Use of Mental Health Services for Patients Diagnosed with Major Depressive Disorders in Primary Care

Profile of individuals served and presumed coverage of Psychosocial Care Centers (CAPS) in Brazil: A study of the period 2013-2019

OBJECTIVE

To describe the profile of individuals with depression who received assistance at CAPS in Brazil between 2013 and 2019, focusing on their clinical and demographic characteristics, and to calculate the estimated coverage of CAPS across the national territory and its constituent federal units.

METHODS

Descriptive, ecological, time-series study with secondary data from national databases, referring to care provided at CAPS in the country for adults aged 18 years or over-diagnosed with depression (F32-32.9 and F33-F33.9). The estimated coverage of CAPS was calculated for 2013 and 2019 using registered and active services.

RESULTS

There was a 107% increase in the number of patients with depression receiving treatment at CAPS between 2013 and 2019. Women accounted for 77% of the patients, with the majority falling within the age range of 41 to 61years (49%). The predominant racial demographics were white (38%) and brown (34%). The diagnosis of depressive episodes was prevalent among 65% of the patients, and individual care was administrated to 75% of them. The presumed CAPS coverage was 71% in 2013 and increased to 87% in 2019 nationwide, although significant discrepancies were observed among different states.

CONCLUSION

Progress was evident in the implementation of CAPS across Brazil during the period spanning 2013 to 2019. Nonetheless, disparities persist among the federative units, and there remains an underutilization of group and family care within CAPS services.

Help-Seeking Behaviors and Related Factors in Chinese Patients With Major Depressive Disorder: A Community-Based Cross-Sectional Study

BACKGROUND

Although evidence-based and effective treatments are available for people with major depressive disorder (MDD), a substantial number do not seek or receive help. Therefore, this study aimed to (1) investigate the total help-seeking rate and first-time help-seeking choices; (2) explore the perceived helpfulness of 23 potential sources; and (3) evaluate the factors related to help-seeking behaviors among patients with MDD.

MATERIALS AND METHODS

Data came from the Tianjin Mental Health Survey (TJMHS), which included a representative sample of adult community residents (n = 11,748) in the Chinese municipality of Tianjin. Of these, 439 individuals were diagnosed with lifetime MDD according to the Diagnostic and Statistical Manual-fourth edition (DSM-IV) and administered a help-seeking questionnaire.

RESULTS

In a survey, 28.2% of patients with MDD living community reported that they had ever sought any help during their entire lifetime before the interview, with 8.2% seeking help in mental healthcare settings, 8.0% only in other healthcare settings, and 12.0% only in non-healthcare sources (e.g., family, friends, and spiritual advisor). Among help-seekers, the first help mainly was sought in non-healthcare sources (61.3%), followed by healthcare settings (25.8%) and mental healthcare settings (12.9%). The majority of MDD individuals thought the non-healthcare sources were not helpful and mental healthcare settings were helpful or possibly helpful to solve mental problems. Female, having 10-12 or higher education years, comorbid anxiety disorders were associated with increased help-seeking.

CONCLUSION

A small percentage of individuals with MDD living in community of Tianjin sought help. They preferred non-healthcare sources to healthcare settings. Demographic and clinical features were associated with help-seeking behaviors.

Editors' Comments on the Special Issue "Social Determinants of Mental Health"

Mental disorders are one of the greatest public health concerns of our time, and they are affected by social factors. To reduce the considerable burden of mental disorders, more global and systematic knowledge of the social determinants of mental health is necessary. This paper presents the results of the 27 studies included in the International Journal of Environmental Research and Public Health Special Issue, “Social Determinants of Mental Health”. The studies are grouped into four broad categories: social inclusion and mental health, young people’s mental health, mental health at work, and mental health service users. The results cover different countries, age populations, settings, and methodologies. Finally, the main findings on the relationship between social determinants and mental health are presented and summarized.