Prevalence and factors associated with mental health problems of psychological distress and depression among rural Victorians – analysis of cross-sectional data (Crossroads II)

Abstract Background Research suggests that rates of mental illness are similar in rural and urban Australia, although there are significant workforce shortages in rural regions along with higher rates of chronic disease and obesity and lower levels of socioeconomic status. However, there are variations across rural Australia and limited local data on mental health prevalence, risk, service use and protective factors. This study describes the prevalence of self-reported mental health problems of psychological distress and depression, in a rural region in Australia and aims to identify the factors associated with these problems. Methods The Crossroads II study was a large-scale cross-sectional study undertaken in the Goulburn Valley region of Victoria, Australia in 2016–18. Data were collected from randomly selected households across four rural and regional towns and then screening clinics from individuals from these households. The main outcome measures were self-reported mental health problems of psychological distress assessed by the Kessler 10 and depression assessed by Patient Health Questionnaire-9. Unadjusted odd ratios and 95% confidence intervals of factors associated with the two mental health problems were calculated using simple logistic regression with multiple logistic regression using hierarchical modelling to adjust for the potential confounders. Results Of the 741 adult participants (55.6% females), 67.4% were aged ≥ 55 years. Based on the questionnaires, 16.2% and 13.6% had threshold-level psychological distress and depression, respectively. Of those with threshold-level K-10 scores, 19.0% and 10.5% had seen a psychologist or a psychiatrist respectively while 24.2% and 9.5% of those experiencing depression had seen a psychologist or a psychiatrist, respectively in the past year. Factors such as being unmarried, current smoker, obesity, were significantly associated with a higher prevalence of mental health problems whereas physical activity, and community participation reduced the risk of mental health problems. Compared to rural towns, the regional town had higher risk of depression which was non-significant after adjusting for community participation and health conditions. Conclusions The high prevalence of psychological distress and depression in this rural population was consistent with other rural studies. Personal and lifestyle factors were more relevant to mental health problems than degree of rurality in Victoria. Targeted lifestyle interventions could assist in reducing mental illness risk and preventing further distress.

**背景** 研究显示，澳大利亚农村与城市地区的精神疾病患病率相近，但农村地区存在显著的医护人力短缺问题，同时慢性病、肥胖患病率更高，社会经济水平更低。然而，澳大利亚农村地区内部存在异质性，且目前关于当地心理健康患病率、风险因素、服务使用情况及保护因素的本地数据十分有限。本研究旨在描述澳大利亚某农村地区人群自我报告的心理痛苦与抑郁类心理健康问题的患病率，并明确与上述两类问题相关的影响因素。

**方法** 本研究依托2016–2018年在澳大利亚维多利亚州古尔本区开展的大型横断面研究——十字路口II（Crossroads II）。研究数据来自四个农村及区域城镇中随机选取的住户，以及针对上述住户个体开设的筛查门诊。本研究的主要结局指标为自我报告的心理痛苦与抑郁类心理健康问题：其中心理痛苦通过凯斯勒10量表（Kessler 10）评估，抑郁则通过患者健康问卷-9（Patient Health Questionnaire-9）评估。研究采用简单逻辑回归计算与两类精神健康问题相关因素的未校正比值比及95%置信区间，并通过分层模型的多重逻辑回归校正潜在混杂因素。

**结果** 本研究共纳入741名成年参与者，其中55.6%为女性，67.4%的参与者年龄≥55岁。问卷结果显示，分别有16.2%和13.6%的人群存在临界值水平的心理痛苦与抑郁症状。在凯斯勒10量表评分达临界值的人群中，过去1年内分别有19.0%和10.5%的个体咨询过心理师或精神科医师；而在存在抑郁症状的人群中，该比例分别为24.2%和9.5%。未婚、当前吸烟、肥胖等因素与精神健康问题患病率升高显著相关，而体力活动与社区参与则可降低精神健康问题的发病风险。与纯农村城镇相比，区域城镇的抑郁发病风险更高，但在校正社区参与与健康状况后，该差异不再具有统计学显著性。

**结论** 本研究人群中心理痛苦与抑郁的高患病率与其他农村地区研究结果一致。在维多利亚州，与农村地域程度相比，个体自身因素与生活方式因素与精神健康问题的关联更为紧密。针对性的生活方式干预或可帮助降低精神疾病发病风险，并缓解进一步的心理痛苦。