Social Psychiatry and Psychiatric Epidemiology

, Volume 52, Issue 8, pp 1023–1030 | Cite as

Proximity to healthcare clinic and depression risk in South Africa: geospatial evidence from a nationally representative longitudinal study

  • Andrew TomitaEmail author
  • Alain M. Vandormael
  • Diego Cuadros
  • Rob Slotow
  • Frank Tanser
  • Jonathan K. Burns
Original Paper


Proximity to primary healthcare facilities may be a serious barrier to accessing mental health services in resource-limited settings. In this study, we examined whether the distance to the primary healthcare clinic (PHCC) was associated with risk of depression in KwaZulu-Natal Province, South Africa. Depressive symptoms and household coordinates data were accessed from the nationally representative South African National Income Dynamics Study. Distances between households and their nearest PHCCs were calculated and mixed-effects logistic regression models fitted to the data. Participants residing <6 km from a PHCC (aOR = 0.608, 95% CI 0.42–0.87) or 6–14.9 km (aOR = 0. 612, 95% CI 0.44–0.86) had a lower depression risk compared to those residing ≥15 km from the nearest PHCC. Distance to the PHCC was independently associated with increased depression risk, even after controlling for key socioeconomic determinants. Minimizing the distance to PHCC through mobile health clinics and technology could improve mental health.


Primary healthcare clinic Depression Social disconnectedness GPS South Africa 



Waves 1–3 Data: Southern Africa Labour and Development Research Unit. National Income Dynamics Study. Cape Town: Southern Africa Labour and Development Research Unit (producer), 2015. Cape Town: DataFirst (distributor), 2015. We thank Lynn Woolfrey at DataFirst at the University of Cape Town. AT was supported by SA MRC Flagship Grant (MRC-RFAUFSP-01-2013/UKZN HIVEPI) and National Institutes of Health Research Training Grant (R25TW009337), funded by the Fogarty International Center and the National Institute of Mental Health. AV was supported by SA MRC Flagship Grant (MRC-RFAUFSP-01-2013/UKZN HIVEPI). FT was supported by South African MRC Flagship (MRC-RFA-UFSP-01-2013/UKZN HIVEPI) and NIH Grants (R01HD084233 and R01AI124389) as well as a UK Academy of Medical Sciences Newton Advanced Fellowship (NA150161). The study was also supported by University of KwaZulu-Natal funding to RS. The content is solely the responsibility of the authors and does not necessarily represent the official views of the SA MRC, UK Academy of Medical Sciences or the NIH. All authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Andrew Tomita
    • 1
    • 5
    Email author
  • Alain M. Vandormael
    • 1
    • 5
  • Diego Cuadros
    • 2
  • Rob Slotow
    • 3
    • 4
  • Frank Tanser
    • 5
    • 6
    • 7
  • Jonathan K. Burns
    • 8
    • 9
  1. 1.College of Health SciencesUniversity of KwaZulu-NatalDurbanSouth Africa
  2. 2.Department of GeographyUniversity of CincinnatiCincinnatiUSA
  3. 3.School of Life SciencesUniversity of KwaZulu-NatalDurbanSouth Africa
  4. 4.Department of Genetics, Evolution and EnvironmentUniversity College LondonLondonUK
  5. 5.Africa Health Research InstituteUniversity of KwaZulu-NatalDurbanSouth Africa
  6. 6.Centre for the AIDS Programme of Research in South Africa (CAPRISA)DurbanSouth Africa
  7. 7.School of Nursing and Public HealthUniversity of KwaZulu-NatalDurbanSouth Africa
  8. 8.Department of PsychiatryUniversity of KwaZulu-NatalDurbanSouth Africa
  9. 9.Institute for Health ResearchUniversity of ExeterExeterUK

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