Socioeconomic and spatial distribution of depressive symptoms and access to treatment in Peru: A repeated nationwide cross-sectional study from 2014 to 2021

Highlights

• Depressive symptoms were more concentrated among the poorest groups.
• Access to treatment had a greatly pro-rich distribution.
• The predicted prevalence of depressive symptoms was heterogeneous.
• High-risk clusters were identified in similar areas in both years under study.
• Social policies are required to tackle mental health disparities.

Abstract

Background

Globally, evidence indicates that poverty and geographical setting influence the prevalence of depressive symptoms and access to treatment. Therefore, this study aimed to evaluate the socioeconomic and spatial distribution of depressive symptoms and treatment in Peru.

Methods

We conducted an observational study based on the analysis of secondary data derived from the Peruvian Demographic and Health Surveys for 2014–2021. Using the Patient Health Questionnaire-9 on depressive symptoms, we estimated the Erreygers concentration index (ECI) to identify socioeconomic inequality in depressive symptoms and access to treatment. Spatial analyses were conducted using Global Moran's I, Kriging interpolation, hotspot analysis (Getis-Ord-Gi∗), and the Bernoulli-based Kulldorff spatial analysis.

Results

The surveys included a total of 113,392 participants. Depressive symptoms exhibited only negative ECI values throughout the 2014–2021 period (pro-poor distribution), whereas access to treatment only displayed positive ECI values (pro-rich distribution). We identified two and four significant clusters in the southeastern areas of Peru in 2014 and 2021, respectively.

Conclusions

Depressive symptoms were concentrated among the poorest, whereas access to treatment was remarkably concentrated among the wealthiest groups. A clustered spatial pattern was observed, and similar high-risk areas were identified. Social policies that address unequal socioeconomic and spatial distribution in depressive symptoms and treatment are required.