Melbourne Institute of Applied Economic and Social Research and Melbourne School of Population and Global Health,University of Melbourne,Melbourne,Australia.
School of Medicine and Public Health,University of Newcastle,Newcastle,Australia.
Epidemiol Psychiatr Sci. 2018 Oct;27(5):500-509. doi: 10.1017/S2045796017000117. Epub 2017 Apr 3.
Rural and remote regions tend to be characterised by poorer socioeconomic conditions than urban areas, yet findings regarding differences in mental health between rural and urban areas have been inconsistent. This suggests that other features of these areas may reduce the impact of hardship on mental health. Little research has explored the relationship of financial hardship or deprivation with mental health across geographical areas.
Data were analysed from a large longitudinal Australian study of the mental health of individuals living in regional and remote communities. Financial hardship was measured using items from previous Australian national population research, along with measures of psychological distress (Kessler-10), social networks/support and community characteristics/locality, including rurality/remoteness (inner regional; outer regional; remote/very remote). Multilevel logistic regression modelling was used to examine the relationship between hardship, locality and distress. Supplementary analysis was undertaken using Australian Household, Income and Labour Dynamics in Australia (HILDA) Survey data.
2161 respondents from the Australian Rural Mental Health Study (1879 households) completed a baseline survey with 26% from remote or very remote regions. A significant association was detected between the number of hardship items and psychological distress in regional areas. Living in a remote location was associated with a lower number of hardships, lower risk of any hardship and lower risk of reporting three of the seven individual hardship items. Increasing hardship was associated with no change in distress for those living in remote areas. Respondents from remote areas were more likely to report seeking help from welfare organisations than regional residents. Findings were confirmed with sensitivity tests, including replication with HILDA data, the use of alternative measures of socioeconomic circumstances and the application of different analytic methods.
Using a conventional and nationally used measure of financial hardship, people residing in the most remote regions reported fewer hardships than other rural residents. In contrast to other rural residents, and national population data, there was no association between such hardship and mental health among residents in remote areas. The findings suggest the need to reconsider the experience of financial hardship across localities and possible protective factors within remote regions that may mitigate the psychological impact of such hardship.
农村和偏远地区的社会经济条件往往比城市地区差，但农村和城市地区心理健康差异的研究结果一直不一致。这表明这些地区的其他特征可能会减轻困难对心理健康的影响。很少有研究探讨过在不同地理区域内，经济困难或贫困与心理健康之间的关系。
本研究分析了一项澳大利亚大型纵向研究中，居住在地区和偏远社区的个人心理健康数据。使用来自之前澳大利亚全国人口研究的项目来衡量经济困难程度，同时还衡量了心理困扰（Kessler-10）、社交网络/支持以及社区特征/所在地，包括农村/偏远地区（内部区域；外部区域；偏远/非常偏远）。采用多水平逻辑回归模型来检验困难程度、所在地和困扰之间的关系。使用澳大利亚家庭、收入和劳动力动态调查（HILDA）的数据进行了补充分析。
澳大利亚农村心理健康研究（Australian Rural Mental Health Study）的基线调查共完成了 2161 名受访者（1879 户家庭），其中 26%来自偏远或非常偏远地区。在区域地区，发现困难项目的数量与心理困扰之间存在显著关联。生活在偏远地区与较少的困难、较低的任何困难风险以及较低的报告七种个别困难项目中的三种的风险相关。对于生活在偏远地区的人来说，增加困难与困扰没有变化相关。与区域居民相比，来自偏远地区的受访者更有可能向福利组织寻求帮助。通过敏感性测试、包括使用 HILDA 数据进行复制、使用替代的社会经济状况衡量标准以及应用不同的分析方法，验证了这些发现。
使用常规的和全国通用的经济困难衡量标准，居住在最偏远地区的人报告的困难比其他农村居民少。与其他农村居民和全国人口数据不同，在偏远地区居民中，这种困难与心理健康之间没有关联。研究结果表明，需要重新考虑不同地区的经济困难经历，以及偏远地区可能减轻这种困难对心理影响的保护因素。
