Use of mental health services by community-resident adults with DSM-IV anxiety and mood disorders in a violence-prone area: Sao Paulo, Brazil

Background: While under-use of mental health services by adults with anxiety and/ or depression is well established, use in a violence-prone area, and as a function of diagnosis and personality characteristics such resilience, is little known. We examine the sociodemographic and personality characteristics (specifically resilience), associated with use of mental health services in a violence-prone city by those with anxiety, depression, and their comorbidity. Methods: The structured Composite International Diagnostic Interview was used to identify 12-month DSM-IV and ICD-10-defined anxiety and depression in a cross-sectional, representative, community-resident sample age 15-75y (N=2536) in Sao Paulo, Brazil, and their use of mental health services. Resilience was determined by the Wagnild and Young scale. Analyses, using weighted, design-corrected statistical tests, included frequency measures and multivariable logistic regression. Results: Mental health services were used by 10% with only anxiety, 22% with only depression, and 34% with comorbidity, with odds of use in controlled analyses doubling from anxiety to depression to comorbidity. Use was significantly higher among those who were white, older (age > 30 years, with substantial social support, low resilience, living in low homicide rate areas; use was not affected by experience of traumatic events. Psychiatrists, general practitioners, and psychologists were the primary providers. Limitations: Cross-sectional design Conclusions: Contrary to expectation, use was greater among residents of lower homicide areas, and was not associated with personal traumatic experience. This may reflect increased immunity to violence in higher homicidal rate areas, lower resilience, and poorer access to services. Increased access to mental health services is needed.