Urban–Rural Differences in Older Adult Depression: A Systematic Review and Meta-analysis of Comparative Studies

Abstract

Context: Depression among older adults (≥age 60) is a problem that could be exacerbated by global trends in urbanization and population aging. The study purpose was to assess whether urban, relative to rural, residence is associated with depression among older adults and whether associations differ in countries with developed versus developing economies.Context: Depression among older adults (aged 60 years or older) is a problem that could be exacerbated by global trends in urbanization and population aging. The study purpose was to assess whether urban, relative to rural, residence is associated with depression among older adults and whether associations differ in countries with developed versus developing economies. Evidence acquisition:In 2017, the authors identified and extracted information from comparative studies of urban-rural depression prevalence among older adults. Studies were identified in PubMed, PsychINFO, and Web of Science and limited to English language articles published after 1985. Eighteen studies met inclusion criteria. Random effects meta-analysis was conducted to produce weighted pooled ORs estimating the association between urban-rural residence and depression for all study participants (N=31,598) and sub-analyses were conducted for developed (n=12,728) and developing (n=18,870) countries.Evidence synthesis: Depression prevalence was significantly higher among urban residents in ten studies and significantly higher among rural residents in three studies (all three conducted in China). Associations between urban-rural residence and depression generally remained significant after adjusting for covariates. In developed countries, the odds of depression were significantly higher among urban than rural residents (pooled OR=1.44, 95% CI=1.10, 1.88).However, in developing countries, this association was not observed (pooled OR=0.91, 95% CI=0.46, 1.77). Conclusions:Converging trends of urbanization and population aging could increase the global burden of depression among older adults. The pathways through which urban-rural residence influences depression risk among older adults might differ by country context. Future research should focus on measuring variation in these contexts. 3CONTEXT Human longevity is increasing, and the demographic composition of societies is aging. Between 2015 and 2050, global life expectancy at birth is projected to increase from 70 to 77 years. 1 By 2050, the proportion of the world's population aged more than 60 years is projected to double and the proportion aged more than 80 years is projected to triple. 2,3 In Europe, the proportion of the population aged more than 60 years is expected to increase from 24% to 34% between 2015 and 2050. Increasing trends are also expected in Latin America (from 11% to 26%), North America (from 21% to 28%), and Asia (from 12% to 25%). 3 These increases in longevity pose challenges for policymakers as they are forced to address the implications of population aging within the context of other societal changes. As Beard and Bloom descr...

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

“…For example, three US-based studies included in a recent meta-analysis suggested lower prevalence of depression among rural versus urban older adults. 12 However, other recent US studies have revealed increasing rates of suicide 5,6,50 and alcohol-related and drug-related deaths 2,4 in rural and sparsely populated regions, suggesting that mental health outcomes may disproportionately burden these areas. Our results add to this growing literature on geographic health disparities by suggesting that the prevalence of elevated depressive symptoms may be higher among participants who lived in the rural United States during childhood.…”

“…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 . However, other recent US studies have revealed increasing rates of suicide and alcohol‐related and drug‐related deaths in rural and sparsely populated regions, suggesting that mental health outcomes may disproportionately burden these areas.…”

“…Most prior studies evaluating US geographic disparities in mental health have focused on residence in adulthood . Previous studies have documented lower prevalence of late‐life depression among older adults residing in rural versus urban areas in the United States . However, some evidence suggests that this association is reversed among those with high financial strain .…”

“…3,4 Previous studies have documented lower prevalence of late-life depression among older adults residing in rural versus urban areas in the United States. 12 However, some evidence suggests that this association is reversed among those with high financial strain. 13 There is little research evaluating inequalities in mental health outcomes in later life by place of residence during critical early life periods, although scholars have documented the late-life health impacts of other early life exposures (e.g., socioeconomic disadvantage).…”

Screening Results of Non-Communicable Diseases in Adult and Elderly People Living in the Rural Area; Cross-sectional Descriptive Study

“…The prevalence of depression in Turkey was reported to be 4.4%, and this ratio was observed to be approximately 8% in adult women and 5.5% in men (26). In a meta-analysis, it was found that the depression rate in developed countries was higher in urban areas than in rural areas and that there was no difference between rural and urban areas in developing countries (27).…”