Determinants of access to health care for depression in 49 countries: A multilevel analysis
Date
2018
Type:
Article
item.page.extent
item.page.accessRights
item.contributor.advisor
ORCID:
Journal Title
Journal ISSN
Volume Title
Publisher
item.page.isbn
item.page.issn
item.page.issne
item.page.doiurl
item.page.other
item.page.references
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, countrylevel 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.
Description
item.page.coverage.spatial
item.page.sponsorship
Citation
Journal of Affective Disorders 234 (2018) 80–88
Keywords
Depressive disorders, Access to Health Care, Treatment gap, Multilevel analysis