Faisal-Cury Alexandre, Ziebold Carolina, Rodrigues Daniel Maurício de Oliveira, Matijasevich Alicia
Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
J Psychiatr Res. 2022 Jul;151:157-165. doi: 10.1016/j.jpsychires.2022.04.025. Epub 2022 Apr 23.
Despite its high prevalence and negative consequences, depression is often underdiagnosed. We aimed to estimate the prevalence and sociodemographic and health related factors associated with depression underdiagnosis among a nationally representative population-based sample in Brazil.
We used data from 70,806 participants (15-107 years old) of the Brazilian National Survey (PNS 2019). Depression underdiagnosis was considered for participants with a Patient Health Questionnaire-9 (PHQ-9) score >9 and with no diagnosis made by a health provider. Logistic regression models were performed to assess the crude and adjusted association between depression underdiagnosis and sociodemographic and health related factors. Population attributable risk fractions were calculated for significant predictors.
The prevalence of depression (according the PHQ-9) was 11.2% (IC95% 10.8:11.7). Depression underdiagnosis prevalence was 63.6% (IC95% 62.0%:65.2%) and was more frequent among male, elderly population, those with lower income, lower schooling, living in the North/Central region of the country, with best health perception, lower number of chronic disease and medical appointments. A significant percentage of depression underdiagnosed cases in Brazil in 2019 would be prevent by improving education (10.18%), income (3.99%), access to health visits (5.59%) and addressing barriers for depression diagnosis among males (5.44%), elderlies (3.32%), and population from the North region (8.29%).
CONCLUSION(S): depression underdiagnosis is common in Brazil. Preventive measures should target the sociodemographic and health related factors associated with depression underdiagnosis.
尽管抑郁症患病率高且后果严重，但往往诊断不足。我们旨在估计巴西全国具有代表性的基于人群的样本中抑郁症诊断不足的患病率以及与之相关的社会人口统计学和健康因素。
我们使用了巴西全国调查（2019年PNS）中70806名参与者（15 - 107岁）的数据。对于患者健康问卷-9（PHQ-9）得分>9且未被医疗服务提供者诊断出抑郁症的参与者，视为抑郁症诊断不足。进行逻辑回归模型以评估抑郁症诊断不足与社会人口统计学和健康相关因素之间的粗略关联和调整关联。计算了显著预测因素的人群归因风险分数。
抑郁症（根据PHQ-9）的患病率为11.2%（95%置信区间10.8:11.7）。抑郁症诊断不足的患病率为63.6%（95%置信区间62.0%:65.2%），在男性、老年人群、低收入、低学历、居住在该国北部/中部地区、健康认知良好、慢性病数量较少且医疗预约较少的人群中更为常见。通过改善教育（10.18%）、收入（3.99%）、获得医疗就诊机会（5.59%）以及解决男性（5.44%）、老年人（3.32%）和北部地区人群（8.29%）中抑郁症诊断的障碍，2019年巴西相当一部分抑郁症诊断不足的病例是可以预防的。
抑郁症诊断不足在巴西很常见。预防措施应针对与抑郁症诊断不足相关的社会人口统计学和健康因素。
