title: Proximity to healthcare clinic and depression risk in South Africa: geospatial evidence from a nationally representative longitudinal study.
abstract: Proximity to primary healthcare facilities may be a serious barrier to accessing mental health services in resource-limited settings. In this study, we examined whether the distance to the primary healthcare clinic (PHCC) was associated with risk of depression in KwaZulu-Natal Province, South Africa. Depressive symptoms and household coordinates data were accessed from the nationally representative South African National Income Dynamics Study. Distances between households and their nearest PHCCs were calculated and mixed-effects logistic regression models fitted to the data. Participants residing <6 km from a PHCC (aOR = 0.608, 95% CI 0.42-0.87) or 6-14.9 km (aOR = 0. 612, 95% CI 0.44-0.86) had a lower depression risk compared to those residing ≥15 km from the nearest PHCC. Distance to the PHCC was independently associated with increased depression risk, even after controlling for key socioeconomic determinants. Minimizing the distance to PHCC through mobile health clinics and technology could improve mental health.
authors.affiliation: College of Health Sciences, University of KwaZulu-Natal, Private Bag X7, Durban, South Africa. tomita@ukzn.ac.za.|Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa. tomita@ukzn.ac.za.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tomita
authors.affiliation: College of Health Sciences, University of KwaZulu-Natal, Private Bag X7, Durban, South Africa.|Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Alain M
authors.initials: AM
authors.lastname: Vandormael
authors.affiliation: Department of Geography, University of Cincinnati, Cincinnati, USA.
authors.forename: Diego
authors.initials: D
authors.lastname: Cuadros
authors.affiliation: School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa.|Department of Genetics, Evolution and Environment, University College London, London, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Slotow
authors.affiliation: Africa Health Research Institute, University of KwaZulu-Natal, Durban, South Africa.|Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.|School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.affiliation: Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa.|Institute for Health Research, University of Exeter, Exeter, UK.
authors.forename: Jonathan K
authors.initials: JK
authors.lastname: Burns
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000453:epidemiology*; D005260:Female; D040362:Geographic Information Systems; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011320:Primary Health Care; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012306:Risk; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: Depression; GPS; Primary healthcare clinic; Social disconnectedness; South Africa