Leventhal Perek Sharon, Thomas Katharine, Gaver Anat, Matalon Andre, Yeshua Hanny
Clalit Health Services, The Family Medicine Department, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Fam Pract. 2019 Jan 25;36(1):21-26. doi: 10.1093/fampra/cmy085.
Depression and anxiety are among the most prevalent disorders in primary care. City dwelling is commonly cited as a risk factor for mental disorders, but epidemiological evidence for this relationship is inconclusive.
To compare the prevalence of antidepressant use, as a proxy for the level of depressive disorders, between patients in Israeli urban and rural communities.
A cross-sectional study, based on data drawn from the registry of the largest health maintenance organization in Israel. The prevalence of antidepressant purchase during 2014 was evaluated for 581291 patients living in urban and rural communities. Data were also collected for potential confounding variables: age, gender, comorbidity, socioeconomic status and being a holocaust survivor.
Results showed higher rates of antidepressant use among patients living in urban (11.8%) compared with rural communities (8.1%; <0.001). A particularly high rate of antidepressant use was found on kibbutz (15.9%), a collective rural community in Israel, compared with both urban and other rural communities. Kibbutz compared with other rural communities: odds ratio (OR) = 1.73, P < 0.001; urban communities compared with non-kibbutz rural communities: OR = 1.21, P < 0.001. A significantly lower rate of antidepressant use was found in urban and rural Arab-majority communities (3.9% and 3.8%, respectively).
Antidepressant use varies significantly between different communities in Israel. The highest rate of antidepressant use in our study was found on kibbutz, followed by that in urban communities, with the lowest rates in non-kibbutz rural communities. This difference may derive from different depression rates, stigma of mental illness and awareness of mental disorders.
抑郁症和焦虑症是初级保健中最常见的疾病。城市居住通常被认为是精神障碍的一个风险因素，但这种关系的流行病学证据尚无定论。
比较以色列城市和农村社区患者中抗抑郁药使用情况（作为抑郁症水平的替代指标）的患病率。
一项横断面研究，基于从以色列最大的健康维护组织登记处提取的数据。对居住在城市和农村社区的581291名患者评估了2014年抗抑郁药购买的患病率。还收集了潜在混杂变量的数据：年龄、性别、合并症、社会经济地位以及是否为大屠杀幸存者。
结果显示，居住在城市的患者中抗抑郁药使用率（11.8%）高于农村社区（8.1%；P<0.001）。在以色列的集体农村社区基布兹，抗抑郁药使用率特别高（15.9%），与城市和其他农村社区相比均如此。基布兹与其他农村社区相比：优势比（OR）=1.73，P<0.001；城市社区与非基布兹农村社区相比：OR=1.21，P<0.001。在城市和以阿拉伯人为主的农村社区，抗抑郁药使用率显著较低（分别为3.9%和3.8%）。
以色列不同社区之间抗抑郁药使用情况差异显著。我们的研究中抗抑郁药使用率最高的是基布兹，其次是城市社区，非基布兹农村社区最低。这种差异可能源于不同的抑郁症发病率、精神疾病的耻辱感以及对精神障碍的认识。
