Abstract
Background
Studies of urban–rural differences in rates of non-psychotic psychiatric disorders have produced contradictory results, with some finding higher urban rates and others no difference.
Aims
This study aimed to compare geographic variability of rates of depression and three anxiety disorders in a large, random community sample of Canadian residents.
Method
Data from the 2002 Canadian Community Health Survey 1.2 were analyzed, using a four-category classification of urban-rurality.
Results
Significant bivariate urban–rural differences were found for age, marital status, country of birth, ethnicity, education, household income, income adequacy, employment, home ownership, physical activity, perceived stress, and physical health. In addition, participants in the urban core and urban fringe had a weaker sense of belonging to their community and reported lower social support. There was a modest urban excess of depression in the previous 12 months but no difference in rates of agoraphobia, panic disorder or social phobia across the geographical areas. The multivariate modeling showed a lower prevalence of depression for people living in the most rural environment only (odds ratio = 0.76, 95% confidence interval = 0.59, 0.98). Factors associated with an increased rate of depression in the model were female gender, younger age, being not married, being born in Canada, white ethnicity, higher education, unemployment, not owning one’s home, and poor physical health. Also, participants with a stronger sense of belonging to their community and higher social support reported lower rates of depression.
Conclusions
These results confirmed a lower risk of depression amongst rural dwellers, which was associated with a stronger sense of community belonging. Further research on this topic could usefully include community-level variables, usually subsumed under the rubric of social capital.
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References
Andrews G, Henderson S, Hall W (2001) Prevalence, comorbidity, disability and service utilisation. Overview of the Australian National Mental Health Survey. Br J Psychiatry 178:145–153
Ayuso-Mateos JL, Vazquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, Wilkinson C, Lasa L, Page H, Dunn G, Wilkinson G (2001) Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry 179:308–316
Beiser M (2005) The health of immigrants and refugees in Canada. Can J Public Health 96(Suppl 2):S30–S44
Blazer D (1982) Social support and mortality in an elderly community population. Am J Epidemiol 115:684–694
Blazer D, George L, Landerman R, Pennybacker M, Melville M, Woodbury M, Manton K, Jordan K, Locke B (1985) Psychiatric disorders. A rural/urban comparison. Arch Gen Psychiatry 42:651–656 [erratum appears in Arch Gen Psychiatry (1986) 43(12):1142]
Crowell BJ, George L, Blazer D, Landerman R (1986) Psychosocial risk factors and urban/rural differences in the prevalence of major depression. Br J Psychiatry 149:307–314
Faris DEL, Dunham HW (1939) Mental disorder in urban areas. Hafner, Chicago University Press, Chicago
Gushulak B (2007) Healthier on arrival? Further insight into the “healthy immigrant effect”. CMAJ 176:1439–1440
Kawachi I, Berkman LF (2001) Social ties and mental health. J Urban Health 78:458–467
Kessler R, McGonagle K, Zhao S, Nelson C, Hughes M, Eshleman S, Wittchem H, Kendler K (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States; results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19
Kessler RC, Ustun TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13:93–121
Kovess-Masfety V, Alonso J, de Graaf R, Demyttenaere K (2005) A European approach to rural–urban differences in mental health: the ESEMeD 2000 comparative study. Can J Psychiatry 50:926–936
Lehtinen V, Michalak E, Wilkinson C, Dowrick C, Ayuso-Mateos JL, Dalgard OS, Casey P, Vazquez-Barquero JL, Wilkinson G (2003) Urban–rural differences in the occurrence of female depressive disorder in Europe—evidence from the ODIN study. Soc Psychiatry Psychiatr Epidemiol 38:283–289
Lewis G, David A, Andreasson S, Allebeck P (1992) Schizophrenia and city life. Lancet 340:137–140
McKenzie K, Whitley R, Weich S (2002) Social capital and mental health. Br J Psychiatry 181:280–283
Murray G, Judd F, Jackson H, Fraser C, Komiti A, Hodgins G, Pattison P, Humphreys J, Robins G (2004) Rurality and mental health: the role of accessibility. Aust N Z J Psychiatry 38:629–634
Parikh SV, Wasylenki D, Goering P, Wong J (1996) Mood disorders: rural/urban differences in prevalence, health care utilization, and disability in Ontario. J Affect Disord 38:57–65
Patten SB, Wang JL (2006) Descriptive epidemiology of major depression in Canada. Can J Psychiatry 51:84–90
Paykel ES, Abbott R, Jenkins R, Brugha TS, Meltzer H (2000) Urban–rural mental health differences in Great Britain: findings from the national morbidity survey. Psychol Med 30:269–280
Peen J, Schoevers RA, Beekman AT, Dekker J (2010) The current status of urban–rural differences in psychiatric disorders. Acta Psychiatr Scand 121:84–93
Pickett KE, Pearl M (2001) Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Comm Health 55:111–122
Romans-Clarkson SE, Walton VA, Herbison GP, Mullen PE (1990) Psychiatric morbidity among women in urban and rural New Zealand: psychosocial correlates. Br J Psychiatry 156:84–91
Silver E, Mulvey EP, Swanson JW (2002) Neighborhood structural characteristics and mental disorder: Faris and Dunham revisited. Soc Sci Med 55:1457–1470
van Os J (2004) Does the urban environment cause psychosis? Br J Psychiatry 184:287–288
Wang JL (2004) Rural–urban differences in the prevalence of major depression and associated impairment. Soc Psychiatry Psychiatr Epidemiol 39:19–25
Whitley R, McKenzie K (2005) Social capital and psychiatry: review of the literature. Harv Rev Psychiatry 13:71–84
Acknowledgments
This work was funded by the Canadian Institutes of Health Research. We thank the anonymous reviewer who encouraged us to use the four value urban-rurality classification.
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Romans, S., Cohen, M. & Forte, T. Rates of depression and anxiety in urban and rural Canada. Soc Psychiatry Psychiatr Epidemiol 46, 567–575 (2011). https://doi.org/10.1007/s00127-010-0222-2
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DOI: https://doi.org/10.1007/s00127-010-0222-2