Rodero-Cosano María Luisa, Salinas-Pérez José A, González-Caballero Juan Luis, García-Alonso Carlos R, Lagares-Franco Carolina, Salvador-Carulla Luis
Department of Mathematics and Engineering, Universidad Loyola Andalucía, Sevilla and Córdoba, Spain.
Department of Statistics and Operational Research, University of Cadiz, Cádiz, Spain.
J Affect Disord. 2016 Sep 1;201:42-9. doi: 10.1016/j.jad.2016.04.024. Epub 2016 Apr 27.
Previous research identified high/low clusters of prevalence of outpatient-treated depression at municipal level in Catalonia (Spain). This study aims to analyse potential risk factors, both socioeconomic and related to the mental health service planning, which could influence the occurrence of hot/cold spots of depressed outpatients at two geographical levels: municipalities and service catchment areas.
Hot/cold spots were examined in relation to socioeconomic indicators at municipal level, such as population density, unemployment, university education, personal income, and also those related to service planning at catchment area level, such as adequacy of healthcare, urbanicity, accessibility and the availability of mental health community centres. The analysis has been carried out through multilevel logistic regression models in order to consider the two different scales.
Hot spots are related to high population density, unemployment, urbanicity, the adequacy of provision of mental health services, and accessibility to mental health community centres at both study levels. On the other hand, the multilevel model weakly explains cold spots, associating them with high personal incomes.
The dependent variables of the multi-level models are binary. This limits the interpretation of the results, since they cannot provide information about the variance of the dependent variables explained by the models.
The results described diverse risk factors at two levels which are related to a high likelihood of hot and cold spots of depression. The findings show the relevance of health planning in the distribution of diseases and the utilisation of healthcare services.
先前的研究确定了西班牙加泰罗尼亚自治区市级门诊治疗抑郁症患病率的高/低聚集区。本研究旨在分析社会经济因素以及与精神卫生服务规划相关的潜在风险因素，这些因素可能在两个地理层面影响抑郁症门诊患者的热点/冷点区域的出现，这两个层面分别是市级行政区和服务覆盖区域。
研究了热点/冷点区域与市级社会经济指标的关系，如人口密度、失业率、大学教育程度、个人收入，以及与服务覆盖区域层面服务规划相关的指标，如医疗保健的充足性、城市化程度、可及性以及精神卫生社区中心的可获得性。分析通过多水平逻辑回归模型进行，以考虑两个不同的尺度。
在两个研究层面，热点区域都与高人口密度、失业率、城市化程度、精神卫生服务的提供充足性以及精神卫生社区中心的可及性相关。另一方面，多水平模型对冷点区域的解释较弱，将其与高个人收入联系起来。
多水平模型的因变量是二元变量。这限制了对结果的解释，因为它们无法提供模型所解释的因变量方差的信息。
研究结果描述了两个层面上与抑郁症热点和冷点区域高可能性相关的不同风险因素。研究结果表明了卫生规划在疾病分布和医疗服务利用方面的相关性。
