Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil
Abstract Background Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the ga...
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| Format: | Article |
| Language: | English |
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BMC
2023-06-01
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| Series: | International Journal of Mental Health Systems |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13033-023-00583-w |
| _version_ | 1797801611448287232 |
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| author | Mariane Henriques Franca Chrianna Bharat Ercole Novello Irving Hwang Maria Elena Medina-Mora Corina Benjet Laura Helena Andrade Daniel V. Vigo Maria Carmen Viana |
| author_facet | Mariane Henriques Franca Chrianna Bharat Ercole Novello Irving Hwang Maria Elena Medina-Mora Corina Benjet Laura Helena Andrade Daniel V. Vigo Maria Carmen Viana |
| author_sort | Mariane Henriques Franca |
| collection | DOAJ |
| description | Abstract Background Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. Methods A representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. Results Among those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). Conclusions This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need. |
| first_indexed | 2024-03-13T04:53:07Z |
| format | Article |
| id | doaj.art-f92c6fda2eab484aaaf55e302f1084c9 |
| institution | Directory Open Access Journal |
| issn | 1752-4458 |
| language | English |
| last_indexed | 2024-03-13T04:53:07Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Mental Health Systems |
| spelling | doaj.art-f92c6fda2eab484aaaf55e302f1084c92023-06-18T11:06:54ZengBMCInternational Journal of Mental Health Systems1752-44582023-06-0117111210.1186/s13033-023-00583-wTowards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, BrazilMariane Henriques Franca0Chrianna Bharat1Ercole Novello2Irving Hwang3Maria Elena Medina-Mora4Corina Benjet5Laura Helena Andrade6Daniel V. Vigo7Maria Carmen Viana8Post-Graduate Program in Public Health, Federal University of Espirito SantoNational Drug & Alcohol Research Centre, Faculty of Medicine, University of New South WalesSYNLAB Computing CenterDepartment of Health Care Policy, Harvard Medical SchoolNational Institute of Psychiatry Ramón de la FuenteDepartment of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente MuñizNucleo de Epidemiologia Psiquiatrica, Departamento e Instituto de Psiquiatria, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo-LIM 23Department of Psychiatry, University of British ColumbiaDepartment of Social Medicine and Post-Graduate Program in Public Health, Federal University of Espirito SantoAbstract Background Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. Methods A representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. Results Among those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). Conclusions This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.https://doi.org/10.1186/s13033-023-00583-wDepressive disorderTreatment coverageEffective treatmentBottlenecks |
| spellingShingle | Mariane Henriques Franca Chrianna Bharat Ercole Novello Irving Hwang Maria Elena Medina-Mora Corina Benjet Laura Helena Andrade Daniel V. Vigo Maria Carmen Viana Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil International Journal of Mental Health Systems Depressive disorder Treatment coverage Effective treatment Bottlenecks |
| title | Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil |
| title_full | Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil |
| title_fullStr | Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil |
| title_full_unstemmed | Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil |
| title_short | Towards measuring effective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil |
| title_sort | towards measuring effective coverage critical bottlenecks in quality and user adjusted coverage for major depressive disorder in sao paulo metropolitan area brazil |
| topic | Depressive disorder Treatment coverage Effective treatment Bottlenecks |
| url | https://doi.org/10.1186/s13033-023-00583-w |
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