title: Use of primary and specialized mental health care for a major depressive episode in Spain by ESEMeD respondents.
abstract: OBJECTIVE
  This study described use of services for a major depressive episode and determined factors associated with use in Spain, a country with universal access to care and a relatively low prevalence of depression.
  
  
  METHODS
  Data were from the European Study of the Epidemiology of Mental Disorders (ESEMeD). ESEMeD-Spain was a cross-sectional, general population survey conducted with a representative sample of noninstitutionalized adults (N=5,473). The Composite International Diagnostic Interview was used, and 12-month use of services for a major depressive episode, types of services used, and receipt of minimally adequate treatment were assessed.
  
  
  RESULTS
  Among the 247 respondents with a major depressive episode in the past 12 months, 59% reported any use of past-year services for their disorder; of this group, 76% reported receipt of any active treatment (from a health care or mental health professional). Among respondents with severe depression, 31% used no services. A higher likelihood of service use was found among those who were unemployed or too disabled to work (OR=4.9, CI=1.3-19), who had moderate depression symptoms (OR=3.2, CI=1.1-9.0), and who had one mental disorder comorbid with depression (OR=2.9, CI=1.2-7.0) or two or more such comorbid disorders (OR=4.1, CI=1.9-8.9). In the active treatment group, only 31.2% received treatment that was minimally adequate.
  
  
  CONCLUSIONS
  There is a need in Spain to increase use of services for a major depressive episode, especially among certain population groups, such as women, and to improve adequacy of treatments. The role of specific factors, such as availability of services and of professionals, deserves further research.
authors.affiliation: Health Services Research Unit, IMIM-Hospital del Mar, Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gabilondo
authors.forename: Sònia
authors.initials: S
authors.lastname: Rojas-Farreras
authors.forename: Angel
authors.initials: A
authors.lastname: Rodríguez
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández
authors.forename: Alejandra
authors.initials: A
authors.lastname: Pinto-Meza
authors.forename: Gemma
authors.initials: G
authors.lastname: Vilagut
authors.forename: Josep M
authors.initials: JM
authors.lastname: Haro
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult