An examination of depression and anxiety in urban-rural areas of the United States: Does urbanization impact depression and anxiety?

摘要

Urbanization is a growing phenomenon not only in the United Sates but all across the world. Several health issues in general and the mental health issues of depression and anxiety in particular have been associated with urbanization. The purpose of this study was to examine the impact of urbanization on the mental disorders of depression and anxiety among the adult population of the United States between the ages of 18 to 64 and also to evaluate the role of socioeconomic variables of age, income, marital status, employment status, gender employment status, and education level in this relationship. This study used the National Health Interview Survey 2012 for analysis. The sample size for this survey consisted of 34,525 out of 43,323 individuals who responded to the survey, resulting in an 80% response rate. In this study, given the large sample size, the p value was set at < 0.01 with a 99% confidence interval. Descriptive statistics were presented to report the overall distribution of depression and anxiety in urban-rural residences in the United States and highlight the demographic characteristics of the respondents. Chi-square statistic tests were conducted to determine statistically significant differences of depression and anxiety by urban-rural residence, as well as by demographic and socioeconomic characteristics (p < .01). Univariate analysis was conducted to assess the relationship between urbanization and depression and anxiety without the socioeconomic variables included in the model (p < .01). Finally, multivariate logistic regression analysis was utilized to assess the role of socioeconomic variables in the relationship between urbanization and depression and anxiety (p < .01). The results of the chi-square statistics tests in this study showed only a slightly higher prevalence rate of depression in the urban area (11%) as compared to the rural areas (10%) and that this relationship was statistically significant (p < 0.01). The univariate logistic regression results showed higher odds of depression in the rural areas than in the urban areas, and this relationship was statistically significant (OR = 1.188, CI = 0.985--1.433, p = .017). However, after adjusting for the socioeconomic variables of gender, age, income, race, marital status, education level, and employment status, it was found that urban residents were more likely to have depression than the rural residents, but this relationship was not statistically significant (OR = 0.912, CI = 0.745--1.117, p =.375). With regard to anxiety, the results of the chi-square test showed a higher prevalence of anxiety in the urban areas (19%) as compared to the rural areas (11%), but this relationship was not statistically significant, X2 (1, N = 6,914) = 0 .392, p = .532. The univariate logistic regression results showed a slightly higher odds ratio for anxiety among the rural residents, but this relationship was not statistically significant (OR = 1.023, CI = 0.893--1.171, p = .670). However, after adjusting for the socioeconomic variables in this study, it was found the urban residents were more likely to have depression than the rural residents, and this relationship was statistically significant (OR = 0.823, CI = 0.715-- 0.947, p < .01). As the results of this study showed, it is not so much the location of the residence that impacts depression and anxiety but the socioeconomic variables that not only confound these relationships but also have a significant relationship with both depression and anxiety.