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Towards measuring efective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Brazil

dc.creatorHenriques Franca, Marianees_ES
dc.creatorBharat, Chriannaes_ES
dc.creatorNovello, Ercolees_ES
dc.creatorHwang, Irvinges_ES
dc.creatorMedina‑Mora, María Elenaes_ES
dc.creatorBenjet, Corinaes_ES
dc.creatorAndrade, Laura Helenaes_ES
dc.creatorVigo, Daniel V.es_ES
dc.creatorViana, Maria Carmenes_ES
dc.date2023
dc.date.accessioned2025-04-08T17:34:09Z
dc.date.available2025-04-08T17:34:09Z
dc.date.issued2023
dc.identifierJC46DIEP23es_ES
dc.identifier.urihttp://repositorio.inprf.gob.mx/handle/123456789/8297
dc.identifier.urihttps://doi.org/10.1186/s13033-023-00583-w
dc.descriptionBackground: Major depressive disorder (MDD) contributes to a significant proportion of disease burden, disability, economic losses, and impact on need of treatment and health care in Brazil, but systematic information about its treatment coverage is scarce. This paper aims to estimate the gap in treatment coverage for MDD and identify key bottlenecks in obtaining adequate treatment among adult residents in the São Paulo Metropolitan area, Brazil. Methods: A representative face-to-face household survey was conducted among 2942 respondents aged 18+ years to assess 12-month MDD, characteristics of 12-month treatment received, and bottlenecks to deliver care through the World Mental Health Composite International Diagnostic Interview. Results: Among those with MDD (n = 491), 164 (33.3% [SE, 1.9]) were seen in health services, with an overall 66.7% treatment gap, and only 25.2% [SE, 4.2] received effective treatment coverage, which represents 8.5% of those in need, with a 91.5% gap in adequate care (66.4% due to lack of utilization and 25.1% due to inadequate quality and adherence). Critical service bottlenecks identified were: use of psychotropic medication (12.2 percentage points drop), use of antidepressants (6.5), adequate medication control (6.8), receiving psychotherapy (19.8). Conclusions: This is the first study demonstrating the huge treatment gaps for MDD in Brazil, considering not only overall coverage, but also identifying specific quality- and user-adjusted bottlenecks in delivering pharmacological and psychotherapeutic care. These results call for urgent combined actions focused in reducing effective treatment gaps within services utilization, as well as in reducing gaps in availability and accessibility of services, and acceptability of care for those in need.es_ES
dc.formatPDFes_ES
dc.language.isoenges_ES
dc.publisherBioMed Centrales_ES
dc.relation17(1):19
dc.rightsAcceso Cerradoes_ES
dc.titleTowards measuring efective coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder in São Paulo metropolitan area, Braziles_ES
dc.typeArtículoes_ES
dc.contributor.affiliationPost-Graduate Program in Public Health, Federal University of Espirito Santo, Vitória, ES, Brazil
dc.contributor.emailmarianehf@yahoo.com.br (Mariane Henriques Franca)
dc.relation.jnabreviadoINT J MENT HEALTH SYST
dc.relation.journalInternational Journal of Mental Health Systems
dc.identifier.placeInglaterra
dc.date.published2023
dc.identifier.organizacionInstituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
dc.identifier.eissn1752-4458
dc.identifier.doi10.1186/s13033-023-00583-w
dc.subject.kwDepressive disorder
dc.subject.kwTreatment coverage
dc.subject.kwEfective treatment
dc.subject.kwBottlenecks


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