Environmental and individual characteristics associated with depressive disorders and mental healthcare use

Margot Annequin (1) , Alain Weill (2) , Frédérique Thomas (3) , Basile Chaix (1)

1 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 CNAMTS - Caisse Nationale d'Assurance Maladie des Travailleurs salariés
3 CIPC - Centre d'Investigations Préventives et Cliniques

Purpose : Few studies examined the relationship between neighborhood characteristics and both depressive disorders and the corresponding mental healthcare utilization. The aim of our study was to investigate neighborhood effects on depressive symptomatology, antidepressant consumption, and the consultation of psychiatrists. Methods : Data from the French RECORD Study (n = 7290, 2007–2008, age 30–79 years) were analyzed. Depressive symptomatology was cross-sectionally assessed with the QD2A scale. Healthcare reimbursement data allowed us to assess antidepressant consumption and psychiatric consultation prospectively over 18 months. Multilevel logistic regression models were estimated. Results : The risk of depressive symptoms increased with decreasing personal educational level and unemployment, and slightly with decreasing neighborhood income. In a sample comprising participants with and without depressive symptoms, high individual and parental educational levels were both associated with the consultation of psychiatrists. In this sample, a low personal educational level increased the odds of consumption of antidepressants. No heterogeneity between neighborhoods was found for antidepressant consumption. However, the odds of consulting psychiatrists increased with median neighborhood income and with the density of psychiatrists, after adjustment for individual characteristics. Among depressive participants only, a particularly strong gradient in the consultation of psychiatrists was documented according to individual socioeconomic status. Conclusion : Future research on the relationships between the environments and depression should take into account healthcare utilization related to depression and consider the spatial accessibility to mental health services among other environmental factors.

Mots clés: mental health; healthcare disparities; depression; residence characteristics; socioeconomic factors

Domaines: Santé publique et épidémiologie

Margot Annequin, Alain Weill, Frédérique Thomas, Basile Chaix. Environmental and individual characteristics associated with depressive disorders and mental healthcare use. Annals of Epidemiology, 2015, 25 (8), pp.605-612. ⟨10.1016/j.annepidem.2015.02.002⟩. ⟨hal-01118138⟩