Can where you live affect your depression risk?

US News & World Report
David Levine
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Location may be the prime directive for real estate, but is it also a factor in mental health? The answer is maybe.

Depression has few direct cause-and-effect relationships; rather, a host of biological and environmental factors may, together or separately, trigger a mood disorder. Then again, they may not. Where you live is a perfect example. Many people actually prefer living in a cold, wintry climate, while many others prefer a sunny, warm beach town. Some people are energized by the commotion of city life, while others prefer the quiet of the country. Move either to the other's hometown, and both are at risk.

Checking the data reveals this quite clearly. Studies on location and depression are at best mixed, and they are often directly contradictory.

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Urban or Rural?

A common research topic is mental health in urban versus rural locations. And for every study you find claiming that one is worse, you will find another saying, no, the other actually poses a higher risk.

Urban or Rural?

A common research topic is mental health in urban versus rural locations. And for every study you find claiming that one is worse, you will find another saying, no, the other actually poses a higher risk.

A 2006 study published in Family Medicine set out to examine the prevalence of depression in rural and urban areas. Looking at data from a nationally representative sample of 30,801 adults age 18 and older, it found that depression "is slightly but significantly higher in residents of rural areas compared to urban areas." But after adjusting for differences in population characteristics, there was no significant spread in prevalence. Rather, depression risk was higher among people in fair or poor health or whose health had changed during the previous year, those with high blood pressure and those whose daily activity was somehow limited.

Then there is a 2004 study published in Social Psychiatry and Psychiatric Epidemiology, which looked at Canadian rural and urban areas and depression, and found that those in rural areas had fewer incidences of major depression. Again, though, the reasons for this are complicated, the authors write, and may depend on age, immigration status, race, working status and marital status as much as location.

A report on suicide rates among adolescents and young adults in this country found that those rates in rural areas were nearly double that in urban locations between 1996 and 2010. But once again, the reasons may be more cultural than geographic; lead author Cynthia Fontanella, of Ohio State University, suggests that easy access to more guns, fewer mental health care resources, more isolation and a culture of self-reliance may be why more rural residents resort to tragic ends.

Likewise, one urban-based study looked at the relationship between home location and depression in older Latino adults and found that depression correlated not with being in a city itself, but in the perceived safety of the neighborhood. Those who felt they could walk safely in their neighborhood were less likely to have mild depression turn into severe depression.

Or Maybe the Suburbs?

The best place to live, according to research out of Penn State University, may be the suburbs. Suburbanites reported the fewest poor-mental-health days, according to the researchers.

"People who live in the suburbs are closer to jobs and all of the amenities that a big city can provide, but they're also far enough away from the stress of the inner city," says lead author Stephan Goetz, a professor of economics at Penn State. "It may be that you don't want to be too close to people, but you don't want to be too far away, either." In addition, those living in a close-knit community – and in better winter weather and a climate free from natural disasters – tend to have better mental health, his research found. "The more supported you are by the community, the happier you are, and the better you are able to cope with troubles," Goetz says.

But is that because of the location itself? It's hard to ascertain. Dr. Peter D. Kramer, emeritus clinical professor of psychiatry and human behavior at Brown University, believes it's more about the person than the location. "Southeastern 'red' states have a lot of depression, but whether moving would help is a complicated question," he says. "The notion is that chronic stress is bad for those liable for depression, and it is probable that people develop depression because they are poor or social services are underfunded."

Stress Is the Problem

When looked at from a global perspective, the U.S. as a whole is among the least depressed nations in the world. A 2013 study published in PLOS Medicine found that the Middle East and North Africa have the world's highest depression rates. The most depressed country, Afghanistan, had diagnostic rates of depression in more than 20 percent of the population, followed by Honduras and the Palestinian territories. (The U.S., by comparison, is at between 4 and 4.5 percent, while Japan, the lowest, is at less than 2.5 percent.) The reasons, the authors argue, are continued military conflict, disease and other stressors to family and community. In other words, it's not the location itself, it's the circumstances that matter.

While some types of depression, such as seasonal affective disorder or other climate-triggered mood disorders, may improve by moving to a different location, for many cases of depression, it's not so much where you live as how you live.

"If you could find yourself in better circumstances, that might be better," Kramer says. "Places that have a lot of depression should invest more resources" to help those struggling with mental illness, he says.