Department of Sociology, University of New Brunswick, PO Box 4400, Fredericton, NB E3B 5A3, Canada.
Health Effects Institute, Boston, MA 02110, USA.
Int J Environ Res Public Health. 2021 Oct 25;18(21):11197. doi: 10.3390/ijerph182111197.
Little is known about the extent to which socioenvironmental characteristics may influence mental health outcomes in smaller population centres or differently among women and men. This study used a gender-based analysis approach to explore individual- and neighbourhood-level sex differences in mental health service use in a context of uniquely smaller urban and rural settlements. This cross-sectional analysis leveraged multiple person-based administrative health datasets linked with geospatial datasets among the population aged 1 and over in the province of New Brunswick, Canada. We used multinomial logistic regression to examine associations between neighbourhood characteristics with risk of service contacts for mood and anxiety disorders in 2015/2016, characterizing the areal measures among all residents (gender neutral) and by males and females separately (gender specific), and controlling for age group. Among the province's 707,575 eligible residents, 10.7% (females: 14.0%; males: 7.3%) used mental health services in the year of observation. In models adjusted for gender-neutral neighbourhood characteristics, service contacts were significantly more likely among persons residing in the most materially deprived areas compared with the least (OR = 1.09 [95% CI: 1.05-1.12]); when stratified by individuals' sex, the risk pattern held for females (OR = 1.13 [95% CI: 1.09-1.17]) but not males (OR = 1.00 [95% CI: 0.96-1.05]). Residence in the most female-specific materially deprived neighbourhoods was independently associated with higher risk of mental health service use among individual females (OR = 1.08 [95% CI: 1.02-1.14]) but not among males (OR = 1.02 [95% CI: 0.95-1.10]). These findings emphasize that research needs to better integrate sex and gender in contextual measures aiming to inform community interventions and neighbourhood designs, notably in small urban and rural settings, to reduce socioeconomic inequalities in the burden of mental disorders.
人们对社会环境特征在较小的人口中心或在女性和男性中的影响程度知之甚少。本研究采用基于性别的分析方法，在独特的较小城市和农村定居点背景下，探索心理健康服务使用方面的个体和社区层面的性别差异。这项横断面分析利用了加拿大新不伦瑞克省的多个基于个人的行政健康数据集，并与地理空间数据集进行了链接，涵盖了 1 岁及以上的人群。我们使用多项逻辑回归来检验社区特征与 2015/2016 年情绪和焦虑障碍服务接触风险之间的关联，以描述所有居民（性别中立）和男性和女性（性别特定）的区域措施，并控制年龄组。在该省 707,575 名符合条件的居民中，有 10.7%（女性：14.0%；男性：7.3%）在观察年度使用了心理健康服务。在调整了性别中立的社区特征的模型中，与最贫困地区的人相比，最贫困地区的人使用心理健康服务的可能性显著更高（OR=1.09[95%CI：1.05-1.12]）；当按个体性别分层时，这种风险模式适用于女性（OR=1.13[95%CI：1.09-1.17]），但不适用于男性（OR=1.00[95%CI：0.96-1.05]）。居住在最女性化的物质贫困社区与个体女性心理健康服务使用风险增加独立相关（OR=1.08[95%CI：1.02-1.14]），但与男性无关（OR=1.02[95%CI：0.95-1.10]）。这些发现强调，需要更好地将性和性别纳入旨在为社区干预和社区设计提供信息的背景措施中，特别是在小型城市和农村环境中，以减少社会经济不平等对精神障碍负担的影响。
