title: Comparisons of prevalence and related factors of depression in middle-aged adults between urban and rural populations in Japan.
abstract: BACKGROUND
  Findings of urban-rural differences in the prevalence of depression have been controversial, and few reports have directly compared the related factors of depression between urban and rural areas. The present study aimed to investigate differences between urban and rural areas in Japan with regards to the prevalence of and related factors of depression in middle-aged adults, in order to further understanding of the features of depression in this demographic.
  
  
  METHODS
  We used a multistage, random sampling procedure and mailing method. In total, 5000 participants were recruited from urban and rural areas in Kumamoto Prefecture (2500 in each area). Participants were aged from 40 to 64 years. Depression was assessed using the Center for Epidemiologic Studies Depression scale (CES-D).
  
  
  RESULTS
  The prevalence of middle-aged depression was not different between the urban and rural areas. Logistic regression analysis found that being female, living alone, and having a chronic illness were significantly associated with depression in urban-dwelling middle-aged adults. Younger age, sleep disturbance, and financial strain were significantly associated with depression in both urban and rural areas.
  
  
  CONCLUSIONS
  The definition of depression was based on CES-D scores, without corroborating clinical evaluation.
  
  
  CONCLUSIONS
  We found no marked differences in the prevalence of middle-aged depression between the urban and rural areas. Some related factors of depression in middle-aged adults differed between urban and rural areas in Japan. Effective intervention programs for middle-aged adults with depression should consider regional differences.
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University Graduate School of Medical Science, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan. Electronic address: nfujise@kumamoto-u.ac.jp.
authors.forename: Noboru
authors.initials: N
authors.lastname: Fujise
authors.affiliation: Yatsushiro Kousei Hospital, 1705 furushiromachi, Yatsushiro, Kumamoto, 866-0043, Japan.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Abe
authors.affiliation: Yatsushiro Kousei Hospital, 1705 furushiromachi, Yatsushiro, Kumamoto, 866-0043, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Fukunaga
authors.affiliation: Kumamoto Prefectural Government, 6-18-1 Suizenji, Chuo-ku, Kumamoto, 862-8570, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University Graduate School of Medical Science, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Nishi
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University Graduate School of Medical Science, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
authors.forename: Asuka
authors.initials: A
authors.lastname: Koyama
authors.affiliation: Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University Graduate School of Medical Science, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ikeda
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: Depression; Japan; Middle-aged; Related factors; Urban-rural