Brief report
Depression, gender, and the treatment gap in Mexico

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Abstract

Background

Gender is associated to lifetime risk of mood disorders, women having the highest lifetime and 12-month prevalence. In Mexico one out of five individuals with any mood disorder receives treatment during the first year. We evaluate the ages at which women and men are more vulnerable for the first onset of a major depressive episode, the longest duration and greatest number of episodes, the areas of daily functioning most affected, and which variables predict whether or not a person receives any kind of treatment.

Methods

The Mexican National Comorbidity Survey, as part of the World Mental Health Surveys Initiative, is based on a stratified, multistage area probability Mexican urban household sample aged 18 to 65 (n = 5782). Wald X2 tests were performed to evaluate gender and cohort differences; logistic regression models were performed to evaluate gender and cohort as treatment predictors.

Results

The most vulnerable group is the cohort of 45–54 year-old women. Once a first episode occurs, there are no sex differences in terms of number or length of episodes. There is a gap in service use, especially among 18–29 year-old women; the oldest women are the most impaired.

Limitations

Individuals from rural communities are not represented and there may have been recall bias due to the retrospective design.

Conclusions

Efforts should focus on factors related to the first onset episode and on early treatment programs to reduce the risk of subsequent episodes. Research and health resources should attend to the most vulnerable group, and the youngest women, who are in the reproductive age and have the largest treatment gap.

Introduction

Mood disorders are the most prevalent mental disorders; between 3.3% and 21.4% of the world population suffer from them (Kessler et al., 2007). In Mexico, the reported lifetime prevalence of any mood disorder is 9.2% (Medina-Mora et al., 2007) and in the last 12 months 4.8% (Medina-Mora et al., 2005a). According to the World Health Organization (WHO, 2008), approximately 56% of the people suffering from depression worldwide do not receive any treatment. Lack of treatment for mood disorders is especially critical given the impairment associated with these disorders. Mood disorders are a major contribution to the total burden of disease and economic burden, which includes unemployment, the need of medicines, and other medical and social services (WHO, 2008).

In Mexico, 70% of those with any mood disorder have received any kind of treatment (Wang et al., 2007); and only 16% received services in the same year that the symptoms started (Medina-Mora et al., 2009, Wang et al., 2007). The duration of delay in treatment has been estimated to be 14 years (Wang et al., 2007). In order to close the treatment gap that exists among the Mexican population, it is important to identify the population groups that are most vulnerable to depression and least likely to seek services.

To date, there has not been a detailed analysis of how the prevalence of major depressive episode (MDE) is distributed among the Mexican population, the disability associated with the disorder, or the treatment needs. Since it is already known that women have a higher prevalence of mood disorders than men (Caraveo-Anduaga et al., 1996, Medina-Mora et al., 2005a, Medina-Mora et al., 2007), we specifically aim to identify the ages at which women and men are most vulnerable for the first onset of MDE, longer duration of episodes and greater number of episodes. In addition, we also want to identify the areas of daily life (such as household or work activities) that are most affected by MDE, and which variables may predict whether or not a person gets any kind of treatment.

Section snippets

Sample and procedure

The Mexican National Comorbidity Survey was based on a stratified, multistage area probability sample of persons aged 18–65 in the non-institutionalized population living in urban areas (population  2500) of Mexico, which represents 75% of the Mexican population. All recruitment and consent procedures were approved by the Internal Review Board of the National Institute of Psychiatry. The response rate was 76.6% (n = 5826) of eligible respondents and within the scope of other surveys from the World

Prevalence and course

Women had a higher lifetime prevalence of MDE than men (Table 1). The highest estimates for women were for those aged 45 to 54 while for men the highest estimates were for those over 55. The lowest prevalence among women was for those aged 18 to 29 and among men, though not significant, was for those aged 30 to 44. Among individuals that reported lifetime prevalence, close to 10% also reported a MDE in the previous year. For the 12-month conditional prevalence, the difference between men and

Discussion

Consistent with previous publications (Caraveo-Anduaga et al., 1996, Hopcroft, 2007, Medina-Mora et al., 2007), we found that women had a higher lifetime prevalence of MDE than men in all age groups. However, our findings differ from international surveys that have reported gender differences to be more evident in the older than younger population (Seedat et al., 2009); we found that in the Mexican population the older men and women have more similar prevalences than the younger. This older age

Conclusions

Even when women are more likely than men to experience a depressive episode, the course and consequences do not differ between them. Men, however, are more likely to use services for treatment of MDE in Mexico. For preventive purposes, in Mexico, as elsewhere, it may be most efficient to focus specifically on the factors related to the first episode onset. Once a first episode has developed, the risk of multiple episodes throughout the lifetime is higher (Judd et al., 2000); which makes it

Role of funding source

The Mexican National Comorbidity Survey was supported by the National Institute of Psychiatry Ramon de la Fuente (grant INPRFM-DIES 4280) and by the National Council on Science and Technology (grant CONACyT-G30544-h), with supplemental support from the Pan American Health Organization.

Conflict of interest

All the authors report no conflicts of interest.

Acknowledgments

We thank the World Mental Health staff for assistance with instrumentation, fieldwork, and data analysis.

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