Racial Inequality in the Prevalence of Symptom-Based Depression Versus Self-Reported Medical Diagnosis in Brazil

A cross-sectional study was conducted with Brazilian adults from the 2019 Pesquisa Nacional de Saúde (PNS 2019; National Health Survey, in English) who self-declared race/skin color white or black (n = 87,187), to investigate racial inequality in the prevalence of symptom-based versus self-reported depression. Symptom-based depression was screened using the Patient Health Questionnaire-9 (cutoff ≥ 10), while medical diagnosis was self-reported. Prevalence of agreement (presence of medical diagnosis among those with symptoms) and disagreement (absence of medical diagnosis among those with symptoms) were compared according to race/skin color. The Odds Ratio (OR) for the association between both depression indicators and race/skin color were estimated by Logistic regression adjusted by socioeconomic variables. The black population had a higher prevalence of symptom-based depression than medical diagnosis (11.0% versus 8.6%; 2.5 percentual points (pp)), with greater differences among younger adults (6.0 pp), without a partner (3.6 pp), with lower income (3.9 pp), education (3.0 pp), less developed regions (north: 3.6 pp; northeast: 4.2 pp) and those with recent access to medical care (4.5 pp). The white population had a higher prevalence of medical diagnosis than symptom-based depression (10.6% versus 12.5%; -1.9 pp), with greater differences between those with higher income (-7.4 pp), education (-4.5 pp) and from south region (-6.0 pp). Disagreement was higher among black individuals while agreement was higher among white, with significant inequality among women for both agreement (33.5% in black versus 41.7% in white) and disagreement (66.5% in black versus 58.3% in white). The black population had a lower chance of having medical diagnosis of depression (OR 0.77; 95%CI 0.70-0.84) than white, regardless of socioeconomic variables. Racial inequality was identified in the prevalence of symptom-based versus self-reported depression, with greater inequality among women and those with lower income and education.