학술논문
Determinants of Depressive Symptoms Among Rural Health Workers: An Application of Socio-Ecological Framework
ORIGINAL RESEARCH
ORIGINAL RESEARCH
Document Type
Academic Journal
Source
Journal of Multidisciplinary Healthcare. September 30, 2020, Vol. 13, p967, 15 p.
Subject
Language
English
ISSN
1178-2390
Abstract
Introduction Depression is a public health concern and one of the most common psychiatric disorders. (1,2) Depression is reported as the most important cause of disability and insufficiency, with decreased [...]
Objective: The objective of this study was to assess depressive symptoms among rural health workers (RHWs) through a multi-factorial socio-ecological framework (SEF) encompassing personal, interpersonal, organizational and community components. Patients and Methods: A random sample of 394 RHWs in all rural areas of East Azerbaijan and fulfilling our other inclusion criteria were recruited. The participants underwent the Short-Form Beck's Depression Inventory and a validated researcher-constructed SEF questionnaire, including subscales on personal, interpersonal, organizational and community factors associated with depressive symptoms. Internal consistency and factor structure parameters of the SEF were also calculated. Results: A total of 394 RHWs were screened, of whom 170 (43.2%) had mild to major depressive symptoms. Only 6.8% were identified with major depressive symptoms. The SEF-based scale was found to have acceptable content validity (content validity index and ratio were 0.80 and 0.77, respectively) and reliability (Cronbach's alpha=0.7). In the structural equation modeling, the fit indices showed our model to fit the data well ([chi square]=14.06, df=14, [chi square]/df=1.00, CFI=0.967, RMSEA=0.032). The highest direct contribution to depressive symptoms was found from the personal factors component ([beta]=-2.32). Also, 'work load and roles interference' (from organizational level, [beta]=-0.76) and 'family/colleague support' (from community level, [beta]=-1.28) made significant direct contributions towards depressive symptoms. Besides the SEF components, female gender ([beta]=1.69), family history of mental illness ([beta]=-1.48), having chronic illnesses ([beta]=-1.64) and being religious ([beta]=3.43) were the strongest direct contributors to depressive symptoms. Conclusion: Depressive symptoms were common among RHWs, arising from all personal-, interpersonal-, organizational- and community-level factors. Our SEF had adequate internal consistency and factor structure parameters to be applied in the Middle East and North Africa (MENA) region countries, such as Iran, as a theoretical framework to plan for interventional efforts aiming at preventing depressive symptoms among RHWs. The burden of depressive symptoms should be reduced through multi-factorial interventions and rational perspectives. Keywords: depression, rural healthcare, socio-ecological framework, rural health workers
Objective: The objective of this study was to assess depressive symptoms among rural health workers (RHWs) through a multi-factorial socio-ecological framework (SEF) encompassing personal, interpersonal, organizational and community components. Patients and Methods: A random sample of 394 RHWs in all rural areas of East Azerbaijan and fulfilling our other inclusion criteria were recruited. The participants underwent the Short-Form Beck's Depression Inventory and a validated researcher-constructed SEF questionnaire, including subscales on personal, interpersonal, organizational and community factors associated with depressive symptoms. Internal consistency and factor structure parameters of the SEF were also calculated. Results: A total of 394 RHWs were screened, of whom 170 (43.2%) had mild to major depressive symptoms. Only 6.8% were identified with major depressive symptoms. The SEF-based scale was found to have acceptable content validity (content validity index and ratio were 0.80 and 0.77, respectively) and reliability (Cronbach's alpha=0.7). In the structural equation modeling, the fit indices showed our model to fit the data well ([chi square]=14.06, df=14, [chi square]/df=1.00, CFI=0.967, RMSEA=0.032). The highest direct contribution to depressive symptoms was found from the personal factors component ([beta]=-2.32). Also, 'work load and roles interference' (from organizational level, [beta]=-0.76) and 'family/colleague support' (from community level, [beta]=-1.28) made significant direct contributions towards depressive symptoms. Besides the SEF components, female gender ([beta]=1.69), family history of mental illness ([beta]=-1.48), having chronic illnesses ([beta]=-1.64) and being religious ([beta]=3.43) were the strongest direct contributors to depressive symptoms. Conclusion: Depressive symptoms were common among RHWs, arising from all personal-, interpersonal-, organizational- and community-level factors. Our SEF had adequate internal consistency and factor structure parameters to be applied in the Middle East and North Africa (MENA) region countries, such as Iran, as a theoretical framework to plan for interventional efforts aiming at preventing depressive symptoms among RHWs. The burden of depressive symptoms should be reduced through multi-factorial interventions and rational perspectives. Keywords: depression, rural healthcare, socio-ecological framework, rural health workers