Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Bldg. 3, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
Department of Social Epidemiology, Graduate School of Medicine, Science Frontier Laboratory, Kyoto University, Floor 2, Yoshida-konoe-cho, Sakyo-ku, Kyotoshi, Kyoto, Japan.
Int J Health Geogr. 2021 Sep 26;20(1):42. doi: 10.1186/s12942-021-00296-8.
Rurality can reflect many aspects of the community, including community characteristics that may be associated with mental health. In this study, we focused on geographical units to address multiple layers of a rural environment. By evaluating rurality at both the municipality and neighborhood (i.e., a smaller unit within a municipality) levels in Japan, we aimed to elucidate the relationship between depression and rurality. To explore the mechanisms linking rurality and depression, we examined how the association between rurality and depression can be explained by community social capital according to geographical units.
We used cross-sectional data from the 2016 wave of the Japan Gerontological Evaluation Study involving 144,822 respondents aged 65 years or older residing in 937 neighborhoods across 39 municipalities. The population density quintile for municipality-level rurality and the quintile for the time required to reach densely inhabited districts for neighborhood-level rurality were used. We calculated the prevalence ratios of depressive symptoms by gender using a three-level (individual, neighborhood, and municipality) Poisson regression. Community social capital was assessed using three components: civic participation, social cohesion, and reciprocity.
The prevalence of depressive symptoms was higher in municipalities with lower population density than those with the highest population density; the ratios were 1.22 (95% confidence intervals: 1.15, 1.30) for men and 1.22 (1.13, 1.31) for women. In contrast, when evaluating rurality at the neighborhood level, the prevalence of depressive symptoms was 0.9 times lower for men in rural areas; no such association was observed for women. In rural municipalities, community civic participation was associated with an increased risk of depressive symptoms. In rural neighborhoods, community social cohesion and reciprocity were linked to a lower risk of depressive symptoms.
The association between rurality and depression varied according to geographical unit. In rural municipalities, the risk of depression may be higher for both men and women, and the presence of an environment conducive to civic participation may contribute to a higher risk of depression, as observed in this study. The risk of depression in men may be lower in rural neighborhoods in Japan, which may be related to high social cohesion and reciprocity.
农村性可以反映社区的许多方面，包括可能与心理健康相关的社区特征。在这项研究中，我们专注于地理单元，以解决农村环境的多个层面。通过在日本评估市和邻里（即市的较小单元）层面的农村性，我们旨在阐明抑郁与农村性之间的关系。为了探讨农村性和抑郁之间的联系机制，我们根据地理单元检验了社区社会资本如何解释农村性与抑郁之间的关联。
我们使用了来自日本老年评估研究 2016 年波的横断面数据，该研究涉及居住在 39 个市的 937 个邻里的 144822 名 65 岁或以上的受访者。市农村性的人口密度五分位数和邻里农村性到达人口稠密区所需时间的五分位数用于评估。我们使用三级（个体、邻里和市）泊松回归计算了按性别划分的抑郁症状的患病率比。社区社会资本使用三个组成部分进行评估：公民参与、社会凝聚力和互惠性。
人口密度较低的市的抑郁症状患病率高于人口密度最高的市；男性的比值为 1.22（95%置信区间：1.15，1.30），女性的比值为 1.22（1.13，1.31）。相比之下，在评估邻里层面的农村性时，男性在农村地区的抑郁症状患病率降低了 0.9 倍；女性则没有这种关联。在农村市，社区公民参与与抑郁症状的风险增加有关。在农村邻里，社区社会凝聚力和互惠性与抑郁症状的风险降低有关。
农村性与抑郁之间的关联因地理单元而异。在农村市，男性和女性的抑郁风险可能更高，本研究中观察到的有利于公民参与的环境可能会增加抑郁风险。日本农村邻里的男性抑郁风险可能较低，这可能与较高的社会凝聚力和互惠性有关。
