Population density, depressive symptoms, and suicidal thoughts

Abstract

Considering the high prevalence of depression worldwide and the increasing burden of consequent disability, 1 identification of potential sociodemographic characteristics associated with this health concern on a nationwide level should be sought to support targeted public policies. In this sense, an interesting paper was published on April 15, 2019, in the Brazilian Journal of Psychiatry (then ahead of print; now in a regular, paginated issue). Carpena et al. 2 extended the knowledge about the association between major determinants and depressive symptoms and found no association of gross domestic product per capita, the Gini index, Psychosocial Care Centers per 20,000 population, and Family Health Strategy per 1,000 population with elevated depressive symptoms or suicidal thoughts. On the other hand, the authors found that men, living with a partner, having a higher assets index, higher educational status, living in a rural area, and a lower number of residents per household were associated with a lower likelihood of depressive symptoms and suicidal thoughts. We consider the findings of Carpena et al. 2 of great interest for public health, and the aim of this letter is to include an important factor in this discussion: population density. This indicator, obtained by dividing the number of inhabitants by total geographic area, has been associated with mental disorders in developed countries. 3,4 Thus, we replicated the procedures of Carpena et al. 2 with estimates of population density by state provided in the latest Brazilian demographic census (2010). Unlike Carpena et al., 2 we considered population density as continuous in the models; we also divided population density into tertiles and analyzed the highest population density (tertile 3) vs. tertiles 1 and 2, as well as the lowest population density (tertile 1) vs. tertiles 2 and 3. We also present models by sex and include the following covariates in the analysis: sex (whole sample), race, chronological age, educational status, employment status, intake of sugary

Implementation of the Icelandic Prevention Model: a critical discussion of its worldwide transferability

“…Another important difference is the population density. Previous studies have shown that the higher the population density, the greater the volume and severity of health problems requiring treatment (Rosenberg, 1982), including mental health disorders, such as depression and suicidal thoughts (Werneck & Silva, 2020) and drug misuse (Galea et al, 2005). Iceland is a country with the lowest population density in Europe and is a fairly secluded island with the lowest number of inhabitants in Europe.…”

Cross-national examination of adolescent suicidal behavior: a pooled and multi-level analysis of 193,484 students from 53 LMIC countries

“…There are conflicting results regarding population density and suicidal behavior. Werneck et al and Stark et al found an increased likelihood of suicide ideation and mortality being associated with a higher population density in Brazil and Scotland [ 44 , 48 ]. The inverse was reported by Knipe et al in Sri Lanka, for example, in rural areas with a low population density [ 21 ]; while no association was found O’Reilly et al in Northern Ireland as well [ 36 ].…”

“…The inverse was reported by Knipe et al in Sri Lanka, for example, in rural areas with a low population density [ 21 ]; while no association was found O’Reilly et al in Northern Ireland as well [ 36 ]. Urban areas represent employment opportunities but could also potentially expose inhabitants to mental health problems due to pressures related to increased competition for jobs, affordable housing and health care [ 48 ]. Furthermore, areas that are rural and with a lower population density may have higher unemployment rates which could exacerbate distress among individuals [ 21 , 45 ].…”

“…Seven country-level variables were identified for inclusion in the multilevel analysis. These included the Gini coefficient (GC), Gross Domestic Product (GDP) per capita, the pupil-to-teacher ratio in primary schools, the population density, the intentional homicide rate, laws regarding suicide and the night light index [ 11 , 21 , 26 , 30 , 32 , 45 , 48 ]. These variables were selected based on their importance as key socio-economic indicators as well as their potential to influence mental wel-being at population levels [ 4 , 11 , 41 ].…”

Association Between Commuting Time and Subjective Well-Being in Relation to Regional Differences in Korea

“… 13 In addition, living in urban areas with high population density is associated with low quality of life and increased risk of depression. 14 15 16 Korea has the highest population density among OECD countries with more than 43.7% of the population concentrated in the capital and metropolitan cities, which accounts for only 5.9% of the total land. 17 18 19 Given these conditions, urbanization differences among metropolitan cities and provinces need to be emphasized while studying commuting time and well-being in Korea.…”