title: Rural/non-rural differences in rates of common mental disorders in Britain: prospective multilevel cohort study.
abstract: BACKGROUND
  Some UK studies have reported an urban excess in the prevalence of the most common mental disorders of anxiety and depression.
  
  
  OBJECTIVE
  To investigate rural/non-rural differences in the onset and maintenance of episodes of common mental disorders, after adjusting for the characteristics of respondents and their households.
  
  
  METHODS
  A12-month cohort study of 7659 adults aged 16-74 years living in 4338 private households, nested within 626 electoral wards in England, Wales and Scotland. Common mental disorders were assessed using the General Health Questionnaire (GHQ). Electoral wards were characterised by Office for National Statistics classification and by population density. Data were analysed using multilevel statistical modelling.
  
  
  RESULTS
  Rural residents had slightly better mental health than non-rural counterparts. The effects of geographical location on the mental health of participants were neither significantly confounded nor modified by socio-economic status, employment status or household income.
  
  
  CONCLUSIONS
  There are small but statistically significant differences in rates of common mental disorders between urban and rural residents. Quantifying between-place differences using population density alone risks missing important contextual effects on mental health.
authors.affiliation: Division of Health in the Community, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. s.weich@warwick.ac.uk
authors.forename: Scott
authors.initials: S
authors.lastname: Weich
authors.forename: Liz
authors.initials: L
authors.lastname: Twigg
authors.forename: Glyn
authors.initials: G
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data