Souza Maximiliano Loiola Ponte de, Caranha Nathalia Paz, Herkrath Fernando José
Escritório Técnico da Fundação Oswaldo Cruz, Eusébio, Ceará, Brazil.
Instituto Leônidas e Maria Deane, Fundação Oswaldo Cruz, Manaus, Amazonas, Brazil.
Int J Soc Psychiatry. 2022 Jun;68(4):762-772. doi: 10.1177/00207640211004999. Epub 2021 Mar 19.
Worldwide, depression is one of the leading causes of disability, contributing significantly to the global burden of disease. The aim of this study was to evaluate in Brazil the effect of living in rural or urban areas on the prevalence of major depressive episode (MDE), as well as the differences among associated factors in both contexts.
Data from 60,202 adult residents from a household-based cross-sectional survey conducted in Brazil were analyzed. The prevalence of MDE, evaluated using PHQ-9, as well as the prevalence ratios between the categories of the independent variables were estimated. Multiple hierarchical Poisson regression analyses based on a theoretical model were reproduced for both rural and urban areas.
Residents of rural areas showed lower MDE prevalence (3.3% [95% CI: 2.9-3.9] vs. 4.2% [95% CI: 3.9-4.6], < .05) and the effect of rurality remained even adjusted by potential confounders (PR = 0.8 [95% CI: 0.7-0.9]). Better education, social network, and access to health services were protective factors for both rural and urban areas, while previous diagnosis of depression, chronic diseases, and obesity were risk factors. Living in the northern region, being indigenous, presenting higher income and number of goods were protective factors only in rural areas. In urban areas, being younger and having an occupation were protective factors, whereas female sex and having some disability were risk factors.
Rural and urban areas differ not only in the prevalence of depression, but also in the way in which different factors influence its occurrence.
在全球范围内，抑郁症是导致残疾的主要原因之一，对全球疾病负担有重大影响。本研究的目的是在巴西评估生活在农村或城市地区对重度抑郁发作（MDE）患病率的影响，以及两种环境下相关因素的差异。
分析了巴西一项基于家庭的横断面调查中60202名成年居民的数据。使用PHQ-9评估MDE的患病率，并估计自变量类别之间的患病率比值。针对农村和城市地区分别基于理论模型进行了多重分层泊松回归分析。
农村地区居民的MDE患病率较低（3.3% [95%置信区间：2.9 - 3.9] 对比4.2% [95%置信区间：3.9 - 4.6]，P < 0.05），即使在对潜在混杂因素进行调整后，农村地区的影响仍然存在（患病率比值 = 0.8 [95%置信区间：0.7 - 0.9]）。更好的教育、社交网络和获得医疗服务的机会对农村和城市地区都是保护因素，而先前诊断为抑郁症、慢性病和肥胖是危险因素。生活在北部地区、为原住民、收入较高和拥有较多物品仅在农村地区是保护因素。在城市地区，较年轻和有职业是保护因素，而女性和有某种残疾是危险因素。
农村和城市地区不仅在抑郁症患病率上存在差异，而且在不同因素影响其发生的方式上也存在差异。
