However, 10% less depression is found among those who live in places from where it takes a long time to the city center
～The Potential of Social Capital to Close the Urban-Rural Divide in Mental Health ～
Is depression more prevalent in urban or rural areas? Research results are inconsistent worldwide. We looked at the correlation between depressive symptoms and rurality among older adults, by focusing on the areal units to assess rurality. We found that when comparing rural and urban municipalities, depressive symptoms were 1.2 times more prevalent in both men and women living in rural municipalities. Not participating in hobbies, sports, or volunteering activities contributed to the high risk of depressive symptoms in rural municipalities. On the other hand, when looking at neighborhoods rather than municipalities, men living in neighborhoods with a longer time to the city center areas tended to be 10% less depressed than those living in city centers. In non-urban and mountainous areas, it was suggested that a sense of trust, attachment to people, and mutual help might be helpful in preventing depression. The prevalence of depressive symptoms varied depending on the areal unit to assess rurality, suggesting that it is important to create an environment that facilitates civic participation in rural municipalities.
Background
Depending on whether one lives in an urban or rural area, there are many different environments that can interact with mental health. For example, a rural municipality with a low population density may have limited tax revenue, limited supply and quality of public services, limited amount of human resources, or large distances between residences that make public transportation difficult. The public service conditions in these municipalities may have a negative impact on the mental health of their residents, such as decreased ease of social participation. Furthermore, there are many different areas within a single municipality. Some areas are located in the city center, where all the facilities and meeting places necessary for daily life are located, while others are located in areas where it takes time to get to the center. There have been no studies that have examined the status of depressive symptoms in urban and rural areas by considering rurality as a multi-regional unit, such as considering a municipal unit or a multi-regional unit within a municipality.
We compared the prevalence of depressive symptoms among older adults between municipalities and between neighborhoods (school districts), which are smaller than municipalities. In addition, we focused on social capital (e.g., connections and bonds between people) to investigate the mechanism of differences in depressive symptoms among regions.
Methods
Participants were 144,822 older adults aged 65 years or older living in 39 municipalities across Japan who participated in the 2016 survey of the Japan Gerontological Evaluation Study. Two regional units were used to assess rurality: the “municipality-level” and the “neighborhood-level”. The population density in each municipality was used to assess rurality at the municipal level, while the time required to reach the densely inhabited district in each ward was used to assess rurality at the school-district level. The richness of community social capital was quantified in each of the following three dimensions.
- Civic participation: Percentage of respondents who participate in group activities such as volunteer work, sports, and hobbies at least once a month.
- Social cohesion: Percentage of people who think they can trust and help each other in the community and who feel attachment to the community.
- Reciprocity: Percentage of people who have someone who listens to/gives advice about their problems or takes care of them when they are sick
We adjusted the results for age and conducted a multilevel analysis to account for variation in responses by municipality, neighborhood, and individual. Additional analyses considered individuals’ educational background, household income, marital status, and living alone or not.
Results
Both men and women tended to have more depressive symptoms in municipalities with lower population densities (specifically, 16.4% of men and 15.5% of women in the most densely populated municipalities and 17.9% of men and 18.5% of women in the least densely populated municipalities). On the other hand, there were no significant differences in the prevalence of depressive symptoms between neighborhoods located in the center of town and those that took longer to reach the center.
The results of the analysis, adjusted for age and regional variations, are shown in the figure. At the municipal level, the results showed that depressive symptoms are about 1.2 times more common among older adults living in municipalities with low population densities than in those with high densities. This correlation was observed for both men and women. The higher risk of depressive symptoms in the less densely populated municipalities was explained by the fact that civic participation tended to be lower in these municipalities. On the other hand, at the neighborhood level, which is smaller than municipalities, male respondents who lived in neighborhoods where it took longer to reach the city center had about 10% fewer depressive symptoms than those who lived in neighborhoods in city centers. No significant differences were found for women. The lower levels of depressive symptoms among men in neighborhoods from where it takes longer to reach the city center were explained by the fact that social cohesion and reciprocity tended to be higher in these neighborhoods.
Individual characteristics such as educational background, household income, marital status, and living alone or not partially explained the higher risk of depressive symptoms in less densely populated municipalities. However, they did not explain the differences in depressive symptoms between neighborhoods located in the city center and those from where it took longer to reach the center.
Conclusion
Our findings suggest that the association between rurality and depressive symptoms differs depending on the areal unit to assess rurality. In rural municipalities with low population density, the risk of depressive symptoms was higher for both men and women, which may be related to the local environment that makes it difficult to participate in group activities such as hobbies, sports, and volunteer work. On the other hand, in rural communities that are located far from the city center, the risk of depression is lower for men, suggesting that a sense of trust, attachment to people, and mutual help may be helpful in preventing depression. It is important to create an environment that facilitates citizen participation in rural municipalities.
Significance of this study
This is the first study in the world to assess the relationship between rurality and depression in each of the areal units to assess rurality in order to unravel the relationship between the complex social environment of “rural areas” and mental health. The importance of depression countermeasures that take into account the differences between urban and rural social environments was presented to facilitate social participation in rural municipalities.
Published Paper
Kanamori, M., Hanazato, M., Takagi, D., Kondo, K., Ojima, T., Amemiya, A., & Kondo, N. (2021). Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES). International Journal of Health Geographics, 20, 42. https://doi.org/10.1186/s12942-021-00296-8
Acknowledgments
This research was supported by the following grants. We would like to express our deepest gratitude: JSPS Grant-in-Aid for Scientific Research, Grant-in-Aid for Scientific Research by the Ministry of Health, Labor and Welfare, Grant-in-Aid for Research and Development on Longevity Science by Japan Agency for Medical Research and Development (AMED), and Grant-in-Aid for Research and Development on Geriatrics and Gerontology, National Center for Geriatrics and Gerontology.
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