The role of rurality on factors associated with major depressive episode screening among Brazilian adults in a national household survey

Abstract

Background: Worldwide, depression is one of the leading causes of disability, contributing significantly to the global burden of disease. The aim of this study was to evaluate in Brazil the effect of living in rural or urban areas on the prevalence of major depressive episode (MDE), as well as the differences among associated factors in both contexts. Methods: Data from 60,202 adult residents from a household-based cross-sectional survey conducted in Brazil were analyzed. The prevalence of MDE, evaluated using PHQ-9, as well as the prevalence ratios between the categories of the independent variables were estimated. Multiple hierarchical Poisson regression analyses based on a theoretical model were reproduced for both rural and urban areas. Results: Residents of rural areas showed lower MDE prevalence (3.3% [95% CI: 2.9–3.9] vs. 4.2% [95% CI: 3.9–4.6], p < .05) and the effect of rurality remained even adjusted by potential confounders (PR = 0.8 [95% CI: 0.7–0.9]). Better education, social network, and access to health services were protective factors for both rural and urban areas, while previous diagnosis of depression, chronic diseases, and obesity were risk factors. Living in the northern region, being indigenous, presenting higher income and number of goods were protective factors only in rural areas. In urban areas, being younger and having an occupation were protective factors, whereas female sex and having some disability were risk factors. Conclusions: Rural and urban areas differ not only in the prevalence of depression, but also in the way in which different factors influence its occurrence.