Ribeiro Dos Santos Edinilza, Huang Hsiang, Menezes Paulo Rossi, Scazufca Marcia
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.
PLoS One. 2016 Mar 1;11(3):e0150046. doi: 10.1371/journal.pone.0150046. eCollection 2016.
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.
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.
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.
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.
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.
抑郁症的患病率在高收入国家以及低收入国家的大城市中已得到广泛研究；然而，对于巴西亚马逊地区偏远地区抑郁症的患病率及治疗差距却知之甚少。
本研究的目的是估计巴西亚马逊地区两个偏远城市中登记在家庭健康战略下的成年人抑郁症患病率，并调查患有抑郁症且接受了精神卫生保健的个体比例。
这是一项对巴西亚马逊州科阿里市和特费市初级保健诊所登记的成年人口进行的横断面研究。抑郁症定义为患者健康问卷-9得分≥10分。通过询问患有抑郁症的参与者在访谈前三个月是否服用了抗抑郁药和/或是否在社区精神卫生中心接受过卫生专业人员的诊治来评估抑郁症护理情况。采用泊松回归分析来检验抑郁症与暴露变量之间的未调整和调整后的关联。
抑郁症的总体患病率为19.1%（95%置信区间：17.2 - 21.1），女性患病率为22.2%（95%置信区间：19.3 - 25.0），男性患病率为16.0%（95%置信区间：13.4 - 18.5）。科阿里市和特费市的抑郁症患病率分别为18.3%（95%置信区间15.7 - 21.0）和19.9%（95%置信区间：17.2 - 22.7）。女性、缺乏社会支持、更多暴露于应激性生活事件以及患有更多的内科合并症始终与抑郁症相关。在未调整分析中，较低的教育程度和收入、吸烟以及危险饮酒也与抑郁症相关。在访谈前三个月，只有11.5%的抑郁症患者正在服用抗抑郁药和/或就诊于精神卫生保健机构。
在我们的样本中，约五分之一的成年人患有抑郁症。很大一部分参与者呈现出社会劣势指标以及先前在全球范围内与抑郁症相关的其他风险因素。亚马逊地区抑郁症的治疗差距很大，这表明巴西初级保健机构需要创新的抑郁症护理模式。
