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Urban–Rural Differences in Older Adult Depression: A Systematic Review and Meta-analysis of Comparative Studies

  • Jonathan Purtle
    Correspondence
    Address correspondence to: Jonathan Purtle, DrPH, MPH, MSc, Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia PA 19104.
    Affiliations
    Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Katherine L. Nelson
    Affiliations
    Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Yong Yang
    Affiliations
    Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee
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  • Brent Langellier
    Affiliations
    Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Ivana Stankov
    Affiliations
    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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  • Ana V. Diez Roux
    Affiliations
    Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania

    Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Published:February 16, 2019DOI:https://doi.org/10.1016/j.amepre.2018.11.008

      Context

      Depression among older adults (aged 60 years or older) is a problem that could be exacerbated by global trends in urbanization and population aging. The study purpose was to assess whether urban, relative to rural, residence is associated with depression among older adults and whether associations differ in countries with developed versus developing economies.

      Evidence acquisition

      In 2017, the authors identified and extracted information from comparative studies of urban–rural depression prevalence among older adults. Studies were identified in PubMed, PsychINFO, and Web of Science and limited to English language articles published after 1985. Eighteen studies met inclusion criteria. Random effects meta-analysis was conducted to produce weighted pooled ORs estimating the association between urban–rural residence and depression for all study participants (N=31,598) and sub-analyses were conducted for developed (n=12,728) and developing (n=18,870) countries.

      Evidence synthesis

      Depression prevalence was significantly higher among urban residents in ten studies and significantly higher among rural residents in three studies (all three conducted in China). Associations between urban–rural residence and depression generally remained significant after adjusting for covariates. In developed countries, the odds of depression were significantly higher among urban than rural residents (pooled OR=1.44, 95% CI=1.10, 1.88). However, in developing countries, this association was not observed (pooled OR=0.91, 95% CI=0.46, 1.77).

      Conclusions

      Converging trends of urbanization and population aging could increase the global burden of depression among older adults. The pathways through which urban–rural residence influences depression risk among older adults might differ by country context. Future research should focus on measuring variation in these contexts.
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      REFERENCES

        • UN, Department of Economic and Social Affairs, Popuation Division
        World Urbanization Prospects: The 2014 Revision, Highlights.
        UN, New York, NY2014
        • UN, Department of Economic and Social Affairs, Population Division
        World Population Prospects: The 2015 Revision, World Population 2015 Wallchart.
        UN, New York, NY2015
        • UN, Department of Economics and Social Affairs, Population Division
        World Population Prospects: The 2017 Revision, World Population 2017 Wallchart.
        UN, New York, NY2017
        • Beard JR
        • Bloom DE
        Towards a comprehensive public health response to population ageing.
        Lancet. 2015; 385: 658-661
        • Beard JR
        • Petitot C
        Ageing and urbanization: can cities be designed to foster active ageing?.
        Public Health Rev. 2010; 32: 427-450
        • Steels S
        Key characteristics of age-friendly cities and communities: a review.
        Cities. 2015; 47: 45-52
        • Buffel T
        • Phillipson C
        Can global cities be ‘age-friendly cities’? Urban development and ageing populations.
        Cities. 2016; 55: 94-100
        • Jackisch J
        • Zamaro G
        • Green G
        • Huber M
        Is a healthy city also an age-friendly city.
        Health Promot Int. 2015; 30: i108-i117
        • Leggett A
        • Zarit S
        Prevention of mental disorders in older adults: recent innovations and future directions.
        Generations. 2014; 38: 45-52
        • Lambert KG
        • Nelson RJ
        • Jovanovic T
        • Cerda M
        Brains in the city: neurobiological effects of urbanization.
        Neurosci Biobehav Rev. 2015; 58: 107-122
        • Galea S
        The urban brain: new directions in research exploring the relation between cities and mood–anxiety disorders.
        Depress Anxiety. 2011; 28: 857-862
        • Srivastava K
        Urbanization and mental health.
        Ind Psychiatry J. 2009; 18: 75-76
        • Sturm R
        • Cohen D
        Proximity to urban parks and mental health.
        J Ment Health Policy Econ. 2014; 17: 19-24
        • Galea S
        • Uddin M
        • Koenen K
        The urban environment and mental disorders: epigenetic links.
        Epigenetics. 2011; 6: 400-404
        • Sundquist K
        • Frank G
        • Sundquist J
        Urbanisation and incidence of psychosis and depression.
        Br J Psychiatry. 2004; 184: 293-298
        • 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
        • DeVylder JE
        • Kelleher I
        • Lalane M
        • Oh H
        • Link BG
        • Koyanagi A
        Association of urbanicity with psychosis in low-and middle-income countries.
        JAMA Psychiatry. 2018; 75: 678-686
        • Fiske A
        • Wetherell JL
        • Gatz M
        Depression in older adults.
        Annu Rev Clin Psychol. 2009; 5: 363-389
        • Hasin DS
        • Goodwin RD
        • Stinson FS
        • Grant BF
        Epidemiology of major depressive disorder: results from the National Epidemiologic Survey on Alcoholism and Related Conditions.
        Arch Gen Psychiatry. 2005; 62: 1097-1106
        • Alexopoulos GS
        Depression in the elderly.
        Lancet. 2005; 365: 1961-1970
        • Blazer D
        Depression in the elderly.
        N Engl J Med. 1989; 320: 164-166
        • Friedhoff AJ
        • Ballenger J
        • Bellack AS
        • et al.
        Diagnosis and treatment of depression in late life.
        JAMA. 1992; 268: 1018-1024
        • Djernes JK
        Prevalence and predictors of depression in populations of elderly: a review.
        Acta Psychiatr Scand. 2006; 113: 372-387
        • Sutin AR
        • Terracciano A
        • Milaneschi Y
        • An Y
        • Ferrucci L
        • Zonderman AB
        The trajectory of depressive symptoms across the adult life span.
        JAMA Psychiatry. 2013; 70: 803-811
        • Blazer DG
        Depression in late life: review and commentary.
        J Gerontol A Biol Sci Med Sci. 2003; 58: 249-265
        • Beekman A
        • Copeland J
        • Prince MJ
        Review of community prevalence of depression in later life.
        Br J Psychiatry. 1999; 174: 307-311
        • Meeks TW
        • Vahia IV
        • Lavretsky H
        • Kulkarni G
        • Jeste DV
        A tune in “a minor” can “b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults.
        J Affect Disord. 2011; 129: 126-142
        • Haigh EA
        • Bogucki OE
        • Sigmon ST
        • Blazer DG
        Depression among older adults: a 20-year update on five common myths and misconceptions.
        Am J Geriatr Psychiatry. 2018; 26: 107-122
        • Kok RM
        • Reynolds III, CF
        Management of depression in older adults: a review.
        JAMA. 2017; 317: 2114-2122
        • Mitchell AJ
        • Subramaniam H
        Prognosis of depression in old age compared to middle age: a systematic review of comparative studies.
        Am J Psychiatry. 2005; 162: 1588-1601
        • Chui H
        • Gerstorf D
        • Hoppmann CA
        • Luszcz MA
        Trajectories of depressive symptoms in old age: integrating age-, pathology-, and mortality-related changes.
        Psychol Aging. 2015; 30: 940-951
        • Cole MG
        • Bellavance F
        • Mansour A
        Prognosis of depression in elderly community and primary care populations: a systematic review and meta-analysis.
        Am J Psychiatry. 1999; 156: 1182-1189
        • Chapman DP
        • Perry GS
        Depression as a major component of public health for older adults.
        Prev Chronic Dis. 2008; 5: A22
        • Rodda J
        • Walker Z
        • Carter J
        Depression in older adults.
        BMJ. 2011; 343: d5219
        • Brodaty H
        • Luscombe G
        • Parker G
        • et al.
        Early and late onset depression in old age: different aetiologies, same phenomenology.
        J Affect Disord. 2001; 66: 225-236
        • Bruce ML
        • McAvay GJ
        • Raue PJ
        • et al.
        Major depression in elderly home health care patients.
        Am J Psychiatry. 2002; 159: 1367-1374
        • Heun R
        • Papassotiropoulos A
        • Jessen F
        • Maier W
        • Breitner JC
        A family study of Alzheimer disease and early-and late-onset depression in elderly patients.
        Arch Gen Psychiatry. 2001; 58: 190-196
        • Cole MG
        • Dendukuri N
        Risk factors for depression among elderly community subjects: a systematic review and meta-analysis.
        Am J Psychiatry. 2003; 160: 1147-1156
        • Perlis ML
        • Smith LJ
        • Lyness JM
        • et al.
        Insomnia as a risk factor for onset of depression in the elderly.
        Behav Sleep Med. 2006; 4: 104-113
        • Fonken LK
        • Finy MS
        • Walton JC
        • et al.
        Influence of light at night on murine anxiety- and depressive-like responses.
        Behav Brain Res. 2009; 205: 349-354
        • Stevens RG
        • Brainard GC
        • Blask DE
        • Lockley SW
        • Motta ME
        Adverse health effects of nighttime lighting: comments on American Medical Association policy statement.
        Am J Prev Med. 2013; 45: 343-346
        • Chepesiuk R
        Missing the dark: health effects of light pollution.
        Environ Health Perspect. 2009; 117: A20-A27
        • Salgado-Delgado R
        • Tapia Osorio A
        • Saderi N
        • Escobar C
        Disruption of circadian rhythms: a crucial factor in the etiology of depression.
        Depress Res Treat. 2011; 2011839743.
        • Julien D
        • Richard L
        • Gauvin L
        • Kestens Y
        Neighborhood characteristics and depressive mood among older adults: an integrative review.
        Int Psychogeriatr. 2012; 24: 1207-1225
        • Elliott J
        • Gale CR
        • Parsons S
        • Kuh D
        • Team HS
        Neighbourhood cohesion and mental wellbeing among older adults: a mixed methods approach.
        Soc Sci Med. 2014; 107: 44-51
        • Richardson R
        • Westley T
        • Gariépy G
        • Austin N
        • Nandi A
        Neighborhood socioeconomic conditions and depression: a systematic review and meta-analysis.
        Soc Psychiatry Psychiatr Epidemiol. 2015; 50: 1641-1656
        • Ivey SL
        • Kealey M
        • Kurtovich E
        • et al.
        Neighborhood characteristics and depressive symptoms in an older population.
        Aging Ment Health. 2015; 19: 713-722
        • Wilson-Genderson M
        • Pruchno R
        Effects of neighborhood violence and perceptions of neighborhood safety on depressive symptoms of older adults.
        Soc Sci Med. 2013; 85: 43-49
        • Marc A
        • Willman AM.
        Violence in the City: Understanding and Supporting Community Responses to Urban Violence.
        World Bank, Washington, DC2010
        • Sjösten N
        • Kivelä SL
        The effects of physical exercise on depressive symptoms among the aged: a systematic review.
        Int J Geriatr Psychiatry. 2006; 21: 410-418
        • Barbour KA
        • Blumenthal JA
        Exercise training and depression in older adults.
        Neurobiol Aging. 2005; 26: 119-123
        • McAuley E
        • Rudolph D
        Physical activity, aging, and psychological well-being.
        J Aging Phys Act. 1995; 3: 67-96
        • Brown DR
        Physical activity, aging, and psychological well-being: an overview of the research.
        Can J Sport Sci. 1992; 17: 185-193
        • Arent S
        • Landers M
        • Etnier J
        The effects of exercise on mood in older adults: a meta-analytic.
        J Aging Phys Act. 2000; 8: 407-430
        • Blake H
        • Mo P
        • Malik S
        • Thomas S
        How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review.
        Clin Rehabil. 2009; 23: 873-887
        • Nolen-Hoeksema S
        • Ahrens C
        Age differences and similarities in the correlates of depressive symptoms.
        Psychol Aging. 2002; 17: 116-124
        • Choi NG
        • DiNitto DM
        Depressive symptoms among older adults who do not drive: association with mobility resources and perceived transportation barriers.
        Gerontologist. 2016; 56: 432-443
        • Musselwhite C
        • Holland C
        • Walker I
        The role of transport and mobility in the health of older people.
        Transp Health. 2015; : 1-4
        • Mammen G
        • Faulkner G
        Physical activity and the prevention of depression: a systematic review of prospective studies.
        Am J Prev Med. 2013; 45: 649-657
        • Beard JR
        • Petitot C
        Ageing and urbanization: can cities be designed to foster active ageing?.
        Public Health Rev. 2010; 32: 427-450
        • Evans GW
        The built environment and mental health.
        J Urban Health. 2003; 80: 536-555
        • Guite H
        • Clark C
        • Ackrill G
        The impact of the physical and urban environment on mental well-being.
        Public Health. 2006; 120: 1117-1126
        • WHO
        Mental Health ATLAS 2017.
        (Published)
        • Montgomery B
        • Roberts P.
        Walk Urban: Demand, Constraints, and Measurement of the Urban Pedestrian Environment.
        World Bank, Washington, DC2008
        • Cervero R
        Transport infrastructure and the environment in the Global South: sustainable mobility and urbanism.
        J Region City Plan. 2014; 25: 174-191
        • Kirkbride JB
        • Keyes KM
        • Susser E
        City living and psychotic disorders—implications of global heterogeneity for theory development.
        JAMA Psychiatry. 2018; (In press. Online October 10, 2018)
        • Franck L
        • Molyneux N
        • Parkinson L
        Systematic review of interventions addressing social isolation and depression in aged care clients.
        Qual Life Res. 2016; 25: 1395-1407
        • Jorm AF
        Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span.
        Psychol Med. 2000; 30: 11-22
        • Luppa M
        • Sikorski C
        • Luck T
        • et al.
        Age- and gender-specific prevalence of depression in latest-life—systematic review and meta-analysis.
        J Affect Disord. 2012; 136: 212-221
        • Vink D
        • Aartsen MJ
        • Schoevers RA
        Risk factors for anxiety and depression in the elderly: a review.
        J Affect Disord. 2008; 106: 29-44
        • Chen R
        • Copeland JR
        • Wei L
        A meta-analysis of epidemiological studies in depression of older people in the People's Republic of China.
        Int J Geriatr Psychiatry. 1999; 14: 821-830
        • Higgins JP
        • Thompson SG
        • Deeks JJ
        • Altman DG
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
      1. UN. World Economic Situation and Prospects 2014. www.un.org/en/development/desa/policy/wesp/wesp_current/2014wesp_country_classification.pdf. Accessed July 1, 2018.

        • Sterne JA
        • Egger M
        Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis.
        J Clin Epidemiol. 2001; 54: 1046-1055
        • Abe Y
        • Fujise N
        • Fukunaga R
        • Nakagawa Y
        • Ikeda M
        Comparisons of the prevalence of and risk factors for elderly depression between urban and rural populations in Japan.
        Int Psychogeriatr. 2012; 24: 1235-1241
        • Ahmadi SM
        • Mohammadi MR
        • Mostafavi SA
        • et al.
        Dependence of the geriatric depression on nutritional status and anthropometric indices in elderly population.
        Iran J Psychiatry. 2013; 8: 92-96
        • Baker FM
        • Okwumabua J
        • Philipose V
        • Wong S
        Screening African-American elderly for the presence of depressive symptoms: a preliminary investigation.
        J Geriatr Psychiatry Neurol. 1996; 9: 127-132
        • Bergdahl E
        • Allard P
        • Lundman B
        • Gustafson Y
        Depression in the oldest old in urban and rural municipalities.
        Aging Ment Health. 2007; 11: 570-578
        • Carpiniello B
        • Carta MG
        • Rudas N
        Depression among elderly people: a psychosocial study of urban and rural populations.
        Acta Psychiatr Scand. 1989; 80: 445-450
        • Chen R
        • Hu Z
        • Wei L
        • Wilson K
        Socioeconomic status and survival among older adults with dementia and depression.
        Br J Psychiatry. 2014; 204: 436-440
        • Chiu H-C
        • Chen C-M
        • Huang C-J
        • Mau L-W
        Depressive symptoms, chronic medical conditions and functional status: a comparison of urban and rural elders in Taiwan.
        Int J Geriatr Psychiatry. 2005; 20: 635-644
        • Feng L
        • Li P
        • Lu C
        • et al.
        Burden and correlates of geriatric depression in the Uyghur elderly population, observation from Xinjiang, China.
        PloS One. 2014; 9e114139
        • Friedman B
        • Conwell Y
        • Delavan RL
        Correlates of late-life major depression: a comparison of urban and rural primary care patients.
        Am J Geriatr Psychiatry. 2007; 15: 28-41
        • Guerra M
        • Ferri CP
        • Sosa AL
        • et al.
        Late-life depression in Peru, Mexico and Venezuela: the 10/66 population-based study.
        Br J Psychiatry. 2009; 195: 510-515
        • Kim JM
        • Shin IS
        • Yoon JS
        • Stewart R
        Prevalence and correlates of late-life depression compared between urban and rural populations in Korea.
        Int J Geriatr Psychiatry. 2002; 17: 409-415
        • Kim JM
        • Stewart R
        • Shin IS
        • Yoon JS
        • Lee HY
        Lifetime urban/rural residence, social support and late-life depression in Korea.
        Int J Geriatr Psychiatry. 2004; 19: 843-851
        • Ma X
        • Xiang YT
        • Li SR
        • et al.
        Prevalence and sociodemographic correlates of depression in an elderly population living with family members in Beijing, China.
        Psychol Med. 2008; 38: 1723-1730
        • Mechakra-Tahiri S
        • Zuzunegui MV
        • Preville M
        • Dube M
        Social relationships and depression among people 65 years and over living in rural and urban areas of Quebec.
        Int J Geriatr Psychiatry. 2009; 24: 1226-1236
        • Schulman E
        • Gairola G
        • Kuder L
        • McCulloch J
        Depression and associated characteristics among community-based elderly people.
        J Allied Health. 2002; 31: 140-146
        • Sengupta P
        • Benjamin AI
        Prevalence of depression and associated risk factors among the elderly in urban and rural field practice areas of a tertiary care institution in Ludhiana.
        Indian J Public Health. 2015; 59: 3-8
        • St John PD
        • Blandford AA
        • Strain LA
        Depressive symptoms among older adults in urban and rural areas.
        Int J Geriatr Psychiatry. 2006; 21: 1175-1180
        • Walters K
        • Breeze E
        • Wilkinson P
        • Price GM
        • Bulpitt CJ
        • Fletcher A
        Local area deprivation and urban-rural differences in anxiety and depression among people older than 75 years in Britain.
        Am J Public Health. 2004; 94: 1768-1774
        • Li LW
        • Liu JY
        • Xu HW
        • Zhang ZM
        Understanding rural–urban differences in depressive symptoms among older adults in China.
        J Aging Health. 2016; 28: 341-362
        • Su D
        • Wu XN
        • Zhang YX
        • et al.
        Depression and social support between China's rural and urban empty-nest elderly.
        Arch Gerontol Geriatr. 2012; 55: 564-569
        • The World Bank
        New Bank report looks at China's rural elderly.
        (Published April 9,)
        • Liu L-J
        • Guo Q
        Loneliness and health-related quality of life for the empty nest elderly in the rural area of a mountainous county in China.
        Qual Life Res. 2007; 16: 1275-1280
        • Ratcliffe M
        • Burd C
        • Holder K
        • Fields A
        Defining Rural at the U.S. Census Bureau: American Community Survey and Geography Brief.
        U.S. Census Bureau, Washington, DC2016
        • Hall SA
        • Kaufman JS
        • Ricketts TC
        Defining urban and rural areas in U.S. epidemiologic studies.
        J Urban Health. 2006; 83: 162-175
        • Definition of “Urban.”
        Demographic Yearbook 2005, table 6.
        (Published)
        • UN Statistics Division
        Population density and urbanization.
        (Published)
        • Rossen LM
        • Hedegaard H
        • Khan D
        • Warner M
        County-level trends in suicide rates in the U.S., 2005–2015.
        Am J Prev Med. 2018; 55: 72-79