title: Prevalence of Depression and Depression Care for Populations Registered in Primary Care in Two Remote Cities in the Brazilian Amazon.
abstract: BACKGROUND
  The prevalence of depression has been widely studied in high-income countries and in large cities of low-income countries; however, little is known about the prevalence and treatment gap of depression in remote areas of the Amazonian region in Brazil.
  
  
  OBJECTIVE
  The objectives of this study are to estimate the prevalence of depression in adults registered with the Family Health Strategy in two remote cities in the Brazilian Amazon and to investigate the proportion of individuals with depression that received mental health care.
  
  
  METHODS
  This is a cross-sectional study of an adult population registered with primary care clinics in the cities of Coari and Tefé, State of Amazon, Brazil. Depression was defined as a score of ≥10 on the Patient Health Questionnaire-9. Depression care was evaluated by asking participants with depression if they received antidepressants and/or had been seen by a health professional at a community mental health center in the three months prior to the interview. Poisson regression was used to examine the unadjusted and adjusted associations between depression and exposure variables.
  
  
  RESULTS
  The overall prevalence of depression was 19.1% (95% CI: 17.2-21.1), with 22.2% (95% CI: 19.3-25.0) among women and 16.0% (95% CI: 13.4-18.5) among men. The prevalence of depression in Coari and Tefé were 18.3% (CI 95% 15.7-21.0) and 19.9% (95% CI:17.2-22.7), respectively. Being a woman, lacking social support, increasing exposure to stressful life events and having a higher number medical comorbidities were consistently associated with depression. Lower educational attainment and income, tobacco use, and risky alcohol use were also associated with depression in the unadjusted analyses. Only 11.5% of those with depression were receiving antidepressants and/or visited the mental health care facility during the three months prior to the interview.
  
  
  CONCLUSIONS
  Approximately one in five adults in our sample had depression. A high proportion of participants presented indicators of social disadvantage and other risk factors previously associated with depression worldwide. There was a large treatment gap for depression in the Amazonian region, which demonstrates the need for innovative models of depression care in primary care settings in Brazil.
authors.affiliation: Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.|Health Sciences School, University of the State of Amazonas, Manaus, Brazil.
authors.forename: Edinilza
authors.initials: E
authors.lastname: Ribeiro Dos Santos
authors.affiliation: Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, United States of America.|Institute of Psychiatry and LIM-23, Clinics Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Hsiang
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo Rossi
authors.initials: PR
authors.lastname: Menezes
authors.affiliation: Institute of Psychiatry and LIM-23, Clinics Hospital, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Scazufca
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003155:Community Mental Health Centers; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D055815:Young Adult