Mood disorders and urban/rural settings
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A review of the main large-scale mental health surveys does not give full support to the idea of urbanicity as a risk factor in mood disorders. Lack of agreement between findings can be attributed, at least in part, to heterogeneous operationalisation of urbanicity, as different ways to define urban and rural areas are likely to lead to different morbidity rates and to have an effect on the respective weight of other risk factors.
A total of 2,638 subjects sampled from two French regions (Basse-Normandie and Ile-de-France) were interviewed using face-to-face parts of the Composite International Diagnostic Interview covering demographic and certain life event questions. Urbanicity was defined according to (1) official index based on population density or (2) type of dwelling. Participation rates were 85 and 79%.
When gender, age, marital status and certain early life events, such as being placed in an institution, as well as events concerning close family members are entered into a logistic regression, the urbanicity association with DSM-IV MDE and especially severe forms disappeared. This finding tends to support the theory that what happens to individuals is more relevant to depression than the place where they live.
It may be wiser to rely on social indicators than on a rural/urban component for planning for mental health care in the various areas; this remark should not prevent to evaluate the topographic situations of the diverse settings to take them into account to provide appropriate resources.
Keywordsrural urban survey mental health planning health care
The Parisian area study was funded by the City of Paris (DASES), the French Ministries of Health, Environment and Defense and the Avenir Foundation. The Basse-Normandie study was made possible through funding by the Regional Councils of Basse-Normandie, Calvados, Manche and Orne, Lilly France Health Economics Department and AXA Insurance Normandie-Maine.
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