This study evaluated the demographic characteristics that contribute to inequalities in the receiving of treatment for depression symptoms among Peruvian adults. Only one in ten adults with depressive symptoms receive treatment, which is like other countries such as Argentina (11.6%), Brazil (9.0%), Canada (9.5%), and Guatemala (8.7%) (20). However, the situation presents a challenge for public health because of the disease's significant prevalence in Peru, which has remained stable over the evaluation period and may increase after the COVID-19 pandemic (2, 17). Improved treatment coverage, while not directly reducing prevalence (29), remains a crucial aspect because of the consequences of untreated depression symptoms, including a decline in quality of life, mental health complications, and an elevated risk of suicide attempts (30–33).
The assessed sociodemographic characteristics (sex, education, wealth index, ethnicity, area, and residence) not only influenced the proportion of adults receiving treatment for depressive symptoms but also impacted the severity of the illness (34–36). The multifactorial nature of mental disorders, including depression, explains this phenomenon (29). Despite women's higher likelihood of developing depressive symptoms, the study revealed that they received more treatment compared to men. Therefore, addressing the gender gap in depression treatment remains crucial in public health strategies (4, 37, 38).
Furthermore, there is an association between lower educational levels, lower wealth quintiles, and a decreased likelihood of looking for treatment for depressed symptoms (11, 39, 40). In this situation, sociodemographic characteristics, especially wealth, intricately connected with education (41–43). The research's discovery of a concentration of Peruvian adults with depressive symptoms receiving treatment in the wealthiest quintiles reinforces this observation. The favorable socioeconomic conditions in these quintiles facilitate access to a diverse array of therapies—pharmacological, behavioral, and educational—which effectively tackle the challenges posed by the extended rehabilitation period and help prevent relapses in chronic conditions like depression (44–46). Also, low educational levels significantly impacted a reduced receipt of treatment for depressive symptoms (47, 48). Education, within the realm of mental disorders like depression, may act as a protective mechanism by fostering skills in comprehending life experiences and making decisions amid challenging situations that can trigger symptom development (49, 50).
One of the main factors contributing to inequality in accessing treatment for depressive symptoms is the area and place of residence (51–53). Peruvian adults in rural areas and the capital city encounter heightened difficulties in receiving treatment, emphasizing the concerning disparities (54). Despite the implementation of mental health reforms during the study period to expand community mental health centers nationwide (17–19), persistent centralization of resources and services in central and southern Peru perpetuates the inequality in treatment receipt, even as symptoms worsen.
In Peru those adults with depression who identify themselves as Quechua or Aymara are less likely to receive treatment for their illness (24). This highlights the unfair treatment that native populations in Peru face when it comes to accessing health services (55). This is concerning because the lack of treatment not only worsens the disease, but it also affects more Afro-Americans and members of indigenous groups than white people (56–60). The reason behind these disparities could be due to discriminatory practices or a lack of cross-cultural integration, which makes timely treatment difficult (61–63). Additionally, negative attitudes toward mental health services, particularly among non-white ethnic groups, contribute to this problem (64, 65).
The study showed that as adults age, they receive less treatment for depressed symptoms, even though older age groups are more likely to suffer from depression (66–68). That can be due to a variety of social and biological causes, including isolation, daily living issues, psychological distress, and increased comorbidities (69–71). Prioritizing prevention, early detection, and treatment for older adults with depressive symptoms, especially in vulnerable groups, like those with comorbidities is crucial, because could diminish the effectiveness of current pharmacological and cognitive-behavioral treatments, underscoring the necessity for targeted interventions (72, 73).
Health insurance affiliation can help to reduce treatment inequality in depression (74, 75). Attributed to policies like universal insurance and the establishment of community mental health facilities, diagnosing and treating insured adults becomes more accessible in Peru (76, 77). However, there is still a need for cross-cultural care approaches in treating mental disorders like depression, that is difficult when resources and services are more available in capital of Peru (19), this reinforces the need of decentralization to address gaps in treatment access in rural area and other regions (78–80).
The study present limitations because of the design that does not allow evaluated causal relationship between sociodemographic conditions and treatment inequality for depression. Additionally, the evaluation is limited to the absence of treatment in the last 12 months, with unknown reasons for this lack or whether respondents previously received any treatment. The study lacks follow-up to gauge the impact of sociodemographic conditions on exacerbating depressive symptoms and perpetuating treatment inequality. Furthermore, factors like family support, recurrence of mental disorders, challenges in accessing health centers, and reasons limiting treatment access remain unexplored, hindering a comprehensive understanding of the causes of inequalities in treating this condition.