Judd Fiona K, Jackson Henry J, Komiti Angela, Murray Greg, Hodgins Gene, Fraser Caitlin
Centre for Rural Mental Health, Bendigo Health Care Group, PO Box 126, Bendigo 3552, Australia.
Aust N Z J Psychiatry. 2002 Feb;36(1):104-13. doi: 10.1046/j.1440-1614.2002.00986.x.
High prevalence disorders (anxiety, depressive and substance use) are generally assumed to be more common in urban than rural dwellers. The aims of this paper are (i) to critically review studies measuring prevalence in rural as opposed to urban location, and (ii) to argue the need to look beyond the 'quantity' question to the quality question: how does urban or rural place influence mental health?
A literature review (Medline and PsychLIT) was carried out using the words 'rural, urban, mental/psychiatric, illness/disorders and prevalence', as well as a review of relevant papers and publications known to the authors.
Many studies examining urban/rural differences in the rate of high prevalence disorders have been reported. Most use a 'one size fits all' definition of urban and rural, which assumes location is the key issue. The majority fail to show the purported difference in prevalence between the two settings. In general, studies have not examined interaction effects, but have simply treated the independent variables as main effects. Available data suggest that a variety of socio-demographic factors are more powerful predictors of difference in prevalence than is the location of residence.
Further studies are required to understand if and how rural or urban place contributes to the development of psychiatric morbidity. These studies should mirror the clinical situation by taking into account a variety of individual and community-based (including urban/rural place) risk factors which may be important determinants of mental health and mental illness, and examining the interaction between them. This may then identify the nature of any differences or what issues are specific to, or especially important, in the rural setting.
普遍认为高发性疾病（焦虑症、抑郁症和物质使用障碍）在城市居民中比农村居民中更为常见。本文的目的是：（i）批判性地回顾测量农村与城市地区患病率的研究；（ii）论证需要超越“数量”问题，转向质量问题：城市或农村环境如何影响心理健康？
使用“农村、城市、心理/精神、疾病/障碍和患病率”等关键词进行文献综述（检索Medline和PsychLIT数据库），并对作者所知的相关论文和出版物进行回顾。
已有许多研究报告了高发性疾病发病率的城乡差异。大多数研究对城市和农村采用“一刀切”的定义，认为地理位置是关键问题。大多数研究未能显示出这两种环境中患病率的所谓差异。总体而言，研究未考察交互作用，只是将自变量作为主效应处理。现有数据表明，与居住地点相比，多种社会人口学因素是患病率差异的更强预测因素。
需要进一步研究以了解农村或城市环境是否以及如何促成精神疾病的发生。这些研究应通过考虑各种可能是心理健康和精神疾病重要决定因素的个体和社区层面（包括城乡环境）的风险因素，并考察它们之间的相互作用，来反映临床情况。这样或许就能确定任何差异的性质，或找出农村环境中特有的或特别重要的问题。
