Abstract
Background: 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. Methods: 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. Results: 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]). Conclusion: 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.
Highlights
IntroductionIt has been widely postulated that more egalitarian social and residential environments can level the health of populations [1,2]
Drawing on multiple linked administrative health and geospatial datasets, we aimed to address the following research questions: (i) are there sex-specific associations between neighbourhood characteristics with individuals’ risk of service contacts for mood and anxiety disorders; and (ii) do these associations remain after controlling for sex-disaggregated neighbourhood-level characteristics
We considered the role of different measures of neighbourhood characteristics available through the Canadian Marginalization Index (CANMarg) [36], as well as sex-disaggregated data curated from census tables [37]
Summary
It has been widely postulated that more egalitarian social and residential environments can level the health of populations [1,2]. A growing body of empirical evidence suggests that selected characteristics of neighbourhood environments—often based on summary indices of multiple deprivation from population census data—are related to higher morbidity and healthcare utilization, even in contexts of universal healthcare coverage such as Canada [3,4,5,6]. Health systems can play an important role in addressing such disparities through policies and programs targeting improved equity in physical and mental health outcomes [7]. Much of the research linking health and neighbourhood characteristics, focuses on physical endpoints, such as cardiometabolic, respiratory, Int. J.
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