Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES)

Abstract

Background 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. Methods 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. Results 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. Conclusions 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.

Video call and depression among older adults during the COVID-19 pandemic in Japan: The JAGES one-year longitudinal study

“…1 ). We selected these factors because a rural setting could be related to a higher incidence of depression ( Kanamori et al, 2021 ) and the limited Internet use among older adults ( Kondo et al, 2021 ) and a state of emergency declaration could change the communication modes of older adults ( Arpino et al, 2021 ; Freedman et al, 2021 ; Greenwood-Hickman et al, 2021 ) and make them depressed due to restricted in-person contact ( Briggs et al, 2021 ; Noguchi et al, 2021 ; Sepúlveda-Loyola et al, 2020 ; Zaninotto et al, 2022 ). We calculated the population density of each municipality using the Statistical Observations of Municipalities in 2019 from the Ministry of Internal Affairs and Communications.…”

Environmental changes and mental distress in rural communities

“…Without exception, mental health in rural areas with a high percentage of farmers and fishermen who are relatively more exposed to environmental changes should be the focus of future research in Japan. A recent study found that in Japan, depression was 1.2 times more prevalent in both men and women living in rural compared with urban municipalities 7) . Although the results of that study do not directly indicate that depression is related to ecological grief, they suggest that risk factors for mental distress include the loss of Japan's rural landscape because of fewer farmers as well as declining crop yields and difficulties in maintaining the livestock industry due to global environmental changes.…”

Urban-Rural Differences in the Prevalence of Depressive Symptoms in Korean Adults

“… 15 On the other hand, in rural areas, factors such as the lack of material resources and lower socioeconomic status of residents are commonly suggested as contributing factors to depression. 16 So, finding the association between residence and depression and its interaction by socioeconomic status may provide valuable information for the development of targeted interventions and policies aimed at promoting mental health equity across diverse settings. By addressing the disparities in depression prevalence, we hope to contribute to the overall improvement of mental health in both urban and rural areas.…”