Margot Annequin1, Alain Weill2, Frédérique Thomas3, Basile Chaix4. 1. Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, UPMC Univ Paris 06, Sorbonne Universités, Paris, France. 2. Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France. 3. Centre d'Investigations Préventives et Cliniques, Paris, France. 4. Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, UPMC Univ Paris 06, Sorbonne Universités, Paris, France. Electronic address: basile.chaix@iplesp.upmc.fr.
Abstract
PURPOSE: Few studies examined the relationship between neighborhood characteristics and both depressive disorders and the corresponding mental health care use. The aim of our study was to investigate neighborhood effects on depressive symptomatology, antidepressant consumption, and the consultation of psychiatrists. METHODS: Data from the French Residential Environment and Coronary heart Disease Study (n = 7290, 2007-2008, 30-79 years of age) were analyzed. Depressive symptomatology was cross-sectionally assessed. Health care reimbursement data allowed us to assess antidepressant consumption and psychiatric consultation prospectively more than 18 months. Multilevel logistic regression models were estimated. RESULTS: The risk of depressive symptoms increased with decreasing personal educational level and unemployment and slightly with decreasing neighborhood income. In a sample comprising participants with and without depressive symptoms, high individual and parental educational levels were both associated with the consultation of psychiatrists. In this sample, a low personal educational level increased the odds of consumption of antidepressants. No heterogeneity between neighborhoods was found for antidepressant consumption. However, the odds of consulting psychiatrists increased with median neighborhood income and with the density of psychiatrists, after adjustment for individual characteristics. Among depressive participants only, a particularly strong gradient in the consultation of psychiatrists was documented according to individual socioeconomic status. CONCLUSIONS: Future research on the relationships between the environments and depression should take into account health care use related to depression and consider the spatial accessibility to mental health services among other environmental factors.
PURPOSE: Few studies examined the relationship between neighborhood characteristics and both depressive disorders and the corresponding mental health care use. The aim of our study was to investigate neighborhood effects on depressive symptomatology, antidepressant consumption, and the consultation of psychiatrists. METHODS: Data from the French Residential Environment and Coronary heart Disease Study (n = 7290, 2007-2008, 30-79 years of age) were analyzed. Depressive symptomatology was cross-sectionally assessed. Health care reimbursement data allowed us to assess antidepressant consumption and psychiatric consultation prospectively more than 18 months. Multilevel logistic regression models were estimated. RESULTS: The risk of depressive symptoms increased with decreasing personal educational level and unemployment and slightly with decreasing neighborhood income. In a sample comprising participants with and without depressive symptoms, high individual and parental educational levels were both associated with the consultation of psychiatrists. In this sample, a low personal educational level increased the odds of consumption of antidepressants. No heterogeneity between neighborhoods was found for antidepressant consumption. However, the odds of consulting psychiatrists increased with median neighborhood income and with the density of psychiatrists, after adjustment for individual characteristics. Among depressiveparticipants only, a particularly strong gradient in the consultation of psychiatrists was documented according to individual socioeconomic status. CONCLUSIONS: Future research on the relationships between the environments and depression should take into account health care use related to depression and consider the spatial accessibility to mental health services among other environmental factors.
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