Yellow	14.93	4.508–39.47
Indigenous	16.05	6.967–32.8
Education
Higher Education	12.03	10.01–14.38	< 0.005
Secondary Education	15.79	13.76–18.05
Primary Education	14.93	13.42–16.59
Illiterate	22.38	18.44–26.87
Per capita income
Up to 1 minimum wage	16.99	15.49–18.6	< 0.005
1–3 minimum wages	14.57	12.94–16.36
Above 3 minimum wages	9.93	7.514–13.02
Place of residence
Rural	15.67	13.76–17.8	0.437
Urban	14.76	13.65–15.96	0.437
Registered at FHS
Yes	15.57	14.17–17.08	0.119
No	14.23	12.45–16.22
Does not know	12.48	10.27–15.1
Self-evaluation of health status
Very good–Good	12.30	10.85–13.91	< 0.005
Regular–Poor– Very poor	17.29	15.84–18.83	< 0.005
Has another CNCD
No	13.72	11.49–16.31	0.333
Yes	15.08	13.91–16.33	0.333
Has activity limitations
No	10.16	9.045–11.4	< 0.005
Yes	20.68	18.89–22.58	< 0.005
Last Consultation
< 6 months	8.60	7.389–9.996	< 0.005
From 6 months to less than 2 years	24.05	21.15–27.2
2 years or more	16.85	15.22–18.62
Does psychotherapy
Yes	3.75	2.622–5.211	< 0.005
No	17.62	16.38–18.94	< 0.005
Use of medications
Yes	12.71	11.42–14.12	< 0.005
No	17.30	15.73–19	< 0.005
Use of ICPs
Yes	14.58	10.55–19.81	0.904
No	14.88	13.82–16	0.904

Variables	Bivariate Analysis			Multivariate Analysis

	Crude PR	95%CI	p-value	Adjusted PR	95% CI	p-value
Gender
Man	1		0.485
Woman	1.06	0.88–1.28	0.485
Age (years)
15–29	1.24	0.97–1.58	0.076	1.52	1.21–1.91	< 0.005
30–59	1.11	0.95–1.30	0.166	1.22	1.05–1.41	0.008
60 or more	1			1
Race or skin color
White	1
Black	1.12	0.97–1.29	0.121
Yellow	1.06	0.34–3.26	0.917
Indigenous	1.14	0.51–2.53	0.744
Education
Higher Education	1			1
Secondary Education	1.31	1.04–1.64	0.019	1.14	0.93–1.40	0.198
Primary Education	1.24	1.00–1.53	0.004	1.04	0.85–1.27	0.697
Illiterate	1.86	1.42–2.42	< 0.005	1.43	1.11–1.83	0.004
Per capita income
Up to 1 minimum wage	1.71	1.28–2.28	< 0.005
1–3 minimum wages	1.46	1.09–1.97	0.011
Above 3 minimum wages	1
Place of residence
Rural	1
Urban	0.94	0.81–1.09	0.437
Registered at FHS
Yes	1
No	0.91	0.77–1.07	0.283
Does not know	0.80	0.64–0.99	0.042
Self-evaluation of health status
Very good - Good	1			1
Regular - Poor - Very poor	1.40	1.20–1.63	< 0.005	1.26	1.08–1.47	0.003
Has another CNCD
No	1
Yes	1.09	0.90–1.33	0.336
Has activity limitations
No	1			1
Yes	2.03	1.75–2.35	< 0.005	2.71	2.29–3.20	< 0.005
Last Consultation
<6 months	1			1.00
From 6 months to less than 2 years	2.79	2.20–3.39	< 0.005	2.63	2.15–3.21	< 0.005
2 years or more	1.95	1.63–2.34	< 0.005	2.25	1.82–2.78	< 0.005
Does psychotherapy
Yes	1			1
No	4.75	3.34–6.77	< 0.005	4.28	2.99–6.14	< 0.005
Use of medications
Yes	1
No	1.36	1.18–1.56	< 0.005
Use of ICPs
Yes	1
No	1.02	0.73–1.41	0.904

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Héllyda de Souza Bezerra Universidade Federal do Rio Grande do Norte. Avenue Capitão Mor Golveia, 2488, Cidade da Esperança 59070-400. Natal, RN, Brazil.E-mail: hellydasbezerra@hotmail.com