Health Policy Manag.  2020 Sep;30(3):355-365. 10.4332/KJHPA.2020.30.3.355.

Related Factors of Depression according to Individual Attributes and Regional Environment: Using Multi-Level Analysis

Affiliations
  • 1Department of Health Administration, Yonsei University Graduate School, Wonju, Korea
  • 2Healthy City Research Center, Institute of Health and Welfare, Yonsei University, Wonju, Korea
  • 3Department of Information Statistics, Yonsei University College of Science Technology, Wonju, Korea

Abstract

Background
This study is aimed to verify individual and regional-level factors affecting the depression of Koreans and to develop social programs for improving the depressive status.
Methods
This study used individual-level variables from the Korean Community Health Survey (2018) and used the e-regional index of the Korean Statistical Information Service as the regional-level variable. A multi-level logistic regression was executed to identify individual and regional-level variables that were expected to affect the extent of depressive symptoms and to draw the receiver operating characteristic curve to compare the volume of impact between variables from both levels.
Results
The results of the multi-level logistic regression analysis in regards to individual-level factors showed that older age, female gender, a lower income level, a lower education level, not having a spouse, the practice of walking, the consumption of breakfast higher levels of stress, and having high blood pressure or diabetes were associated with a greater increase in depressive symptoms. In terms of regional factors, areas with fewer cultural facilities and fewer car registration had higher levels of depressive symptoms. The comparison of area under the curve showed that individual factors had a greater influence than regional factors.
Conclusion
This study showed that while both, individual and regional-level factors affect depression, the influence of the latter was relatively weaker as compared to the first. In this sense, it is necessary to develop programs focused on the individual, such as social prescribing at the local or community-level, rather than the city and nation-level approach that are currently prevalent.

Keyword

Multilevel analysis; Depression; Community care; Social prescription; Community health survey; ROC curve
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