Asociación entre el diagnóstico de depresión y la cobertura de servicios de salud: un análisis multinivel de la Encuesta Nacional de Salud de Brasil, 2019

Silva, Flávia Oliveira da; Carvalho, Andressa Lourenço; Schnepper, Guilherme Guimarães Maia; Marchesi, Léo Domingues; Leite, Isabella Ribeiro; Endo, Laura Vazarin; Lima, Camila Del Valhe Sanchez; Massa, Kaio Henrique Correa

doi:10.1590/S2237-96222026v35e20250666.en

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 35 • 2026 • https://doi.org/10.1590/S2237-96222026v35e20250666.en linkcopiar

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10.1590/S2237-96222026v35e20250666.a

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Asociación entre el diagnóstico de depresión y la cobertura de servicios de salud: un análisis multinivel de la Encuesta Nacional de Salud de Brasil, 2019

Autoría SCIMAGO INSTITUTIONS RANKINGS

Objetivo Analizar la asociación entre la prevalencia del diagnóstico de depresión en adultos y la cobertura de servicios de salud en las Unidades Federativas de Brasil.

Métodos Estudio transversal con datos de la Encuesta Nacional de Salud de 2019. Se calcularon las razones de momios ajustadas (odds ratio, OR) y los intervalos de confianza del 95 % (IC95%) mediante modelos de regresión logística multinivel para analizar la asociación entre el diagnóstico de depresión y la cobertura de servicios de salud.

Resultados En 2019 se analizaron 88.531 adultos residentes en las 27 Unidades Federativas brasileñas. Se observó una mayor probabilidad de diagnóstico de depresión entre los adultos residentes en Unidades Federativas con mayor cobertura de la Estrategia de Salud Familiar (OR 1,35; IC95% 1,29; 1,42), y con un mayor número de centros de apoyo a la salud familiar (OR 1,17; IC95% 1,13; 1,21) y centros de atención psicosocial (OR 1,31; IC95% 1,23; 1,41).

Conclusión Los resultados de este estudio indicaron que mayor cobertura de los servicios de salud se asoció con mayor prevalencia de diagnósticos de depresión. Estos hallazgos refuerzan la importancia de ampliar y fortalecer la red de atención psicosocial para mejorar el diagnóstico y la atención de las personas con trastornos mentales en Brasil.

Palabras clave
Depresión; Acceso a los Servicios de Salud; Determinantes Sociales de la Salud; Salud Mental; Epidemiología

Variables	Prevalence of depression n (%)
Total	8,242 (10.2)
Sex
Male	1,930 (5.1)	<0.001
Female	6,312 (14.7)
Age group (years)
18–24	402 (5.9)	<0.001
25–39	1,805 (8.1)
40–59	3,669 (12.7)
≥60	2,336 (11.8)
Race/skin color
White	3,796 (12.5)	<0.001
Brown	3,573 (8.6)
Black	766 (8.2)
Schooling
Incomplete elementary education	3,269 (10.9)	<0.001
Complete elementary education	996 (9.4)
Complete high school education	2,363 (9.0)
Complete higher education	1,614 (12.2)
Marital status
Single	2,961 (8.4)	<0.001
Married	3,119 (10.1)
Divorced	1,151 (17.9)
Widowed	1,011 (14.2)
Alcohol consumption frequency
Never	5,566 (11.6)	<0.001
Less than once a month	910 (9.1)
Once or more times a month	1,766 (8.0)
Regular physical activity (≥150 minutes/week)
No	6,163 (10.6)	0.004
Yes	2,079 (9.3)
Tobacco smoking
Never smoked	4,436 (9.3)	<0.001
Former smoker	2,545 (11.8)
Current smoker	1,231 (11.5)
Presence of hypertension
No	4,853 (8.7)	<0.001
Yes	3,355 (15.3)
Presence of diabetes
No	7,033 (10.3)	<0.001
Yes	1,032 (15.4)
Presence of chronic kidney disease
No	7,993 (10.1)	<0.001
Yes	249 (21.1)
Presence of chronic obstructive pulmonary disease
No	7,946 (9.9)	<0.001
Yes	962 (27.3)
Household registered with the Family Health Strategy (ESF)
No	2,069 (10.1)	0.771
Yes	5,257 (10.3)
Frequency of ESF household visits in the last year
Never received a visit	1,383 (11.5)	0.015
Monthly	1,902 (9.6)
Bimonthly or less	1,972 (10.3)
Presence of private health insurance
No	5,739 (9.3)	<0.001
Yes	2,503 (12.7)

Variables	Model 1a OR (95%CI)	Model 2b OR (95%CI)
Sex
Male	1.00	1.00
Female	3.16d (2.86; 3.49)	3.07d (2.65; 3.56)
Age group (years)
18–24	1.00	1.00
25–39	1.33c (1.10; 1.60)	1.39 (0.85; 1.52)
40–59	2.06d (1.66; 2.57)	1.58c (1.17; 2.18)
≥60	1.83d (1.51; 2.22)	1.01 (0.71; 1.44)
Race/skin color
White	1.00	1.00
Brown	0.86d (0.82; 0.91)	0.82d (0.77; 0.88)
Black	0.77d (0.68; 0.88)	0.71d (0.59; 0.86)
Schooling
Incomplete elementary education	1.00	1.00
Complete elementary education	0.95 (0.79; 1.15)	0.96 (0.78; 1.19)
Complete high school education	0.89c (0.81; 0.98)	0.89 (0.77; 1.03)
Complete higher education	1.03 (0.89; 1.19)	0.91 (0.80; 1.04)
Marital status
Single	1.00	1.00
Married	0.96 (0.89; 1.03)	0.93 (0.84; 1.03)
Divorced	1.48d (1.37; 1.61)	1.58d (1.40; 1.78)
Widowed	0.94 (0.83; 1.05)	0.80c (0.66; 0.97)
Alcohol consumption frequency
Never	1.00
Less than once a month	0.73d (0.64; 0.82)
Once or more times a month	0.72d (0.60; 0.87)
Regular physical activity (≥150 minutes/week)
No	1.00
Yes	0.96 (0.89; 1.04)
Tobacco smoking
Never smoked	1.00
Former smoker	1.33d (1.18; 1.50)
Current smoker	1.43d (1.25; 1.64)
Presence of hypertension
No	1.00
Yes	1.49d (1.38; 1.62)
Presence of diabetes
No	1.00
Yes	1.18d (1.08; 1.31)
Presence of chronic kidney disease
No	1.00
Yes	1.50c (1.15; 1.95)
Presence of chronic obstructive pulmonary disease
No	1.00
Yes	2.47d (2.08; 2.94)
Frequency of Family Health Strategy household visits in the last year
Never received a visit	1.00
Monthly	0.83c (0.74; 0.93)
Bimonthly or less	0.94c (0.88; 0.99)
Presence of private health insurance
No	1.00
Yes	1.17c (1.04; 1.33)
Bayesian information criterion	96.189.144	56.066.876
Intraclass correlation coefficient	0.0268	0.0196

Variables	Model 1 OR (95%CI)	Model 2 OR (95%CI)	Model 3 OR (95%CI)
Second level: Federative Unit of residence
Family Healtd Strategy coverage, quartile
1	1.00
2	1.54^b (1.50; 1.58)
3	1.78^b (1.71; 1.85)
4	1.35^b (1.29; 1.42)
Family Health Support Center coverage, quartile
1		1.00
2		0.97 (0.93; 1.01)
3		2.01^b (1.91; 2.09)
4		1.17^b (1.13; 1.21)
Psychosocial Care Center coverage, quartile
1			1.00
2			1.26^b (1.15; 1.38)
3			1.09^c (1.01; 1.19)
4			1.31^b (1.23; 1.41)
Per capita income, quartile
1	1.00	1.00	1.00
2	1.27^b (1.20; 1.33)	1.05 (0.98; 1.11)	2.18^b (1.99; 2.38)
3	1.82^b (1.73; 1.91)	2.15^b (2.02; 2.29)	2.23^b (2.09; 2.38)
4	2.33^b (2.18; 2.49)	1.77^b (1.64; 1.91)	1.78^c (1.64; 1.92)
Bayesian information criterion	56.044.227	56.047.232	56.055.753
Intraclass correlation coefficient	0.0034	0.0081	0.0233

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[1] ^aModel adjusted with the demographic and socioeconomic variables; ^bModel adjusted with the demographic, socioeconomic, lifestyle, presence of diseases and health service coverage variables; ^cp-valor<0,050; ^dp-valor≤0,001.