Understanding the journey of patients with depression in Brazil: A systematic review

Meleiro, Alexandrina; Teng, Chei Tung; Demetrio, Frederico Navas; Batista, Vivian Cardoso; Vieira, Luiz Fernando; Elorza, Paola Marina

doi:10.1016/j.clinsp.2023.100192

Alexandrina Meleiro

contributed to study planning, reviewed the manuscript, and approved the final manuscript

Physician’s Mental Health Care Commission, ABP, Rio de Janeiro, RJ, Brazil

Chei Tung Teng

contributed to study planning, reviewed the manuscript, and approved the final manuscript

Collaborating Professor, Department of Psychiatry, Institute of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil

http://orcid.org/0000-0001-8163-2445

Frederico Navas Demetrio ^**Corresponding author. E-mail address:frederico.demetrio@hc.fm.usp.br (F.N. Demetrio).

contributed to study planning, reviewed the manuscript, and approved the final manuscript

Project Mood Disorders (GRUDA), Anxiety and Depression Ward (EAND), Institute of Psychiatry, Instituto de Psiquiatria Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

http://orcid.org/0000-0003-0818-7378

Vivian Cardoso Batista

contributed to study planning, reviewed the manuscript, and approved the final manuscript

Research, Development and Medical, Upjohn – a Pfizer Division, São Paulo, SP, Brazil

Luiz Fernando Vieira

contributed to study planning, reviewed the manuscript, and approved the final manuscript

Research, Development and Medical, Upjohn – a Pfizer Division, São Paulo, SP, Brazil

Paola Marina Elorza

contributed to study planning, reviewed the manuscript, and approved the final manuscript

Research, Development and Medical, Upjohn – a Pfizer Division, Latin America, Argentina

http://orcid.org/0000-0002-0092-8357

*Corresponding author. E-mail address:frederico.demetrio@hc.fm.usp.br (F.N. Demetrio).

Conflicts of interest

The authors declare no conflicts of interest.

Term	Definition
Depression	Depression is defined according to the criteria common to the Diagnostic and Statistical Manual (DSM)-III, DSM-IV and DSM-V: the presence of ≥5 symptoms in the last 2 weeks with >1 symptom being either depressed mood or the loss of interest or pleasure. Mild depression is diagnosed when the severity of the symptoms is distressing but manageable, there are few, if any, symptoms beyond those necessary for the diagnosis, and they only slightly impair social or occupational functioning. Whereas in severe depression, the severity of the symptoms is extremely upsetting and uncontrollable, the number of symptoms is far greater than that needed to make the diagnosis, and the symptoms significantly impair social and occupational functioning [⁴⁷47 Park LT, Zarate Jr CA. Depression in the primary care setting. New Engl J Med 2019;380(6):559–68.]
Awareness	Self-reported knowledge or awareness of depression/depressive disorders
Screening	Use of assessment questionnaires to screen for depression/depressive symptoms/depressive disorders
Diagnosis	Diagnosis of depression/ depressive disorder by an HCP
Treatment	Use of pharmacotherapy or psychotherapy to treat depression/depressive disorders
Adherence	Self-reported adherence and/or compliance with prescribed pharmacotherapy or psychotherapy
Control/Remission	Improvement in depressive symptoms during treatment

S No	Authors	Year	Study design	Sample size (n)	Patient journey data
1	Wang et al. [²¹21 Wang YP, Chiavegatto Filho AD, Campanha AM, Malik AM, Mogadouro MD, Cambraia M, et al. Patterns and predictors of health service use among people with mental disorders in São Paulo metropolitan area, Brazil. Epidemiol Psychiatr Sci 2017;26(1):89–101.]	2017	A cross-sectional multistage representative study (São Paulo Mental Health Survey)	540	Treatment (32.80%)
2	Barros et al. [¹⁹19 Barros MB, Lima MG, Azevedo RC, Medina LB, Lopes CD, Menezes PR, et al. Depression and health behaviors in Brazilian adults–PNS 2013. Rev Saude Publica 2017;51:8s.]	2017	A population-based cross-sectional study (using the database of the National Survey on Health).	49,025	Prevalence (9.7%), Diagnosis (7.2%)
3	Munhoz et al. [²²22 Munhoz TN, Nunes BP, Wehrmeister FC, Santos IS, Matijasevich A. A nationwide population-based study of depression in Brazil. J Affect Disord 2016;192:226–33.]	2016	Survey (household-based interviews) conducted with random and cluster-based sampling (performed in three stages: census tracts, households and individuals).	60,202	Prevalence (4.1%)
4	Galvao et al. [²³23 Galvao TF, Silva MT, Gross R, Pereira MG. Medication use in adults living in Brasilia, Brazil: a cross-sectional, population-based study. Pharmacoepidemiol Drug Saf 2014(5):507–14.]	2014	A cross-sectional population-based study. Sample selected using a two-stage probabilistic sampling and interviewed in their home	1,820	Treatment (60.4%)
5	Viana et al. [²⁴24 Viana MC, Teixeira MG, Beraldi F, Bassani ID, Andrade LH. Sao Paulo Megacity Mental Health Survey-a population-based epidemiological study of psychiatric morbidity in the Sao Paulo metropolitan area: aims, design and field implementation. Braz J Psychiatry 2009;31(4):375–86.]	2012	A cross-sectional population-based epidemiological study.	5,037	Prevalence (16.9%)
6	Prado et al. [²⁵25 Prado JD, Kerr-Correa F, Lima MC, Silva GG, Santos JL. Relations between depression, alcohol and gender in the metropolitan region of São Paulo, Brazil. Cien Saude Colet 2012;17:2425–34.]	2012	An epidemiological survey using a stratified probability sample	2,083	Prevalence (21.8%)
7	Fujii et al. [²⁶26 Fujii RK, Goren A, Annunziata K, Mould-Quevedo J. Prevalence, awareness, treatment, and burden of major depressive disorder: estimates from the national health and wellness survey in Brazil. Value Health Reg Issues 2012;1(2):235–43.]	2012	A cross-sectional survey	12,000	Prevalence (10.2%), Awareness (42.4%), Diagnosis (65.9%), Treatment (54.5%)
8	Andrade et al. [²⁷27 Andrade LH, Wang YP, Andreoni S, Silveira CM, Alexandrino-Silva C, Siu ER, et al. Mental disorders in megacities: findings from the Sao Paulo megacity mental health survey, Brazil. PLoS One. 2012;7(2):e31879.]	2012	A representative sample survey	5,037	Prevalence (9.4%)
9	Moreno et al. [²⁰20 Moreno DH, Andrade LH. Latent class analysis of manic and depressive symptoms in a population-based sample in São Paulo, Brazil. J Affect Disord 2010;123:208–15.]	2010	A cross-sectional study	1464	Prevalence (9%)
10	Lopes et al.	2016	National Health Survey (PNS)	60202	Prevalence (7.9%)
11	KOL Opinion (Anecdotal data)		NA		Screening (25% to 50%)

Awareness	Screening	Diagnosis	Treatment	Adherence	Control
42.4%^a a Published data,	37.5%^‡ ‡ Simple average, , ^b b Anecdotal data.	18.7%^† † Weighted average, , ^a a Published data,	54.4%^† † Weighted average, , ^a a Published data,	No data	No data

[1] *Corresponding author. E-mail address:frederico.demetrio@hc.fm.usp.br (F.N. Demetrio).

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Understanding the journey of patients with depression in Brazil: A systematic review

Abstract

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