Mental illness in metropolitan, urban and rural Georgia populations

Abstract

BackgroundMental illness represents an important public health problem. Local-level data concerning mental illness in different populations (e.g., socio-demographics and residence – metropolitan/urban/rural) provides the evidence-base for public health authorities to plan, implement and evaluate control programs. This paper describes prevalence and covariates of psychiatric conditions in Georgia populations in three defined geographic areas.MethodsData came from the Georgia population-based random-digit-dialing study investigating unwellness and chronic fatigue syndrome (CFS) in Georgia populations of three defined geographic areas (metropolitan, urban, and rural). Respondents were screened for symptoms of fatigue, sleep, cognition, and pain at household screening interviews, and a randomly selected sample completed detailed individual phone interviews. Based on the detailed phone interviews, we conducted one-day clinical evaluations of 292 detailed interview participants classified as unwell with a probable CFS (i.e. CFS-like; a functional somatic syndrome), 268 classified as other unwell, and 223 well (matched to CFS-like). Clinical evaluation included psychiatric classification by means of the Structured Clinical Interview for DSM (SCID). To derive prevalence estimates we used sample weighting to account for the complexity of the multistage sampling design. We used 2- and 3-way table analyses to examine socio-demographic and urbanicity specific associations and multiple logistic regression to calculate adjusted odds ratios.ResultsAnxiety and mood disorders were the most common psychiatric conditions. Nineteen percent of participants suffered a current anxiety disorder, 18% a mood disorder and 10% had two or more conditions. There was a significant linear trend in occurrence of anxiety or mood disorders from well to CFS-like. The most common anxiety disorders were post-traumatic stress disorder (PTSD) (6.6%) and generalized anxiety disorder (GAD) (5.8%). Logistic regression showed that lower education and female sex contributed significantly to risk for both PTSD and GAD. In addition, rural/urban residence and Hispanic ethnicity were associated with PTSD. We defined moderate to severe depression as Major Depressive Disorder or a Zung score >60 and logistic regression found lower education to be significantly associated but sex, age and urbanicity were not.ConclusionsOverall occurrence of anxiety and mood disorders in Georgia mirrored national findings. However, PTSD and GAD occurred at twice the published national rates (3.6 and 2.7%, respectively). State and local prevalence and associations with education, sex and urbanicity comprise important considerations for developing control programs. The increased prevalence of anxiety and mood disorders in people with a functional somatic syndrome (or CFS-like illness) is important for primary care providers, who should consider additional psychiatric screening or referral of individuals presenting with somatoform symptoms.

Inequalities in elevated depressive symptoms in middle‐aged and older adults by rural childhood residence: The important role of education

“…Prior literature evaluating mental health disparities in adulthood by place of adult residence, rural versus nonrural areas, has shown equivocal results . Aspects of geographic context that affect mental health may differ across both context (country) and time (birth cohorts and life course period of exposure).…”

“…Prior literature evaluating mental health disparities in adulthood by place of adult residence, rural versus nonrural areas, has shown equivocal results. [47][48][49] Aspects of geographic context that affect mental health may differ across both context (country) and time (birth cohorts and life course period of exposure). For example, three US-based studies included in a recent meta-analysis suggested lower prevalence of depression among rural versus urban older adults.…”

Animal models of gene–environment interaction in schizophrenia: A dimensional perspective

“…The effect of urban residency was also evident for psychotic disorders at large and for “psychotic-like symptoms” in different studies from several different regions of the world (Kelly et al, 2010; Szoke et al, 2014; van Os et al, 2001). In addition, some studies reported positive association between urbanicity and development of other mental disorders, such as bipolar disorder (Paksarian et al, 2014), post-traumatic stress disorder (Reeves et al, 2013), depression and anxiety symptoms (Lundberg et al, 2009) but contradicting findings also exist (Baxter et al, 2006; Breslau et al, 2014). …”

Socio-demographic patterns of posttraumatic stress disorder in Medellin, Colombia and the context of lifetime trauma exposure

“…32,38 Peen and colleagues (2010) conducted a large-scale meta-analysis of international studies across 16 developed nations, spanning 25 y. 34 Pooled total prevalence rates for psychiatric disorders were significantly higher for urban settings compared with rural areas, a finding that was consistent across total disorders, mood disorders, and anxiety disorders.…”

“…Specific to PTSD rates in the United States, Reeves and colleagues (2013) 41 compared metropolitan Atlanta to urban (moderate size metropolitan areas) and rural areas in the state of Georgia. PTSD rates were significantly higher for both urban and rural areas compared with the Atlanta metropolitan area.…”