Social support and age influence distress outcomes differentially across urban, regional and remote Australia: an exploratory study

BMC Public Health

Brian J Kelly³  John Attia²  Terry J Lewin³  Kerry J Inder¹  Joanne Allen³ 

[1] Hunter Medical Research Institute, Newcastle, Australia;Centre for Clinical Epidemiology and Biostatistics, University of Newcastle and Hunter New England Health, Newcastle, NSW, Australia;Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter New England Health, Newcastle, NSW, Australia

关键词: Aged 55 and over;    Social support;    Psychological distress;    Rural health;   

Others  :  1162906
DOI  :  10.1186/1471-2458-12-928

 received in 2012-02-15, accepted in 2012-10-08,  发布年份 2012

【 摘 要 】

Background

The variation of determinants of mental health with remoteness has rarely been directly examined. The current research aims to examine whether the association of psychosocial factors with psychological distress outcomes varies with increasing remoteness.

Methods

Participants were persons aged 55 and over from two community cohorts sampling from across rural and urban New South Wales (N = 4219; mean age = 69.00 years; 46.1% male). Measures of social support from these studies were calibrated to facilitate comparison across the sample. Remoteness was assessed using a continuous measure, the Accessibility/Remoteness Index of Australia. The association between demographic characteristics, social support, remoteness, and their interactions with remoteness in the prediction of high psychological distress (cut-off > 21 on the Kessler 10) were examined using logistic regression.

Results

Not being in a married or defacto relationship (OR 0.69; 99% CI 0.51-0.94), lower education (OR 0.52; 99% CI 0.38-0.71) and decreased social support (OR 0.36; 99% CI 0.31-0.42) significantly predicted psychological distress. There was a significant interaction of age and remoteness (OR 0.84; 99% CI 0.67-1.00), indicating that as remoteness increases, older persons are less likely to be highly distressed, as well as a significant interaction of social support and remoteness (OR 1.22; 99% CI 1.04-1.44), indicating that as remoteness decreases, persons with low levels of social support are more likely to be highly distressed.

Conclusions

Remoteness may moderate the influence of social support and age on psychological distress outcomes.

【 授权许可】

   
2012 Allen et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Kutek SM, Turnbull D, Fairweather-Schmidt AK: Rural men’s subjective well-being and the role of social support and sense of community: Evidence for the potential benefit of enhancing informal networks. Aust J Rural Health 2011, 19:20-26.
• [2]Romans S, Cohen M, Forte T: Rates of depression and anxiety in urban and rural Canada. Soc Psychiatry Psychiatr Epidemiol 2010, 46:1-9.
• [3]Romans SE, Walton VA, Herbison GP, Mullen PE: Social networks and psychiatric morbidity in New Zealand women. Aust N Z J Psychiatry 1992, 26:485-492.
• [4]Collins JE, Winefield H, Ward L, Turnbull D: Understanding help seeking for mental health in rural South Australia: thematic analytical study. Aust J Prim Health 2009, 15:159-165.
• [5]Fuller J, Edwards J, Procter N, Moss J: How definitions of health problems can influence help seeking in rural and remote communities. Aust J Rural Health 2000, 8:148-153.
• [6]Sartore GM, Kelly B, Stain H, Albrecht G, Higginbotham N: Control, uncertainty, and expectations for the future: a qualitative study of the impact of drought on a rural Australian community. Rural Remote Heal 2008, 8:950.
• [7]Hillman K, Rothman S: Movement of non-metropolitan youth towards the cities. Camberwell, VIC: The Australian Council for Educational Research Ltd; 2007.
• [8]Australian Bureau of Statistics: Population distribution. Canberra: Youth migration within Australia ABS catalogue no. 4102.0; 2003.
• [9]Kelly B, Lewin T, Stain H, Coleman C, Fitzgerald M, Perkins D, Carr V, Fragar L, Fuller J, Lyle D, Beard J: Determinants of mental health and well-being within rural and remote communities. Soc Psychiatry Psychiatr Epidemiol 2011, 46:1331-1342.
• [10]Murray G, Judd F, Jackson H, Fraser C, Komiti A, Hodgins G, Pattison P, Humphreys J, Robins G: Rurality and mental health: the role of accessibility. Aust N Z J Psychiatry 2004, 38:629-634.
• [11]Rohrer J, Borders T, Blanton J: Rural residence is not a risk factor for frequent mental distress: a behavioral risk factor surveillance survey. BMC Publ Health 2005, 5:46. BioMed Central Full Text
• [12]Peen J, Schoevers RA, Beekman AT, Dekker J: The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand 2010, 121:84-93.
• [13]Smith KB, Humphreys JS, Wilson MGA: Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research? Aust J Rural Health 2008, 16:56-66.
• [14]Judd FK, Jackson HJ, Komiti A, Murray G, Hodgins G, Fraser C: High prevalence disorders in urban and rural communities. Aust N Z J Psychiatry 2002, 36:104-113.
• [15]Ayuso-Mateos JL, Vazquez-Barquero JL, Dowrick C, Lehtinen V, Dalgard OS, Casey P, Wilkinson C, Lasa L, Page H, Dunn G, Wilkinson G: Depressive disorders in Europe: prevalence figures from the ODIN study. Br J Psychiatry 2001, 179:308-316.
• [16]Canadian Institute for Health Information: How healthy are rural Canadians? An assessment of their health status and health determinants. Ottawa: Canadian Institute for Health Information; 2006.
• [17]Dekker J, Peen J, Koelen J, Smit F, Schoevers R: Psychiatric disorders and urbanization in Germany. BMC Publ Health 2008, 8:17. BioMed Central Full Text
• [18]Kim J-M, Stewart R, Shin I-S, Yoon J-S, Lee H-Y: Lifetime urban/rural residence, social support and late-life depression in Korea. Int J Geriatr Psychiatry 2004, 19:843-851.
• [19]Kovess-Masfety V, Alonso J, de Graaf R, Demyttenaere K: A European approach to rural–urban differences in mental health: the ESEMeD 2000 comparative study. Can J Psychiatry 2005, 50:926-936.
• [20]Kovess-Masfety V, Lecoutour X, Delavelle S: Mood disorders and urban/rural settings. Soc Psychiatry Psychiatr Epidemiol 2005, 40:613-618.
• [21]Lehtinen V, Michalak E, Wilkinson C, Dowrick C, Ayuso-Mateos J-L, Dalgard OS, Casey P, Vázquez-Barquero J-L, Wilkinson G: Urban-rural differences in the occurrence of female depressive disorder in Europe. Soc Psychiatry Psychiatr Epidemiol 2003, 38:283-289.
• [22]Amato PR, Zuo J: Rural poverty, urban poverty, and psychological well-being. Sociol Q 1992, 33:229-240.
• [23]Romans-Clarkson SE, Walton VA, Herbison GP, Mullen PE: Psychiatric morbidity among women in urban and rural New Zealand: psycho-social correlates. Br J Psychiatry 1990, 156:84-91.
• [24]Ziersch AM, Baum F, Darmawan IGN, Kavanagh AM, Bentley RJ: Social capital and health in rural and urban communities in South Australia. Aust N Z J Public Health 2009, 33:7-16.
• [25]Kelly BJ, Stain HJ, Coleman C, Perkins D, Fragar L, Fuller J, Lewin TJ, Lyle D, Carr VJ, Wilson JM, Beard JR: Mental health and well-being within rural communities: The Australian Rural Mental Health Study. Aust J Rural Health 2010, 18:16-24.
• [26]McEvoy M, Smith W, D’Este C, Duke J, Peel R, Schofield P, Scott R, Byles J, Henry D, Ewald B, et al.: Cohort profile: the Hunter Community Study. Int J Epidemiol 2010, 39:1452-1463.
• [27]Australian Bureau of Statistics: Australian social trends 2008. Canberra: ABS catalogue no. 4102.0; 2008.
• [28]Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-LT, Walters EE, Zaslecsky AM: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002, 32:959-976.
• [29]Kessler RC, Üstün TB: The world health organization world mental health 2000 initiative. London: International Hospital Federation; 2000.
• [30]Andrews G, Henderson S, Hall W: Prevalence, comorbidity, disability and service utilisation: Overview of the Australian National Mental Health Survey. Br J Psychiatry 2001, 178:145-153.
• [31]Slade T, Grove R, Burgess P: Kessler psychological distress scale: normative data from the 2007 Australian national survey of mental health and wellbeing. Aust N Z J Psychiatry 2011, 45:308-316.
• [32]Phongsavan P, Chey T, Bauman A, Brooks R, Silove D: Social capital, socio-economic status and psychological distress among Australian adults. Soc Sci Med 2006, 63:2546-2561.
• [33]Berkman LF, Syme SL: Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda county residents. Am J Epidemiol 1979, 109:186-204.
• [34]Koenig H, Westlund R, George L, Hughes D, Blazer D, Hybels C: Abbreviating the duke social support index for use in chronically ill elderly individuals. Psychosomatics 1993, 34:61-69.
• [35]Undén A-L, Orth-Gomér K: Development of a social support instrument for use in population surveys. Soc Sci Med 1989, 29:1387-1392.
• [36]Inder KJ, Berry H, Kelly BJ: Using cohort studies to investigate rural and remote mental health. Aust J Rural Health 2011, 19:171-178.
• [37]Australian Institute of Health and Welfare: Rural, regional and remote health: a guide to remoteness classifications. Canberra: AIHW; 2004.
• [38]Australian Bureau of Statistics: Age by sex - New South Wales. Canberra: ABS catalogue no. 2068.0; 2007.
• [39]Australian Bureau of Statistics: Social marital status by Age by Sex - New South Wales. Canberra: ABS catalogue no. 2068.0; 2007.
• [40]Kilkkinen A, Kao-Philpot A, O’Neil A, Philpot B, Reddy P, Bunker S, Dunbar J: Prevalence of psychological distress, anxiety and depression in rural communities in Australia. Aust J Rural Health 2007, 15:114-119.
• [41]Patten SB, Wang JL, Williams JV, Currie S, Beck CA, Maxwell CJ, El-Guebaly N: Descriptive epidemiology of major depression in Canada. Can J Psychiatry 2006, 51:84-90.
• [42]Moorin RE, Holman CDJ, Garfield C, Brameld KJ: Health related migration: evidence of reduced “urban-drift”. Health Place 2006, 12:131-140.
• [43]Lazarus RS, Folkman S: Stress, appraisal and coping. New York: Springer; 1984.
• [44]Lakey B, Cronin A: Low social support and major depression: Research, theory, and methodological issues. In Risk factors for depression. Edited by Dobson KS, Dozois D. San Diego, CA: Academic Press; 2008:385-408.
• [45]Lakey B, Orehek E: Relational regulation theory: a new approach to explain the link between perceived social support and mental health. Psychol Rev 2011, 118:482-495.
• [46]Boyd CP, Hayes L, Wilson RL, Bearsley-Smith C: Harnessing the social capital of rural communities for youth mental health: An asset-based community development framework. Aust J Rural Health 2008, 16:189-193.
• [47]Winter I: Major themes and debates in the social capital literature: the Australian connection. In Social capital and public policy in Australia. Edited by Winter I. Melbourne: Australian Institute of Family Studies; 2000:17-42.
• [48]Beard JR, Cerda M, Blaney S, Ahern J, Vlahov D, Galea S: Neighborhood characteristics and change in depressive symptoms among older residents of New York city. Am J Public Health 2009, 99:1308-1314.
• [49]Bauer D, Hussong A: Psychometric approaches for developing commensurate measures across independent studies: traditional and new models. Psychol Methods 2009, 14:101-125.
• [50]Curran PJ, Hussong AM: Integrative data analysis: the simultaneous analysis of multiple data sets. Psychol Methods 2009, 14:81-100.