Determinants of access to health care for depression in 49 countries: A multilevel analysis

Ricardo Araya, Pedro Zitko, Niina Markkula, Dheeraj Rai, Kelvyn Jones

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


Background: The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. Methods: We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. Results: The sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, country-level factors explained 27.6% of the variance in access to diagnosis and 24.1% in access to treatment. Access to treatment for depression improved with increasing country income. Female gender, better education, the presence of physical co-morbidity, more material assets, and living in urban areas were individual level determinants of better access. Limitations: Data on other contextual factors was not available. Unmet need was likely underestimated, since only lifetime treatment data was available. Conclusion: This study highlights major inequalities in access to a diagnosis and treatment of depression. Unlike the prevalence of depression, where contextual factors have shown to have less importance, a significant proportion of the variance in access to depression care was explained by country-level income.

Original languageEnglish
Pages (from-to)80-88
Number of pages9
JournalJournal of Affective Disorders
StatePublished - Jul 2018
Externally publishedYes


  • Access to Health Care
  • Depressive disorders
  • Multilevel analysis
  • Treatment gap


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