Prevalence, Awareness, Treatment, and Burden of Major Depressive Disorder: Estimates from the National Health and Wellness Survey in Brazil

ObjectiveMajor depressive disorder (MDD) is often underdiagnosed, undertreated, and associated with negative health outcomes. The current study examined the prevalence of MDD signs and symptoms in Brazil, including awareness, diagnosis, treatment, and the association of MDD with health outcomes.MethodsData were collected from the 2011 National Health and Wellness Survey in Brazil (N = 12,000). Excluding those with bipolar disorder, respondents who met Patient Health Questionnaire-9 criteria for MDD (n = 1105) were compared with those not qualifying as having MDD or any depressive symptoms (n = 8684), analyzing separately those currently taking (n = 184) or not taking (n = 155) prescription medication for depression. Sociodemographics and health status, symptoms, experience of depression, diagnosis, MDD severity, pharmacotherapy, productivity impairment (Work Productivity and Activity Impairment questionnaire), health status (Short-Form 12, version 2), and health care resource use were measured. Results were weighted and projected to the Brazil adult population. Differences were measured with column proportion and mean tests for categorical and continuous outcomes, respectively.ResultsMDD prevalence was 10.2%, with only 28.1% of the individuals with MDD diagnosed and 15.6% currently using prescription medication for depression. Males were especially likely to be unaware of MDD. Compared with non-MDD controls, patients with MDD (treated or untreated) reported significantly greater overall work impairment, worse mental and physical health status, and greater health care resource utilization (all P<0.05). There was a trend for worsening health outcomes with increasing MDD severity.ConclusionsThese findings suggest that Brazilians may be underdiagnosed and undertreated for MDD. Individuals with MDD reported substantially poorer health outcomes, suggesting the need to increase MDD awareness, especially among males, and provide better access to treatment.