Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, USA.
Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA.
Sci Rep. 2019 Jan 30;9(1):979. doi: 10.1038/s41598-018-37791-1.
Wider recognition of the mental health burden of disease has increased its importance as a global public health concern. However, the spatial heterogeneity of mental disorders at large geographical scales is still not well understood. Herein, we investigate the spatial distribution of incident depression in South Africa. We assess depressive symptomatology from a large longitudinal panel survey of a nationally representative sample of households, the South African National Income Dynamics Study. We identified spatial clusters of incident depression using spatial scan statistical analysis. Logistic regression was fitted to establish the relationship between clustering of depression and socio-economic, behavioral and disease risk factors, such as tuberculosis. There was substantial geographical clustering of depression in South Africa, with the excessive numbers of new cases concentrated in the eastern part of the country. These clusters overlapped with those of self-reported tuberculosis in the same region, as well as with poorer, less educated people living in traditional rural communities. Herein, we demonstrate, for the first time, spatial structuring of depression at a national scale, with clear geographical 'hotspots' of concentration of individuals reporting new depressive symptoms. Such geographical clustering could reflect differences in exposure to various risk factors, including socio-economic and epidemiological factors, driving or reinforcing the spatial structure of depression. Identification of the geographical location of clusters of depression should inform policy decisions.
疾病带来的心理健康负担得到了更广泛的认识，这使其成为全球公共卫生关注的一个重要问题。然而，在较大的地理尺度上，精神障碍的空间异质性仍然没有得到很好的理解。在此，我们研究了南非抑郁症的空间分布。我们从南非全国代表性家庭的一项大型纵向面板调查，即南非国家收入动态研究中评估了抑郁症状。我们使用空间扫描统计分析来识别抑郁症的空间聚集。我们拟合逻辑回归来确定抑郁症聚类与社会经济、行为和疾病风险因素（如结核病）之间的关系。南非的抑郁症存在大量的地理聚集，新发病例的数量集中在该国的东部。这些集群与同一地区报告的自我报告结核病以及居住在传统农村社区的较贫穷、受教育程度较低的人群相重叠。在此，我们首次证明了抑郁症在全国范围内的空间结构，表明有明显的地理“热点”区域集中了报告新抑郁症状的个体。这种地理聚集可能反映了各种风险因素暴露的差异，包括社会经济和流行病学因素，从而推动或加强了抑郁症的空间结构。确定抑郁症集群的地理位置可以为政策决策提供信息。
