The predictors of depression in a longitudinal cohort of community dwelling rural adults in Australia
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Many major studies of depression in Australia are under-representative of rural and remote residents, limiting the generalizability of their findings. This study explores the contributions of a range of individual, social, and community factors to the trajectory of depressive symptoms among a cohort of rural and remote residents.
Data from four waves of the Australian Rural Mental Health Study (baseline n = 2639), a 5 year longitudinal study of rural community residents, were examined within generalized linear mixed models to predict depressive symptoms. Depression was measured using the PHQ-9, with key correlates including social support, employment status, financial wellbeing, neuroticism, and rural community factors.
Moderate-to-severe depression was reported by 6.3% of the baseline sample. Being permanently unable to work resulted in over a threefold increase in the odds of depression at the following survey wave. Self-rated financial hardship was associated with a fourfold increase in the odds of future depression, as was a high level of community concerns. Neuroticism and tobacco use also made a significant independent contribution to future depressive symptoms. Interpersonal support was a protective factor, reducing the odds of next-wave depression by 64%.
Financial and employment-related difficulties appear to be important risk factors for depression, and targeting individuals experiencing such difficulties may be an effective means of reducing depression among certain sub-groups. Strategies to prevent depression in rural and remote Australia may benefit from a focus on interpersonal and community-level support, as the effects of this support are lasting and contribute to a reduced likelihood of depressive episodes in future years.
KeywordsRural Depression Social support Employment Financial stress
We wish to recognise the contributions of the ARMHS investigators: David Lyle, David Perkins, Lyn Fragar, John Beard, Vaughan Carr, Jeffrey Fuller, Helen Stain, Kerry Inder, Prasuna Reddy and Senior Project Co-ordinator Clare Coleman. We also wish to acknowledge the support of the Directors of Mental Health Services in the relevant Local Health Districts during the course of the study: Russell Roberts, Richard Buss and Dinesh Arya, and particularly acknowledge the research site coordinators in each site: Jan Sidford, John Ogle (Broken Hill), Trim Munro, Amy Strachan (Moree), Louise Holdsworth, Kath O’Driscoll (Lismore), Cheryl Bennett, Jannelle Bowler (Orange), along with Fleur Hourihan, Gina Sartore and Denika Novello.
The study was funded by the National Health and Medical Research Council (Project Grants #401241, #631061) and also supported by a Research Capacity Building Grant to the Australian Rural Health Research Collaboration.
Compliance with ethical standards
Conflict of interest
The authors declare no competing interests.
- 1.World Health Organization (2016) Depression: fact sheet. World Health Organization, GenevaGoogle Scholar
- 5.Harvey SB, Joyce S, Tan L, Johnson A, Nguyen H, Modini M, Groth M (2014) Developing a mentally healthy workplace. A review of the literature University of New South Wales and the Black Dog Institute, SydneyGoogle Scholar
- 6.World Health Organization (2011) Global status report on non-communicable diseases 2010. World Health Organization, GenevaGoogle Scholar
- 17.Baxter J, Hates A, Gray M (2011) Families in regional, rural and remote Australia (Facts Sheet). Australian Institute of Family Studies, MelbourneGoogle Scholar
- 18.Kelly BJ, Lewin TJ, Stain HJ, Coleman C, Fitzgerald M, Perkins D, Carr VJ, Fragar L, Fuller J, Lyle D, Beard JR (2011) Determinants of mental health and well-being within rural and remote communities. Soc Psychiatry Psychiatr Epidemiol 46(12):1331–1342. https://doi.org/10.1007/s00127-010-0305-0 CrossRefPubMedGoogle Scholar
- 19.Inder KJ, Handley TE, Fitzgerald M, Lewin TJ, Coleman C, Perkins D, Kelly BJ (2012) Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia. BMC Public Health 12:586. https://doi.org/10.1186/1471-2458-12-586 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Handley TE, Inder KJ, Kelly BJ, Attia JR, Lewin TJ, Fitzgerald MN, Kay-Lambkin FJ (2012) You’ve got to have friends: the predictive value of social integration and support in suicidal ideation among rural communities. Soc Psychiatry Psychiatr Epidemiol 47(8):1281–1290. https://doi.org/10.1007/s00127-011-0436-y CrossRefPubMedGoogle Scholar
- 23.Kelly BJ, Stain HJ, Coleman C, Perkins D, Fragar L, Fuller J, Lewin TJ, Lyle D, Carr VJ, Wilson JM, Beard JR (2010) Mental health and well-being within rural communities: the Australian rural mental health study. Aust J Rural Health 18(1):16–24. https://doi.org/10.1111/j.1440-1584.2009.01118.x CrossRefPubMedGoogle Scholar
- 27.Chipuer HM, Pretty GMH (1999) A review of the sense of community index: current uses, factor structure, reliability, and further development. J Commun Psychol 27(6):643–658. https://doi.org/10.1002/(SICI)1520-6629(199911)27:6<643::AID-JCOP2>3.0.CO;2-B CrossRefGoogle Scholar
- 33.Mitchell A, Yadegarfar M, Gill J, Stubbs B (2016) Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies. B J Psych Open 2(2):127–138. https://doi.org/10.1192/bjpo.bp.115.001685 CrossRefGoogle Scholar
- 34.Casey L, Pui-Tak Liang R (2013) Stress and wellbeing in Australia survey 2013. InPsych 35:24–26Google Scholar
- 36.Andrews G (2014) We can manage depression better with technology. Aust Fam Phys 43(12):838–841Google Scholar
- 37.Mansfield S (2014) Patients and technology: improving access to healthcare. Aust Fam Phys 34(12):821Google Scholar