Black Georgina, Roberts Rachel M, Li-Leng Tan
Psychological Services, Families SA Country Directorate, Adelaide, South Australia, Australia.
Rural Remote Health. 2012;12:2092. Epub 2012 Aug 12.
There is growing evidence in the literature which indicates that the prevalence of depression is similar in both non-metropolitan and metropolitan areas. However, it is generally perceived that factors associated with compromised mental health in rural residents include deprivation and lack of access to healthcare services. This study examines the relationship between depression and possible determinants of mental health among rural adolescents. The determinants identified were degree of remoteness, gender, socioeconomic status and the perception of rural community characteristics. Rural community characteristics examined were long waiting lists and lack of mental health professionals.
Respondents were 531 South Australian adolescents (55.7% female) aged 13 to 18 years, living outside the Adelaide (state capital) metropolitan area. Respondents completed a questionnaire including: demographic questions; the Kutcher Adolescent Depression Scale (KADS); and questions regarding individual perceptions of community characteristics. The data were obtained by self-report, degree of remoteness was measured using the Accessibility and Remoteness Index of Australia Plus, and socio-economic status was determined from the Australian Bureau of Statistics (ABS) Socio-Economic Index of Relative Socio-Economic Advantage and Disadvantage (SEIFA).
The rate of depression obtained from this sample of rural adolescents is concerning; 18% screened positive for depression on the KADS, 41% reported low mood much of the time or more often, and 20% experienced occasional or more frequent self-harm or suicidal thoughts, plans or actions. Depression was related to gender, with more females (23%) screening positive for depression than males (11.8%). Prevalence of depression was unrelated to degree of remoteness or the socioeconomic status of the participants. This finding is not consistent with other research that identifies socioeconomic status as a psychosocial determinant of mental health. It is noteworthy that the perception of long waiting lists and a lack of mental health professionals were related to depression but that this relationship was only significant for females. This may be because those who experience symptoms of depression are more likely to be aware of service availability due to help-seeking behaviour. That this finding is significant for females is consistent with research that identifies females as being better able to identify symptoms of depression and more willing to seek help.
Efforts to enhance the mental health of rural Australian adolescents should focus on improving the availability of mental health services, improving mental health literacy and promoting help-seeking behaviour for mental health difficulties. Consideration should be given to the gender differences identified when developing future mental health initiatives.
文献中越来越多的证据表明,非大城市地区和大城市地区的抑郁症患病率相似。然而,人们普遍认为,农村居民心理健康受损的相关因素包括贫困以及难以获得医疗服务。本研究探讨农村青少年抑郁症与心理健康可能的决定因素之间的关系。确定的决定因素包括偏远程度、性别、社会经济地位以及对农村社区特征的认知。所考察的农村社区特征包括等候名单长和缺乏心理健康专业人员。
研究对象为531名年龄在13至18岁之间、居住在阿德莱德(州首府)大都市区以外的南澳大利亚青少年(55.7%为女性)。研究对象完成了一份问卷,包括:人口统计学问题;库彻青少年抑郁量表(KADS);以及关于个人对社区特征认知的问题。数据通过自我报告获取,偏远程度使用澳大利亚可及性与偏远程度指数升级版进行衡量,社会经济地位根据澳大利亚统计局(ABS)的相对社会经济优势与劣势社会经济指数(SEIFA)确定。
该农村青少年样本的抑郁症患病率令人担忧;18%的人在KADS量表上筛查出抑郁症呈阳性,41%的人报告大部分时间或更频繁地情绪低落,20%的人偶尔或更频繁地有自我伤害或自杀念头、计划或行为。抑郁症与性别有关,筛查出抑郁症呈阳性的女性(23%)多于男性(11.8%)。抑郁症患病率与研究对象的偏远程度或社会经济地位无关。这一发现与其他将社会经济地位视为心理健康社会心理决定因素的研究不一致。值得注意的是,对等候名单长和缺乏心理健康专业人员的认知与抑郁症有关,但这种关系仅在女性中显著。这可能是因为那些有抑郁症症状的人由于寻求帮助的行为更有可能意识到服务的可及性。这一发现对女性显著与将女性认定为更能识别抑郁症症状且更愿意寻求帮助的研究一致。
提高澳大利亚农村青少年心理健康水平的努力应侧重于改善心理健康服务的可及性、提高心理健康素养以及促进针对心理健康问题的求助行为。在制定未来的心理健康倡议时应考虑到所发现的性别差异。