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标题：Local Area Deprivation and Urban–Rural Differences in Anxiety and Depression Among People Older Than 75 Years in Britain
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作者：Kate Walters ; Elizabeth Breeze ; Paul Wilkinson 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：10
页码：1768-1774
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to determine the association of depression and anxiety with “area deprivation” (neighborhood socioeconomic deprivation) and population density among people older than 75 years in Britain. Methods. Postal codes were used to link census area information to individual data on depression and anxiety in 13349 people aged 75 years and older taking part in a trial of health screening. Results. Living in the most socioeconomically deprived areas was associated with depression (OR=1.4), but this relation disappeared after adjusting for individual deprivation characteristics. There was no association with anxiety. Living in the highest density and intermediate low-density areas was associated with depression (OR=1.6 and 1.5) and anxiety (OR=1.5 and 1.3) compared with the lowest density areas. Conclusions. An association between area deprivation and depression in older people was explained by individual health, demographic, and socioeconomic factors. Higher population density was consistently associated with increased depression and anxiety. Depression and anxiety are common problems in later life and are associated with considerable morbidity. 1, 2 Their origins are complex and multifactorial. A variety of potential risk factors, including female gender, low income, social isolation, loneliness, life events, absence of confiding relationships, and physical illness, have been reported in older people (≥55 years). 2, 3 There are complex overlapping pathways of effect for relations between socioeconomic factors and mental health. The relation between “area deprivation” (neighborhood socioeconomic deprivation) and psychiatric illness has been explored in general adult populations but not in older populations. In younger adults (<65 years), associations have been demonstrated between high scores on local area composite deprivation indices and overall psychiatric admission, 4, 5 suicide/parasuicide rates, 5 and psychological distress. 6, 7 However, the relative importance of local area deprivation and individual deprivation is not clear. 6, 7 The social and physical environment in which people live is an important potential risk factor in depression and anxiety, but it has not been studied extensively in older populations. Past research has tended to focus on either rural or urban environments or younger adult populations and to be on relatively small samples, often not adequately controlled for confounding. This research has produced conflicting results. 1, 8– 17 Historically, adults living in urban environments were thought to be at higher risk of depression 9– 11 and general psychological distress, 12, 13 although there was some evidence this may not apply to older populations. 14 However, further research in younger adults in North America has found no difference in rates of psychiatric disorder between rural and urban areas 15, 16 and increased depression in men living in more rural areas. 17 Rural living has been associated with stigmatized attitudes toward mental health care and reduced willingness to seek help, 17 fewer visits to a mental health specialist, 18, 19 lower concordance with guidelines on treatment, 18 increased risk of admission for mental health problems, 19 and increased risk of suicide. 20 Little research has specifically examined the relations between a finer categorization of population density and psychiatric morbidity. There is some evidence that the relationship between population density and mental illness is nonlinear and forms part of a more complex pathway or “system.” 21 Other research has highlighted intrarural variation in rates of nonspecific, limiting long-term illness, suggesting a J-shaped curve with higher morbidity in both extreme rural and urban areas. 22 The impact of socioeconomic and environmental risk factors on mental health may change in later life. For example, low job control, job insecurity, and unemployment are frequently cited risk factors that clearly have less relevance to older populations. The local living environment and deprivation may be more important to older people because they may spend more time in the immediate vicinity of their homes after retirement or because of other factors such as decreased mobility. They may have a heightened sense of vulnerability to factors associated with areas of deprivation, such as crime, which affects their confidence to leave their homes and hence increases social isolation. 23 We evaluated for the first time the relation between local environment, deprivation, and mental well-being in a large representative sample of community-dwelling people older than 75 years.