Abstract
The risk of depression is related to multiple various determinants. The consideration of multiple neighborhoods daily frequented by individuals has led to increased interest in analyzing socio-territorial inequalities in health. In this context, the main objective of this study was (i) to describe and analyze the spatial distribution of depression and (ii) to investigate the role of the perception of the different frequented spaces in the risk of depression in the overall population and in the population stratified by gender. Data were extracted from the 2010 SIRS (a French acronym for “health, inequalities and social ruptures”) cohort survey. In addition to the classic individual characteristics, the participants reported their residential neighborhoods, their workplace neighborhoods and a third one: a daily frequented neighborhood. A new approach was developed to simultaneously consider the three reported neighborhoods to better quantify the level of neighborhood socioeconomic deprivation. Multiple simple and cross-classified multilevel logistic regression models were used to analyze the data. Depression was reported more frequently in low-income (OR = 1.89; CI = [1.07–3.35]) or middle-income (OR = 1.91; CI = [1.09–3.36]) neighborhoods and those with cumulative poverty (OR = 1.64; CI = [1.10–2.45]). In conclusion, a cumulative exposure score, such as the one presented here, may be an appropriate innovative approach to analyzing their effects in the investigation of socio-territorial inequalities in health.
Highlights
According to the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative [2], France ranks first in the lifetime prevalence of major depressive episodes (21.0%) among the 18 countries that participate in the WMH surveys, ahead of the USA (19.2%), Brazil (Sao Paulo, 18.4%), the Netherlands
After adjusting for individual characteristics and difficult life events, this study indicated that depression was associated with a negative perception of one’s bodyweight, feeling unsafe and a perception of one’s neighborhood as being deprived, in terms of income and available services
Whereas numerous previous studies have shown that certain neighborhood characteristics, such as income and a built environment, may be associated with a higher ‘ecological’ risk of depression, this study is the first one in France to consider the contextual characteristics of both residential and nonresidential neighborhoods in multilevel models, that take into account individual characteristics and/or perceptions of their residential neighborhood
Summary
The World Health Organization (WHO) estimates that mental disorders caused by depression are the primary risk factors leading to death or disability [1]. According to the WHO World Mental Health (WMH) Survey Initiative [2], France ranks first in the lifetime prevalence of major depressive episodes (21.0%) among the 18 countries that participate in the WMH surveys, ahead of the USA (19.2%), Brazil (Sao Paulo, 18.4%), the Netherlands (17.9%) and New Zealand (17.8%) [3]. In France, where the consumption of psychotropic drugs is four times higher than in other European countries [4], the prevalence of depression in the past 12 months in the 18–75-year-old population was 9.8% in 2017, and twice as high in women (13.0%) than in men (6.4%) [5]. The largest share of these costs stems from reduced productivity (€99.3 billion) and health-care costs (€37.0 billion) [6]
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