title: Inequities in access to depression treatment: results of the Brazilian National Health Survey - PNS.
abstract: Despite depression being one of the most prevalent mental disorders in the world, access to treatment is still insufficient, especially in low- and middle-income countries. The aim of this study is to investigate differences in access to treatment for depression according to socio-demographic characteristics, geographical area and multi-morbidity in a nationally representative sample of individuals with depression.
  
  
  
  This study analyses data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), a Brazilian household-based nationwide survey, which comprises 60,202 adults (aged 18 years or older). Depression was evaluated through the Patient Health Questionnaire-9 (PHQ-9). Prevalence Ratios and corresponding 95 % confidence intervals (95%CI) were calculated using Poisson regression.
  
  
  
  The general prevalence of depression was 7.9 % (95 % CI 7.5 to 8.3). Among those with depression, 78.8 % did not receive any treatment, and 14.1 % received only pharmacotherapy. Multivariable analyses showed that being female, white, aged between 30 and 69 years, living in regions other than the North, having higher education and having multi-morbidities were independently associated with higher likelihood of access to any treatment.
  
  
  
  Most Brazilians with clinically relevant depressive symptoms are not receiving any treatment. Access to care is unequal, with the poor and those living in low resource areas having higher difficulties to access mental health care. Understanding these disparities is important for the provision of effective interventions aimed at reducing the prevalence of depression and inequities in access to mental health care.
authors.affiliation: Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil. cslopesims@gmail.com.
authors.forename: Claudia Souza
authors.initials: CS
authors.lastname: Lopes
authors.affiliation: Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Natália
authors.initials: N
authors.lastname: Hellwig
authors.affiliation: Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Gulnar de Azevedo
authors.initials: GA
authors.lastname: E Silva
authors.affiliation: Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo Rossi
authors.initials: PR
authors.lastname: Menezes
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology / Q000628:therapy; D003866:Depressive Disorder / Q000453:epidemiology / Q000628:therapy; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011203:Poverty; D044469:Racial Groups; D012111:Residence Characteristics; D012737:Sex Factors; D012923:Social Class; D055815:Young Adult
keywords: Depression; Health surveys; Mental health; Mental health service access; PHQ-9