Barriers to depression care among middle-aged and older adults in Taiwan's universal healthcare system

BACKGROUND: Barriers to depression care differ across countries, highlighting the importance of identifying gaps in health-service coverage for regional health systems. This study aims to identify the bottlenecks of depression care and associated factors. METHODS: We used data from the Taiwan Longitudinal Study on Aging of 2015, included 7675 participants aged 50 years and older. We identified participants with clinically relevant depression using the Center for Epidemiological Studies Depression Scale or Taiwan's National Health Insurance program claims records of depressive disorders. Bottleneck analysis was based on a modified Tanahashi framework with four stages: healthcare accessibility, initial contact, adequate treatment, and effective coverage. Individual factors associated with achieving these stages were estimated using multivariable logistic regression models with multiple imputation. FINDINGS: We identified 1253 patients with clinically relevant depression; 83% perceived it as convenient to access healthcare, but only 27% had initial contact with health services, 16% received adequate coverage, and 11% achieved effective treatment. In terms of factors associated with initial contact, being female, married, or retired/unemployed; having a high education level, social group engagement, or self-reported diabetes mellitus; exercising regularly; and participating in social leisure activities were associated with increasing contact. Those with alcohol use had a low likelihood of treatment. INTERPRETATION: Initial contact constitutes the primary bottleneck of depression care in Taiwan. Improving mental health literacy and enhancing depression screening would be helpful to elevate treatment rates and improve depression care. FUNDING: This study was supported by a grant from the Ministry of Health and Welfare, Taiwan.