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 an...
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| Format: | Article |
| Language: | English |
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BMC
2021-09-01
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| Series: | International Journal of Health Geographics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12942-021-00296-8 |
| _version_ | 1818407342619754496 |
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| author | Mariko Kanamori Masamichi Hanazato Daisuke Takagi Katsunori Kondo Toshiyuki Ojima Airi Amemiya Naoki Kondo |
| author_facet | Mariko Kanamori Masamichi Hanazato Daisuke Takagi Katsunori Kondo Toshiyuki Ojima Airi Amemiya Naoki Kondo |
| author_sort | Mariko Kanamori |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T09:26:19Z |
| format | Article |
| id | doaj.art-5f841daa08e34765bb5aeca7462a99ed |
| institution | Directory Open Access Journal |
| issn | 1476-072X |
| language | English |
| last_indexed | 2024-12-14T09:26:19Z |
| publishDate | 2021-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal of Health Geographics |
| spelling | doaj.art-5f841daa08e34765bb5aeca7462a99ed2022-12-21T23:08:10ZengBMCInternational Journal of Health Geographics1476-072X2021-09-0120111310.1186/s12942-021-00296-8Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES)Mariko Kanamori0Masamichi Hanazato1Daisuke Takagi2Katsunori Kondo3Toshiyuki Ojima4Airi Amemiya5Naoki Kondo6Department of Health and Social Behavior, Graduate School of Medicine, The University of TokyoDepartment of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba UniversityDepartment of Health and Social Behavior, Graduate School of Medicine, The University of TokyoDepartment of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba UniversityDepartment of Community Health and Preventive Medicine, Hamamatsu University School of MedicineDepartment of Social Epidemiology, Graduate School of Medicine, Science Frontier Laboratory, Kyoto UniversityDepartment of Social Epidemiology, Graduate School of Medicine, Science Frontier Laboratory, Kyoto UniversityAbstract 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.https://doi.org/10.1186/s12942-021-00296-8Depressive symptomsGeographical unitJapanMultilevel analysisMunicipalityNeighborhood |
| spellingShingle | Mariko Kanamori Masamichi Hanazato Daisuke Takagi Katsunori Kondo Toshiyuki Ojima Airi Amemiya Naoki Kondo 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 Depressive symptoms Geographical unit Japan Multilevel analysis Municipality Neighborhood |
| title | Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES) |
| title_full | Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES) |
| title_fullStr | Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES) |
| title_full_unstemmed | Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES) |
| title_short | Differences in depressive symptoms by rurality in Japan: a cross-sectional multilevel study using different aggregation units of municipalities and neighborhoods (JAGES) |
| title_sort | differences in depressive symptoms by rurality in japan a cross sectional multilevel study using different aggregation units of municipalities and neighborhoods jages |
| topic | Depressive symptoms Geographical unit Japan Multilevel analysis Municipality Neighborhood |
| url | https://doi.org/10.1186/s12942-021-00296-8 |
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