Depression is the second leading cause of death among young adults and a major cause of disability worldwide. Some studies suggest a disparity between rural and urban outcomes for depression. Collaborative Care Management (CCM) is effective in improving recovery from depression, but its effect within rural and urban populations has not been studied. A retrospective cohort study of 3870 patients diagnosed with depression in a multi-site primary care practice that provided optional, free CCM was conducted. US Census data classified patients as living in an Urban Area, Urban Cluster, or Rural area and the distance they resided from their primary care clinic was calculated. Baseline demographics, clinical data, and standardized psychiatric assessments were collected. Six month Patient Health Questionnaire (PHQ 9) scores were used to judge remission (PHQ9 < 5) or Persistent Depressive Symptoms (PDS) (PHQ9 ≥ 10) in a multivariate model with interaction terms. Rural patients had improved adjusted odds of remission (AOR = 2.8) and PDS (AOR = 0.36) compared to urban area patients. The natural logarithm transformed distance to primary care clinic was significant for rural patients resulting in a lower odds of remission and increased odds of PDS with increasing distance from clinic. The marginal probability of remission or PDS for rural patients equaled that of urban area patients at a distance of 34 or 40 km respectively. Distance did not have an effect for urban cluster or urban area patients nor did distance interact with CCM. Residing in a rural area had a beneficial effect on the recovery from depression. However this effect declined with increasing distance from the primary care clinic perhaps related to greater social isolation or difficulty accessing care. This distance effect was not seen for urban area or urban cluster patients. CCM was universally beneficial and did not interact with distance.

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农村住所和离诊所的距离对初级保健医疗家庭实践中抑郁症结局的影响

抑郁症是年轻人中第二大死亡原因，也是全球范围内致残的主要原因。一些研究表明，农村和城市抑郁症的结果之间存在差异。协作护理管理（CCM）可有效改善抑郁症的康复，但尚未研究其在城乡人口中的作用。在一项多站点初级保健实践中，对3870名被诊断为抑郁症的患者进行了回顾性队列研究，该研究提供了可选的免费CCM。美国人口普查数据将患者分类为居住在城市地区，城市群或农村地区，并计算了他们与初级保健诊所之间的居住距离。收集了基线人口统计学，临床数据和标准化的精神病学评估。在具有交互作用项的多变量模型中，使用六个月的患者健康调查问卷（PHQ 9）评分来判断缓解（PHQ9 <5）或持续性抑郁症状（PDS）（PHQ9≥10）。与城市地区的患者相比，农村地区的患者调整后的缓解几率（AOR = 2.8）和PDS（AOR = 0.36）有所改善。到基层医疗诊所的自然对数转换距离对于农村患者而言意义重大，随着离诊所距离的增加，缓解的机率降低，PDS的机率提高。农村患者在34 km或40 km处的缓解率或PDS的边际概率分别等于城市患者。距离对城市群或市区患者没有影响，距离也不会与CCM相互作用。居住在农村地区对抑郁症的康复有有益的影响。然而，这种影响随着与初级保健诊所的距离越来越远而下降，这可能与更大的社会隔离或获得保健的困难有关。对于城市地区或城市群患者，未观察到这种距离效应。CCM普遍受益，并且不会与距离互动。