title: Environmental and individual characteristics associated with depressive disorders and mental health care use.
abstract: OBJECTIVE
  Few studies examined the relationship between neighborhood characteristics and both depressive disorders and the corresponding mental health care use. The aim of our study was to investigate neighborhood effects on depressive symptomatology, antidepressant consumption, and the consultation of psychiatrists.
  
  
  METHODS
  Data from the French Residential Environment and Coronary heart Disease Study (n = 7290, 2007-2008, 30-79 years of age) were analyzed. Depressive symptomatology was cross-sectionally assessed. Health care reimbursement data allowed us to assess antidepressant consumption and psychiatric consultation prospectively more than 18 months. Multilevel logistic regression models were estimated.
  
  
  RESULTS
  The risk of depressive symptoms increased with decreasing personal educational level and unemployment and slightly with decreasing neighborhood income. In a sample comprising participants with and without depressive symptoms, high individual and parental educational levels were both associated with the consultation of psychiatrists. In this sample, a low personal educational level increased the odds of consumption of antidepressants. No heterogeneity between neighborhoods was found for antidepressant consumption. However, the odds of consulting psychiatrists increased with median neighborhood income and with the density of psychiatrists, after adjustment for individual characteristics. Among depressive participants only, a particularly strong gradient in the consultation of psychiatrists was documented according to individual socioeconomic status.
  
  
  CONCLUSIONS
  Future research on the relationships between the environments and depression should take into account health care use related to depression and consider the spatial accessibility to mental health services among other environmental factors.
authors.affiliation: Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, UPMC Univ Paris 06, Sorbonne Universités, Paris, France.
authors.forename: Margot
authors.initials: M
authors.lastname: Annequin
authors.affiliation: Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Weill
authors.affiliation: Centre d'Investigations Préventives et Cliniques, Paris, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Thomas
authors.affiliation: Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Social Epidemiology, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, UPMC Univ Paris 06, Sorbonne Universités, Paris, France. Electronic address: basile.chaix@iplesp.upmc.fr.
authors.forename: Basile
authors.initials: B
authors.lastname: Chaix
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy / Q000523:psychology*; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012923:Social Class; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014478:Unemployment
chemical_list: D000928:Antidepressive Agents
keywords: Depression; Health care disparities; Mental health; Residence characteristics; Socioeconomic factors