Abstract
BackgroundThere is a large “treatment gap” for depression worldwide. This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression.MethodsData were analysed from a two round cross-sectional community survey conducted in rural Madhya Pradesh between May 2013 and December 2016. We examined the proportion of individuals who screened positive for depression (≥10) on the Patient Health Questionnaire (PHQ-9) who sought treatment in different sectors, for depression symptoms and for any reason, and compared the latter with health service use by screen-negative individuals. We analysed the frequency with which barriers to healthcare utilisation were reported by screen-positive adults. We also analysed the association between seeking treatment for depression and various predisposing, enabling and need factors using univariable regression.Results86% of screen-positive adults reported seeking no depression treatment. However, 66% had used health services for any reason in the past 3 months, compared to 46% of screen-negative individuals (p < 0.0001). Private providers were most frequently consulted by screen-positive adults (32%), while only 19% consulted traditional providers. Structural barriers to healthcare use such as cost and distance to services were frequently reported (54 and 52%, respectively) but were not associated with treatment-seeking for depression. The following factors were found to be positively associated with treatment-seeking for depression: higher symptom severity; lack of energy, lack of interest/pleasure, low self-esteem, or slow movements/restlessness on more than 7 days in the past 2 weeks; being married; having discussed depression symptoms; and reporting problems with medication availability and supply as a barrier to healthcare. No evidence was found for an association between treatment-seeking for depression and most socio-economic, demographic or attitudinal factors.ConclusionsThese findings suggest that the majority of adults who screen positive for depression seek healthcare, although not primarily for depression symptoms, indicating the need to improve detection of depression during consultations about other complaints. Private providers may need to be considered in programmes to improve depression treatment in this setting. Further research should test the hypotheses generated in this descriptive study, such as the potential role of marriage in facilitating treatment-seeking.
Highlights
There is a large “treatment gap” for depression worldwide
This study is a descriptive analysis of treatment-seeking for depression by adults in Sehore sub-district, Madhya Pradesh, with the following specific objectives: (1) To estimate the proportion of adults who screen positive for depression who consult different types of treatment providers, (a) for depression symptoms and (b) for any reason, and to compare the latter with general health care use by people who screen negative for depression; (2) To measure the prevalence of self-reported barriers to using health services among adults who screen positive for depression; (3) To estimate the change in probability of treatmentseeking for symptoms of depression associated with need, predisposing and enabling factors, among screen-positive individuals
Sample This report is a secondary analysis of data from a population-based, cross-sectional community survey carried out with the primary aim of estimating the change in treatment-seeking among adults who screen positive for depression, before and after implementation of the Mental Health Care Plans (MHCP)
Summary
This study aimed to better understand the treatment gap in rural India by describing health care use and treatment-seeking for depression. In developed countries only 54.3% of people with a 12 month major depressive episode report visiting any service provider for mental health reasons in the past year, and just 25.2% in low- and middle-income countries (LMIC) [2]. The World Health Organization (WHO) advocates integrating evidence-based interventions into primary care to increase the availability and accessibility of services [4] as a strategy to reduce the gap. In the World Mental Health Surveys, only 34.6% of people with depression in LMIC regarded themselves as needing treatment [3], suggesting that the treatment gap cannot be explained solely in terms of limited availability of mental health services
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