Multi-country analysis of the characteristics associated with undiagnosed depression

Background: Multiple factors contribute to depression symptoms and receiving diagnosis including gender, age, culture, religion, health infrastructure, and country development amongst others. Few studies have explored this phenomenon worldwide. Methods: 2003 WHO World Health Survey data was linked to 2001-03 World Bank Indicators, CIA Fact book and WHO data. Bivariate analyses and logistic regression assessed characteristics associated with depression symptoms and diagnosis. Results: A disparity exists between reported symptoms of depression (28.6%) and receiving a diagnosis (8.6%). Women, those > 30 years, and those unemployed had higher symptom estimates including individuals from countries pre-dominantly Hindu versus Christian (OR: 5.8; 95% CI 4.0-8.4) Southeast Asia, America's, and Western Pacific regions when compared to Africa (ORs ranging from 1.5-1.8), and higher income nations. (OR: 1.8; 95% CI 1.2-2.7) Lower estimates were found in countries allocating a small proportion of the total GDP towards health (<6%) and mental health (<1%). (ORs ranging from 0.5-0.7) Amongst screen positives, non-diagnosis was higher amongst unemployed individuals, > 30 years, and rural residents, publically financed mental health systems, countries allocating a large proportion of the total GDP to healthcare (> 6%) and mental health care (> 1%), predominantly Hindu versus Christian countries (OR: 6.3; CI: 4.2-9.4) and countries with < 1:1 ratio of male to female literacy (ORs ranging from 1.7-1.8) and a lower risk amongst lower-middle income. (OR: 0.5; CI: 0.3-0.8) Implications: These results provide an understanding of characteristics associated with prevalence and diagnosis of depression and can inform evolving mental health systems and policies worldwide.