Depression, gender, and the treatment gap in Mexico

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 X-2 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. (C) 2011 Elsevier B.V. All rights reserved.