Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis

Abstract

Aims The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations. Methods Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression. Results Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5–10.3), 10.8% (95% CI: 10.4–11.2) and 6.9% (95% CI: 6.6–7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9–9.3 v. 10.7%; 95% CI: 10.2–11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4–12.1 v. 11.3%; 95% CI: 10.8–11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77–0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78–0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57–0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66–0.79) and other (adjusted OR: 0.63; 95% CI: 0.45–0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes. Conclusions Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.

Epidemiology of Mental Disorders And The Transdiagnostic Aproach In Mental Health, In Northwest of São Paulo state, Brazil

“…The rate was above 50%, being especially high in women, the unemployed, people with low education, and low income 22,23,24 . These results place Brazil as one of the countries with the highest number of anxious people in the world, demonstrating a high prevalence of mental disorders in the Brazilian population 25 . Having the pro le of these patients is important for the promotion of public policies, adequate treatment, and clinical improvement.…”

“…In young adults these conditions may re ect socioeconomic vulnerability, with reduced productive capacity and increased use of health services. They also indicate greater needs for social assistance, justice, and informal care 25,26 .…”

“…Following the indices of international reports 23,24,25 , we also identi ed the predominance of females for anxiety and depressive disorders: for the group with generalized anxiety, 78.86% of the patients were women. However, many patients have multiple conditions -anxiety and depression, for example, and there seems to be a tendency for these patients to have more than one diagnosis.…”

Inequalities in the prevalence of cardiovascular disease risk factors in Brazilian slum populations: A cross-sectional study

“…The United Nations Human Settlements Programme (UN-Habitat) definition of slums was used to identify respondents living in slums and has been used in similar studies in Brazil [49,50]. It defines slums as an environment where inhabitants lack access to one or more of these conditions: improved water source, improved sanitation facilities, sufficient living area, housing durability and security of tenure (Table 1) [51].…”

Slums and pandemics

“… 8 Before the pandemic, there were no large differences in cellphone penetration between slum and non-slum areas. Using the 2019 National Health Survey data and Pitcairn et al (2021) ’s methodology to classify households into slum and non-slum residents, we find that 95.80% and 92.58% of households in non-slum and slum areas have cellphones, respectively. However, individuals in slums might use their phones differently during the pandemic (e.g., the possibility of remote working is different between the two groups of residents).…”