A European approach to rural-urban differences in mental health:: The ESEMeD 2000 comparative study

Objective: The study aimed to answer the following questions: Are there any rural-urban differences in mental health once sociodemographic variables are controlled for, and are any of these differences observed in EU countries? Did the individuals suffering from mental health disorders have the same characteristics in rural and urban areas, particularly concerning self-reported impairment? Method: The European Study of the Epidemiology of Mental Disorders (ESEMeD 2000 study) is a cross-sectional, in-person, household interview survey based on probability samples representative of the adult population of 6 European countries: Belgium, France, Germany, Italy, the Netherlands, and Spain. The rural population is defined as those living in towns with fewer than 10 000 inhabitants, and the urban population is defined as those living in towns or cities with 10 000 or more inhabitants. A stratified, multistage, random sample without replacement was drawn in each country. The overall response rate of the study was about 61.2% (weighted response rate). Results: The study results confirmed previous findings on the variation in mood disorders between rural and urban areas. Overall, urbanicity seemed to be linked to a higher risk of mental health disorders, particularly depressive disorders, whereas the link to anxiety disorders was only moderate and there was no link at all to alcohol disorders. Country differences concerned male respondents and not female respondents, with the exception of Belgium, where the differences concerned women only (and showed fewer disorders in rural areas). Conclusions: This study will, hopefully, stimulate further intra-European studies using comparable methods and instruments to look at the experience across the European continent and introduce steps to harmonize rural-urban population limits across diverse countries.