Poor access to health services for depression treatment in Brazil
DOI:
https://doi.org/10.11606/s1518-8787.2023057004654Keywords:
Depression, Health Services Accessibility, Health Status Disparities, Health SurveysAbstract
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.
References
World Health Organization. Depression and other common mental disordes: global health estimates. Geneva: World Health Organization; 2017.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders – DSM-5. 5th ed. Washington: APA; 2013.
Bonadiman CS, Malta DC, Passos VMA, Naghavi M, Melo AP. Depressive disorders in Brazil: results from the Global Burden of Disease Study 2017. Popul Health Metr. 2020 Sep;18(S1 Suppl 1):6. https://doi.org/10.1186/s12963-020-00204-5
Razzouk D, Razzouk D. Why should Brazil give priority to depression treatment in health resource allocation? Epidemiol Serv Saúde. 2016;25(4):845-8. https://doi.org/10.5123/S1679-49742016000400018
Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet. 2011 May;377(9779):1778-97. https://doi.org/10.1016/S0140-6736(11)60054-8
Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981 Feb;19(2):127-40. https://doi.org/10.1097/00005650-198102000-00001
Donabedian A. Aspects of medical care administration. Boston: Harvard University Press; 1973.
Travassos C, Martins M. [A review of concepts in health services access and utilization]. Cad Saude Publica. 2004;20 Suppl 2:S190-8. Portuguese. https://doi.org/10.1590/S0102-311X2004000800014
Dimenstein M, Simoni AC, Macedo JP, Nogueira N, Barbosa BC, Silva BI, et al. [Equity and access to mental health care in three Northeastern states]. Cienc Saúde Coletiva. 2016 May;26(5):1227-38. Portuguese. https://doi.org/10.1590/1413-81232021265.04912021
Instituto Brasileiro de Geografia e Estatística. Coordenação de Trabalho e Rendimento. Pesquisa nacional de saúde: 2019: informações sobre domicílios, acesso e utilização dos serviços de saúde : Brasil, grandes regiões e unidades da federação. Rio de Janeiro: IBGE; 2020.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995 Mar;36(1):1-10. https://doi.org/10.2307/2137284
Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry. 2017 Feb;16(1):90-9. https://doi.org/10.1002/wps.20388
Wittayanukorn S, Qian J, Hansen RA. Prevalência de sintomas depressivos e preditores de tratamento entre adultos americanos de 2005 a 2010. Gen Hosp Pschiastry. 2014;36(3):330-6. https://doi.org/10.1016/j.genhosppsych.2013.12.009
Dantas MN, Souza DL, Souza AM, Aiquoc KM, Souza TA, Barbosa IR. Fatores associados ao acesso precário aos serviços de saúde no Brasil. Rev Bras Epidemiol. 2021;24:24. https://doi.org/10.1590/1980-549720210004
Ministério da Saúde (BR). Saúde mental e atenção básica: o vínculo e o diálogo necessários. Brasília, DF: Ministério da Saúde; 2013.
Motta CC, Moré CL, Nunes CH. Psychological assistance provided to patients diagnosed with depression in primary care. Cienc Saúde Colet. 2017;22(3):911-20. https://doi.org/10.1590/1413-81232017223.27982015
Pupo LR, Rosa TE, Sala A, Ferffermann M, Alves MC, Morais ML. [Mental health in Primary Care: identification and organization of care in the state of São Paulo]. Saúde Debate. 2021 Oct;44(spe 3):107-27. Portuguese. https://doi.org/10.1590/0103-11042020E311
Chisholm D, Sweeny K, Sheehan P, Rasmussen B, Smit F, Cuijpers P, et al. Scaling-up treatment of depression and anxiety: a global return on investment analysis. Lancet Psychiatry. 2016 May;3(5):415-24. https://doi.org/10.1016/S2215-0366(16)30024-4
Dimenstein M, Macedo JP, Gomes MS, Marinho AM. A saúde mental e atenção psicossocial: regionalização e gestão do cuidado integral no sus. Salud Soc. 2018;9(1):70-85. https://doi.org/10.22199/S07187475.2018.0001.00004
Macedo JP, Abreu MM, Fontanele MG, Dimenstein M. [The regionalization of mental health and new challenges of the Psychiatric Reform in Brazil]. Saúde Soc. 2017 Jan-Mar;26(1):155-70. Portuguese. https://doi.org/10.1590/S0104-12902017165827
Molina MR, Wiener CD, Branco JC, Jansen K, Souza LD, Tomasi E, et al. Prevalence of depression in users of primary care settings. Arch Clin Psychiatry. 2012;39(6):194-7. https://doi.org/10.1590/S0101-60832012000600003
Bezerra HdS, Alves RM, Souza TA, Medeiros AA, Barbosa IR. Factors associated with mental suffering in the Brazilian population: a multilevel analysis. Front Psychol. 2021 Mar;12:625191. https://doi.org/10.3389/fpsyg.2021.625191
Leite JF, Dimenstein M, Dantas CB, Silva EL, Macedo JP, Sousa AP. Lifestyle, mental health and gender conditions in rural contexts: a study within agraria reform settlements of Northeastern Brazil. Av Psicol Latinoam. 2017 May-Ago;35(2):301-16.
https://doi.org/10.12804/revistas.urosario.edu.co/apl/a.4768.
Schraiber LB. Healthcare needs, public policies and gender: the perspective of professional practices. Cien Saúde Colet. 2012 Oct;17(10):2635-44. https://doi.org/10.1590/S1413-81232012001000013
Ibanez G, Mercedes BP, Vedana KG, Miasso AI. [Adherence and difficulties related to drug treatment in patients with depression]. Rev Bras Enferm. 2014;67(4):556-62. Portuguese. https://doi.org/10.1590/0034-7167.2014670409
Siniscalchi KA, Broome ME, Fish J, Ventimiglia J, Thompson J, Roy P, et al. Depression screening and measurement-based care in primary care. J Prim Care Community Health. 2020;11:2150132720931261. https://doi.org/10.1177/2150132720931261
Stopa SR, Malta DC, Monteiro CN, Szwarcwald CL, Goldbaum M, Cesar CL. Use of and access to health services in Brazil, 2013 National Health Survey. Rev Saúde Pública. 2017;51(suppl1):3s. https://doi.org/10.1590/S1518-8787.2017051000074
Melo AK, Siebra AJ, Moreira V. Depression in adolescents: review of the literature and the place of phenomenological research. Psicol Cienc Prof. 2017 Jan-Mar;37(1):18-34. Portuguese. https://doi.org/10.1590/1982-37030001712014
Silva JF, Matskura TS, Ferigato SH, Cid MF. Adolescence and mental health from the perspective of Primary Healthcare professionals. Interface. 2019;23:e180630. https://doi.org/10.1590/Interface.180630
Alegría M, Chatterji P, Wells K, Cao Z, Chen CN, Takeuchi D, et al. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv. 2008 Nov;59(11):1264-72. https://doi.org/10.1176/ps.2008.59.11.1264
Smolen JR, Araujo EM. Race/skin color and mental health disorders in Brazil: a systematic review of the literature. Cienc Saúde Colet. 2008 Dez;22(12):4021-30. https://doi.org/10.1590/1413-812320172212.19782016
Gomes SC, Esperidião MA. [Indigenous peoples’ access to health services in Cuiabá, Mato Grosso State, Brazil]. Cad Saúde Pública. 2017 Jun;33(5):e00132215. Portuguese. https://doi.org/10.1590/0102-311x00132215
Malta DC, Bernal RT, Lima MG, Araújo SS, Silva MM, Freitas MI, et al. Noncommunicable diseases and the use of health services: analysis of the National Health Survey in Brazil. Rev Saúde Pública. 2017;51 Supl 1:4s. https://doi.org/10.1590/S1518-8787.2017051000090
Arruda NM, Maia AG, Alves LC. [Inequality in access to health services between urban and rural areas in Brazil: a disaggregation of factors from 1998 to 2008]. Cad Saúde Pública. 2018 Jun;34(6):e00213816. Portuguese. https://doi.org/10.1590/0102-311x00213816
Published
Issue
Section
License
Copyright (c) 2023 Héllyda de Souza Bezerra, Isabelle Ribeiro Barbosa
This work is licensed under a Creative Commons Attribution 4.0 International License.
