Prevalence, healthcare service utilization, and factors associated with depression among older adults in Brazil

Silva, Matteus Pio Gianotti Pereira Cruz; Feitosa, Paula Yhasmym de Oliveira; Silva, Júlia Emmily Gomes dos Santos; Nogueira, Matheus Figueiredo; Rocha, Fabiana Lucena; Figueiredo, Danielle Samara Tavares de Oliveira

doi:10.1590/1981-22562024027.230289.en

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Revista Brasileira de Geriatria e Gerontologia

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Original Articles • Rev. bras. geriatr. gerontol. 27 • 2024 • https://doi.org/10.1590/1981-22562024027.230289.en copy

Prevalence, healthcare service utilization, and factors associated with depression among older adults in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

To estimate the prevalence of depression among older adults in Brazil and the associated factors, and to describe the characteristics of health service utilization and treatments provided to older adults with depression.

Method

A cross-sectional, analytical study involving 22,728 older adults who participated in the National Health Survey (PNS), randomly selected across Brazil from August 2019 to March 2020. The outcome was self-reported depression, and the exposures were sociodemographic variables and a social network score. Descriptive and multiple analyses using logistic regression were employed.

Results

The prevalence of self-reported depression among older adults was 11.8% (95% CI: 11.1-12.57). It was observed that 71.6% (95% CI: 67.9-75.0) of the older population with depression only undergoes pharmacological treatment. There was a higher likelihood of depression among older women (OR=2.46; 95% CI: 2.06-2.94), aged 60 to 69 years (OR=1.67; 95% CI: 1.31-2.14), with white skin color (OR=2.95; 95% CI: 1.62-5.39), residents of the South region (OR=3.01; 95% CI: 2.27-4.00), and with multimorbidity (OR=1.79; 95% CI: 1.49-2.14).

Conclusion

Depression appeared with considerable frequency among older adults, especially among women. There is a need to encourage the adoption of non-pharmacological measures for the treatment of the condition, such as the use of integrative and complementary practices, physical activities, lifestyle changes, and the promotion of social activities.

Keywords
Aged; Depression; Health Services

Sociodemographic Characteristics	n^a, (%)^b,	CI (95%)^c,
Sex
Male	10,193 (44.5)	43.5-45.5
Female	12,535 (55.5)	54.5-56.5
Age group (years)
60 to 69	12,555 (54.8)	53.8-55.8
70 to 79	7,157 (31.1)	30.2-32.0
80 or more	3,016 (14.1)	13.3-14.8
Skin Color*
White	9,901 (51.3)	50.2-52.4
Black	2,455 (10.2)	9.6-10.8
Mixed-race	10,001 (36.7)	35.7-37.7
Yellow or Indigenous	369 (1.8)	1.5-2.1
Marital status
With partner	9,946 (43.3)	42.3-44.3
Without partner	12,782 (56.7)	55.7-57.8
Education (years)
12 or more	2,701 (13.1)	12.2-13.9
9 to 11	3,616 (16.5)	15.7-17.4
0 to 8	16,414 (70.4)	69.2-71.5
Social Class *
A	240 (1.5)	1.1-2.0
B	2,810 (13.8)	12.9-14.7
C, D and E	19,675 (84.7)	83.5-85.7
Residential area
Urban	17,313 (85.5)	84.8-86.1
Rural	5,415 (14.5)	13.9-15.2
Region
Southeast	5,825 (46.4)	45.3-47.6
South	3,307 (15.7)	15.0-16.4
Central-West	2,373 (6.4)	6.0-6.8
North	3,487 (6.1)	5.7-6.4
Northeast	7,736 (25.4)	24.5-26.2
Total	22,728 (100)

Variables	Depression
	Yes		No
	n^a,	%^b, CI (95%)^c,	n^a,	%^b, CI (95%)^c,	p-value^d,
Total	2,366	8 (11.1-12.5)	20,342	88.2 (87.4-88.9)
Sex					<0.0001
Male	571	6.6 (5.8-7.5)	9,622	93.4 (92.3-94)
Female	10,740	15.9 (14.9-16.9)	1,795	84.1 (83-85.3)
Age Group (years)					0.0005
60 to 69	1,417	13.2 (12.0-14.1)	11,138	86.8 (85.8-88.0)
70 to 79	705	10.6 (9.5-11.8)	6,452	89.4 (88.0-90.5)
80 or more	244	9.4 (7.6-11.2)	2,772	90.6 (88.8-92.2)
Skin Color					<0.0001
Black	177	8.9 (7.1-11.1)	2,278	91.1 (88.9-92.8)
White	1,275	14.0 (13.0-15.1)	8,626	86.0 (84.9-87.0)
Mixed-race	886	10.0 (9.1-11.0)	9,115	90.0 (89.0-90.1)
Yellow or Indigenous	28	6.3 (3.7-10.4	341	93.7 (89.6-96.3)
Marital Status					0.0001
With partner	913	10.0 (9.1-10.1)	9,033	90.0 (89.0-90.9)
Without partner	1,453	13.3 (12.3-14.3)	11,329	86.7 (85.7-87.7)
Education (years)					0.0823
12 or more	716	14.3 (12.1-16.7)	5,014	85.7 (83.3-87.9)
9 to 11	223	13.2 (11.6-14.9)	1,788	86.8 (85.1-88.4)
0 to 8	1,427	11.2 (10.4-12.1)	13,560	88.8 (87.8-89.6)
Social Class					0.0091
A	28	14.6 (9.2-22.5)	187	85.4 (77.5-90.8)
B	321	14.5 (12.5-16.8)	2,061	85.5 (83.2-87.5)
C. D e E	2,017	11.4 (10.7-12.1)	18,111	88.6 (87.9-89.3)
Residential Area					<0.0001
Urban	1,985	12.5 (11.7-13.3)	15,328	87.5 (86.7-88.3)
Rural	381	8.3 (7.1-9.6)	5,034	91.7 (90.4-92.9)
Region					<0.0001
Southeast	691	12.6 (11.4-13.8)	5,134	87.4 (86.1-84.5)
South	565	17.1 (15.5-18.9)	2,742	82.9 (81.1-84.5)
Central-West	269	11.7 (10.1-13.4)	2,104	88.3 (86.6-89.9)
North	220	6.1 (5.0-7.4)	3,267	93.9 (92.6-95.0)
Northeast	621	8.3 (7.5-9.2)	7,115	91.7 (90.7-92.5)
Multimorbidity					<0.0001
No	420	8.0 (6.9-9.2)	6,015	92.0 (90.8-93.1)
Yes	1,924	13.7 (12.8-14.6)	13,609	86.3 (85.4-87.2)
Social Network Score					0.3112
Higher social network (3^rd, and 4^th, quartiles)	1,301	11.5 (11.1-12.6)	8,761	85.5 (87.5-89.4)
Lower network (1^st, and 2^nd, quartiles)	1,065	12.2 (11.1-13.5)	11,601	87.8 (86.5-88.9)

Variables	%^a,	95%^b, CI
Does Mr./Ms. regularly visit the physician/health service because of depression or only when there is a problem?
Yes	39.3	36.3-42.5
No, only when there is a problem	31.5	28.8-34.3
Never goes	29.2	26.6-31.9
What is the main reason for Mr./Ms. not visiting the physician/health service regularly because of depression?
No longer depressed	71.6	67.9-75.0
The health service is distant	2.4	1.7-3.4
Lack of motivation	0.7	5.0-8.6
Financial difficulties	3.9	2.5-6.1
Time/hour-related issues	4.4	0.4-5.0
Could not schedule an appointment through the health plan	0.6	0.3-1.3
Does not know who to seek or where to go	0.5	0.2-0.9
Others	10.0	7.7-12.8
Treatments for depression
Undergoes psychotherapy
Yes	13.1	11.1-15.4
No	86.9	84.6-88.9
Takes medication
Yes	61.8	58.7-64.8
No	38.1	35.2-41.2
Uses integrative or complementary practices
Yes	4.0	3.3-5.6
No	96.0	94.4-96.7
When was the last time Mr./Ms. received medical attention for depression?
Less than 6 months ago	41.2	38.1-44.4
6 months to less than 1 year ago	10.1	8.4-12.1
1 year to less than 2 years ago	6.5	5.2-8.1
2 years to less than 3 years ago	4.1	3.1-5.4
3 years or more	36.5	33.5-39.4
Never received	1.6	1.1-2.3

Variables	Depression
Variables	OR Unadjusted^a,	(95%CI)^b,	p-value^c,	OR Adjusted^d,	(95%CI) ^b,	p-value^c,
Sex reference (male)
Female	2.64	2.25-3.12	<0.0001	2.46	2.06-2.94	<0.0001
Age group reference (80 or more)
70 to 79 years	1.17	0.91-1.51	0.215	1.22	0.94-1.58	0.118
60 to 69 years	1.47	1.16-1.86	0.001	1.67	1.31-2.14	<0.0001
Skin color reference (Yellow or Indigenous)
Black	1.76	0.92-3.37	0.087	2.21	1.20-4.06	0.011
Mixed-race	1.99	1.09-3.62	0.087	1.73	0.88-3.37	0.106
White	3.16	1.75-5.70	<0.0001	2.95	1.62-5.39	<0.0001
Marital status reference (With partner)
Without partner	1.32	1.14-1.52	<0.0001	-
Education reference (0 to 8 years)
9 to 12 years	1.07	0.83-1.36	0.595	-
12 years or more	1.19	1.0-1.40	0.025	-
Socioeconomic status reference (Class A)
B	0.92	0.47-1.79	0.822	-
C, D and E	0.71	0.38-1.35	0.308	-
Residential area reference (Urban)
Rural	0.67	0.55-0.80	<0.0001	-
Region reference (North)
South	3.63	2.80-4.72	<0.0001	3.01	2.27-4.00	<0.0001
Southeast	2.29	1.76-2.96	<0.0001	1.94	1.48-2.55	<0.0001
Central-West	2.02	1.50-2.73	<0.0001	1.76	1.28-1.41	<0.0001
Northeast	1.43	1.10-1.86	<0.0001	1.37	1.05-1.79	<0.0001
Multimorbidity reference (No)
Multimorbidity	1.82	1.53-2.17	<0.0001	1.79	1.49-2.14	<0.0001

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[1] Correspondence Matteus Pio Gianotti Pereira Cruz Silva matteuspgpcs@gmail.com

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Prevalence, healthcare service utilization, and factors associated with depression among older adults in Brazil

Abstract

﻿Objectives

Method

Results

Conclusion

Objectives