Tomita Andrew, Vandormael Alain M, Cuadros Diego, Slotow Rob, Tanser Frank, Burns Jonathan K
College of Health Sciences, University of KwaZulu-Natal, Private Bag X7, Durban, South Africa.
Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Soc Psychiatry Psychiatr Epidemiol. 2017 Aug;52(8):1023-1030. doi: 10.1007/s00127-017-1369-x. Epub 2017 Mar 15.
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.
在资源有限的环境中，距离基层医疗设施较近可能成为获得心理健康服务的严重障碍。在本研究中，我们调查了南非夸祖鲁 - 纳塔尔省距离基层医疗诊所（PHCC）的远近是否与患抑郁症的风险相关。抑郁症状和家庭坐标数据来自具有全国代表性的南非国民收入动态研究。计算了家庭与其最近的PHCC之间的距离，并对数据拟合了混合效应逻辑回归模型。与居住在距离最近的PHCC≥15公里的人群相比，居住在距离PHCC<6公里（调整后的比值比[aOR]=0.608，95%置信区间[CI]为0.42 - 0.87）或6 - 14.9公里（aOR = 0.612，95% CI为0.44 - 0.86）的参与者患抑郁症的风险较低。即使在控制了关键的社会经济决定因素之后，距离PHCC的远近仍与抑郁症风险增加独立相关。通过移动健康诊所和技术将距离PHCC的距离最小化可以改善心理健康。
