Socioeconomic and racial/ethnic inequalities in depression prevalence and the treatment gap in Brazil: A decomposition analysis.
Socioeconomic and racial/ethnic inequalities in depression prevalence and the treatment gap in Brazil: A decomposition analysis.
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DOI：
10.1016/j.ssmph.2022.101266
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发表时间：
2022-12
影响因子：
4.7
通讯作者：
Rocha, Rudi
中科院分区：
文献类型：
--
作者：
Mrejen, Matias;Hone, Thomas;Rocha, Rudi
抑郁症是一个主要的全球健康负担，在抑郁症的患病率和获得抑郁症治疗方面存在明显的社会经济不平等。在巴西，种族/族裔不平等尤其令人关切，但造成这些不平等的因素大多仍不为人所知。本文首先探讨了抑郁症的决定因素和治疗差距（即，未经治疗的患者），并确定社会经济和卫生系统因素是否解释了随着时间的推移而发生的变化。其次，它分析了收入和种族/民族不平等的抑郁症和治疗差距，并确定因素解释不平等通过分解方法。使用了两波（2013年和2019年）代表性家庭调查的数据。2019年，10.8%的成年人患有抑郁症，但超过70%的抑郁症成年人没有得到治疗。黑人或棕色人种/混血巴西人更有可能患有未经治疗的抑郁症，居住地区是这些种族/民族不平等的最重要决定因素。值得注意的是，白色个体与黑人和棕色/混血个体之间44.6%的治疗差异无法通过可观察性差异来解释，这可能是由于其他不可观察性特征造成的歧视或难以获得治疗。就业、年龄、暴力和体力活动是抑郁症患者收入不平等的主要因素。这些结果表明，旨在提高低收入者风险因素暴露水平的政策可能会对心理健康和心理健康不平等产生积极影响，而解决心理健康服务提供和资源分配方面的不平等问题以及消除歧视造成的获取障碍对于公平弥合治疗差距至关重要。2019年，10.8%的成年人患有抑郁症，但超过70%的抑郁症成年人没有得到治疗。低收入人群更容易患抑郁症。黑色或棕色/混合的个体更有可能患有未经治疗的抑郁症。居住地区是在待遇差距方面种族/族裔不平等的最重要决定因素。暴露于暴力和体力活动是抑郁症患者收入不平等的相关促成因素。
Depression is a major global health burden and there are stark socioeconomic inequalities in both the prevalence of depression and access to treatment for depression. In Brazil, racial/ethnic inequalities are of particular concern, but the factors contributing to these inequalities remain mostly unknown. This paper firstly explores determinants of depression and the treatment gap (i.e., untreated afflicted individuals) in Brazil and identifies if socio-economic and health system factors explain changes over time. Secondly, it analyses income and racial/ethnic inequalities in depression and the treatment gap and identifies factors explaining inequalities through decomposition methods. Data from two waves (2013 and 2019) of a representative household-based survey are used. In 2019, 10.8% of adults were depressed, but over 70% of depressed adults did not receive care. Black or brown/mixed Brazilians were more likely to have untreated depression, and region of residence was the most important determinant of these racial/ethnic inequalities. Notably, 44.6% of the difference in the treatment gap between white individuals and black and brown/mixed individuals was not explained by differences in observables, which could potentially be due to discrimination or difficulties in accessing treatment due to other non-observable characteristics. Employment, age, exposure to violence and physical activity are the main contributing factors to income inequalities in depression. These results suggest that policies aimed at improving the levels of exposure of lower-income individuals to risk factors may positively impact mental health and mental health inequalities, while addressing inequalities in service provision and resourcing for mental health and tackling barriers to access stemming from discrimination are essential to bridge the treatment gap equitably. In 2019, 10.8% of adults were depressed, but over 70% of depressed adults did not receive care. Lower income individuals were more likely to have depression. Black or brown/mixed individuals were more likely to have untreated depression. Region of residence was the most important determinant of racial/ethnic inequalities in the treatment gap. Exposure to violence and physical activity are relevant contributing factors to income inequalities in depression.
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影响因子：
4.5
作者：
Freeman A;Tyrovolas S;Koyanagi A;Chatterji S;Leonardi M;Ayuso-Mateos JL;Tobiasz-Adamczyk B;Koskinen S;Rummel-Kluge C;Haro JM
通讯作者：
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影响因子：
3.8
作者：
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通讯作者：
Rizzo, John
DOI：
10.1111/j.1530-0277.2006.00274.x
发表时间：
2007-01-01
影响因子：
3.2
作者：
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通讯作者：
Rehm, Juergen
影响因子：
10.7
作者：
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通讯作者：
Maselko, Joanna
影响因子：
34.3
作者：
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通讯作者：
Bull, Fiona C.