Despite attempts to improve universal health coverage (UHC) in low income countries like Nepal, most healthcare utilization is still financed by out-of-pocket (OOP) payments, with detrimental effects on the poorest and most in need. Evidence from high income countries shows that depression is associated with increased healthcare utilization, which may lead to increased OOP expenditures, placing greater stress on families. To inform policies for integrating mental healthcare into UHC in LMIC, we must understand healthcare utilization and OOP expenditure patterns in people with depression. We examined associations between symptoms of depression and frequency and type of healthcare utilization and OOP expenditure among adults in Chitwan District, Nepal. We analysed data from a population-based survey of 2040 adults in 2013, who completed the PHQ-9 screening tool for depression and answered questions about healthcare utilization. We examined associations between increasing PHQ-9 score and healthcare utilization frequency and OOP expenditure using negative binomial regression. We also compared utilization of specific outpatient service providers and their related costs among adults with and without probable depression, determined by a PHQ-9 score of 10 or more. We classified 80 (3.6%) participants with probable depression, 70.9% of whom used some form of healthcare in the past year compared to 43.9% of people without probable depression. Mean annual OOP healthcare expenditures were $118 USD in people with probable depression, compared to $110 USD in people without. With each unit increase in PHQ-9 score, there was a 14% increase in total healthcare visits (95% CI 7–22%, p < 0.0001) and $9 USD increase in OOP expenditures (95% CI $2–$17; p < 0.0001). People with depression sought most healthcare from pharmacists (30.1%) but reported the greatest expenditure on specialist doctors ($36 USD). In this population-based sample from Central Nepal, we identified dose-dependent increases in healthcare utilization and OOP expenditure with increasing PHQ-9 scores. Future studies should evaluate whether provision of mental health services as an integrated component of UHC can improve overall health and reduce healthcare utilisation and expenditure, thereby alleviating financial pressures on families.

中文翻译：

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与成人抑郁症相关的医疗保健利用率和自付费用：尼泊尔的横断面分析

尽管尼泊尔等低收入国家试图改善全民健康覆盖 (UHC)，但大多数医疗保健利用仍然由自付费用 (OOP) 资助，这对最贫困和最需要帮助的人产生了不利影响。来自高收入国家的证据表明，抑郁症与医疗保健利用率的增加有关，这可能会导致 OOP 支出增加，给家庭带来更大的压力。为了为中低收入国家将精神卫生保健纳入全民健康覆盖的政策提供信息，我们必须了解抑郁症患者的医疗保健利用率和 OOP 支出模式。我们研究了尼泊尔奇特旺地区成年人抑郁症状与医疗保健利用频率和类型以及 OOP 支出之间的关联。我们分析了 2013 年对 2040 名成年人进行的人口调查数据，这些成年人完成了 PHQ-9 抑郁症筛查工具，并回答了有关医疗保健利用的问题。我们使用负二项式回归研究了 PHQ-9 分数增加与医疗保健使用频率和 OOP 支出之间的关联。我们还比较了患有和不患有抑郁症的成年人对特定门诊服务提供者的利用情况及其相关费用（由 PHQ-9 得分为 10 或更高确定）。我们对 80 名 (3.6%) 可能患有抑郁症的参与者进行了分类，其中 70.9% 在过去一年中使用过某种形式的医疗保健，而没有可能患有抑郁症的人中这一比例为 43.9%。可能患有抑郁症的人每年平均 OOP 医疗保健支出为 118 美元，而没有抑郁症的人为 110 美元。随着 PHQ-9 分数每增加一个单位，总医疗就诊次数增加 14%（95% CI 7–22%，p < 0.0001），OOP 支出增加 9 美元（95% CI $2–17；p < 0.0001）。抑郁症患者向药剂师寻求最多的医疗保健（30.1%），但向专科医生寻求的支出最多（36 美元）。在尼泊尔中部的这个基于人口的样本中，我们发现随着 PHQ-9 分数的增加，医疗保健利用率和 OOP 支出呈剂量依赖性增加。未来的研究应该评估提供心理健康服务作为全民健康覆盖的一个组成部分是否可以改善整体健康并减少医疗保健的利用率和支出，从而减轻家庭的经济压力。