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Title: Determinants of effective treatment coverage for major depressive disorder in the WHO World Mental Health Surveys
Authors: Vigo, Daniel V
Kazdin, Alan E
Sampson, Nancy A
Hwang, Irving
Alonso, Jordi
Andrade, Laura Helena
Ayinde, Olatunde
Borges, Guilherme
Bruffaerts, Ronny
Bunting, Brendan
de Girolamo, Giovanni
Florescu, Silvia
Gureje, Oye
Haro, Josep Maria
Harris, Meredith G
Karam, Elie G.
Karam, Georges
Kovess-Masfety, Viviane
Lee, Sing
Navarro-Mateu, Fernando
Posada-Villa, José
Scott, Kate
Stagnaro, Juan Carlos
Have, Margreet Ten
Wu, Chi-Shin
Xavier, Miguel
Kessler, Ronald C
Affiliations: Faculty of Medicine 
Keywords: Effective coverage
Global mental health
Major depressive disorder
Mental health services
Mental health systems
Issue Date: 2022-01-03
Part of: International Journal of Mental Health Systems
Volume: 16
Issue: 1
Most individuals with major depressive disorder (MDD) receive either no care or inadequate care. The aims of this study is to investigate potential determinants of effective treatment coverage.

In order to examine obstacles to providing or receiving care, the type of care received, and the quality and use of that care in a representative sample of individuals with MDD, we analyzed data from 17 WHO World Mental Health Surveys conducted in 15 countries (9 high-income and 6 low/middle-income). Of 35,012 respondents, 3341 had 12-month MDD. We explored the association of socio-economic and demographic characteristics, insurance, and severity with effective treatment coverage and its components, including type of treatment, adequacy of treatment, dose, and adherence.

High level of education (OR = 1.63; 1.19, 2.24), private insurance (OR = 1.62; 1.06, 2.48), and age (30–59yrs; OR = 1.58; 1.21, 2.07) predicted effective treatment coverage for depression in a multivariable logistic regression model. Exploratory bivariate models further indicate that education may follow a dose—response relation; that people with severe depression are more likely to receive any services, but less likely to receive adequate services; and that in low and middle-income countries, private insurance (the only significant predictor) increased the likelihood of receiving effective treatment coverage four times.

In the regression models, specific social determinants predicted effective coverage for major depression. Knowing the factors that determine who does and does not receive treatment contributes to improve our understanding of unmet needs and our ability to develop targeted interventions.
ISSN: 1752-4458
DOI: 10.1186/s13033-022-00539-6
Open URL: Link to full text
Type: Journal Article
Appears in Collections:Faculty of Medicine

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