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Risk Factors Associated with Depression and Suicidal Ideation in a Rural Population

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Risk Factors Associated with Depression and Suicidal Ideation in a Rural Population Environmental Health and Toxicology Open Access Volume: 31, Article ID: e2016018, 8 pages http://dx.doi.org/10.5620/eht.e2016018 • Original Article eISSN: 2233-6567 Risk factors associated with depression and suicidal ideation in a rural population Yosub Joo1, Sangchul Roh1,2 1Department of Occupational and Environmental Medicine, Dankook University College of Medicine, Cheonan; 2Center for Farmers’ Safety and Health, Dankook University Hospital, Cheonan, Korea Objectives This study aimed to evaluate the risk factors associated with depression and Correspondence: Sangchul Roh suicidal ideation in a rural population. 119 Dandae-ro, Dongnam-gu, Cheonan 31116, Korea Methods A survey was conducted with 543 farmers from Chungcheongnam-do Province Tel: +82-41-550-3956 using the Center for Epidemiologic Studies Depression Scale (CES-D) for depression, Fax: +82-41-556-6461 E-mail: [email protected] Lubben Social Network Scale (LSNS) for social support, Swedish Q16 for neurotoxicity symptoms and a survey tool for farmer’s syndrome. Results After adjusting for socioeconomic factors using logistic regression analysis, Received: July 26, 2016 Accepted: August 5, 2016 poor self-rated health, low social support and neurotoxicity were positively associated Published: August 26, 2016 with the risk of depression (odds ratio [OR], 15.96; 95% confidence interval [CI], 3.11 to 81.97; OR, 3.14; 95% CI, 1.26 to 7.82; and OR, 3.68; 95% CI, 1.08 to 12.57, respectively). This article is available from: http://e-eht.org/ The risk of suicidal ideation significantly increased with low social support, neurotoxicity and farmer’s syndrome (OR, 2.28; 95% CI, 1.18 to 4.40; OR, 6.17; 95% CI, 2.85 to 13.34; and OR, 3.70; 95% CI, 1.51 to 9.07, respectively). Conclusions Given the overall results of this study, there is a need to establish programs which can improve the health and social relationships of farmers. Also, when farmers have neurological symptoms from pesticide exposure and characteristic symptoms of farmer’s syndrome, a monitoring system for depression and suicide must be made available. Keywords Depression, Suicidal ideation, Neurotoxicity symptom, Farmer’s syndrome Introduction Korea’s population is one of the fastest aging among Organiza- tion for Economic Cooperation and Development member Depression is one of the most common psychiatric problems states: The country is forecast to become an aged society by in the world. Reportedly, 10% to 20% of the population suffer 2017 and a super-aged society by 2026. Notably, aging most se- from the disease [1] and the rate is steadily increasing. Depres- riously impacts Korea in rural areas. The aging rate of the farm- sion causes serious social, occupational, and physical disabilities. ing population is 35.6%, more than three times higher than that Around 10% to 15% of its victims commit suicide [2]. Depres- of the overall aging rate of the rest of the Korean population [6]. sion is more prevalent in older age groups. In fact, it is one of the Comparison of elderly depression rates in urban and rural areas most frequently occurring health problems in the elderly, affect- shows that the elderly in rural areas have higher depression ing 20% to 50% of the population [3]. Notably, depression in scores than their urban counterparts. This is due to the fact that old age carries even a higher risk of suicide [4]. According to there are gaps in physical/psychological factors, socioeconomic Statistics Korea, in 2014, the suicide rate of those 65 or older in status, and access to medical resources between the two places, Korea was 55.5 people (per 100000), nearly double that of all which also signifies that the elderly in the rural areas are more age groups, 27.3 people [5]. vulnerable to physical, psychological, and social health prob- Copyright © 2016 The Korean Society of Environmental Health and Toxicology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ Page 1 of 8 licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. http://e-eht.org/ Environmental Health and Toxicology 2016018;31:e2016018 lems [7]. their written consent was obtained. Depression is a serious health issue that should not be over- looked, for it is known to be a crucial predictor of suicide and Questionnaire Survey Design and Content known to decrease participation in daily activities, which may General demographic characteristics of the subjects were ob- lead to a lower quality of life [8]. Therefore, to prevent and man- tained through the questionnaire, such as sex, age, education age perceived depression, factors that influence depression as level, marital status, and income. Farming-related factors from well as mediating variables need to be identified. the questionnaire were also researched, including cropland area, In particular, considering the unique characteristics of rural ar- hours of work, and annual amount of pesticide exposure. For eas, it is worth examining the factors that influence farmers ex- measuring self-rated health condition, a Likert 5-point scale was clusively and the effects they have on depression and suicidal used, in which subjects evaluated their own health status using a ideation. Recent studies have reported that there is an associa- single question: 5=“very healthy”; 4=“healthy”; 3=“fair”; tion between the exposure to pesticide and elderly depression 2=“unhealthy”; and 1=“very unhealthy.” [9,10]. Another study found that higher biological exposure in- For evaluating depression, the Center for Epidemiologic Stud- dex values of agrochemicals may increase the risk of depression ies Depression Scale (CES-D) [12] was used and the presence [11]. Therefore, it is necessary to investigate the relationship be- of depression is identified when the score is 16 or higher. In or- tween pesticide-caused neurotoxicity and depression or suicidal der to measure suicidal ideation, the subjects were asked wheth- thoughts. As farmer’s syndrome is a variable closely linked to er they have had suicidal thoughts during the past year. For farmers’ stress, it is also meaningful to examine the association measuring social support, the Lubben Social Network Scale between the two factors. (LSNS) [13] composed of ten questions was used and it is de- This study aims to identify gaps in depression symptoms and termined that a person has high social support if the score ex- suicidal thoughts by the different sociodemographic character- ceeds 20. The Swedish Q16 [14] was used for measuring neu- istics of farmers. Moreover, this study will evaluate the influence rotoxicity caused by organic solvent (pesticide) poisoning and that factors related to occupation and health condition have on scores of six or higher indicate probable neurotoxicity. depression symptoms and suicidal ideation. An instrument developed by Park et al. [15], composed of eight questions on shoulder stiffness, low back pain, numb limbs, Materials and Methods nocturia, dyspnea, insomnia, dizziness, and abdominal discom- fort, was utilized to measure farmer’s syndrome. The results were Study Site and Subjects classified as follows: 0-2=“negative”; 3-6=“probable”; and 7 or From September to December 2014, a survey was conducted higher=“positive.” on 287 farmers who use protected cultivation and grow field crops in Gongju City, Chungcheongnam-do Province. In addi- Data Analysis tion, from July 21 to July 24 in 2015, 332 farmers who grow fruit The collected data was analyzed using SPSS version 22.0 trees in Yesan County, Chungcheongnam-do Province were (IBM Corp., Armonk, NY, USA) to find the general characteris- surveyed. To recruit subjects for the survey, the intention and tics of the subjects and the frequency and percentage of their follow-up steps of the survey were explained in village offices depression symptoms and suicidal ideation. To identify risk fac- and community health centers in the areas of the survey and tors of the subjects’ depression symptoms and suicidal thoughts, consent was obtained. The survey was also promoted to com- a logistic regression analysis was performed using all surveyed munity leaders and farmers at leadership meetings and Korea factors as independent variables and presence of depression National Agricultural Cooperative Federation’s education ses- symptoms and suicidal ideation as dependent variables. sions, and volunteers registered to participate in the survey. Lat- Model 1 was adjusted for sex, age, education level, marital sta- er, one-on-one phone interviews with the volunteers were con- tus, and self-rated health condition. Model 2, in addition to the ducted to explain about the survey and to encourage their par- adjusted variables in model 1, was adjusted for each occupation- ticipation. A total of 619 farmers participated in the initial study; al factor including hours of work, cropland area, exposure time however, 76 participants had missing data and were excluded, to pesticide, neurotoxicity, and farmer’s syndrome. leaving a total of 543 subjects. The study was approved by the institutional review board of Study Results Dankook University Hospital (no. 2014-08-003). The details of Males accounted for 58.7% and females accounted for 41.3% participation in the study were explained to the subjects and of the subjects. Those who were 60 or older represented 66.5% Page 2 of 8 http://e-eht.org/ Yosub Joo, et al. | Risk factors associated with depression and suicidal ideation of all subjects. Those who competed elementary school educa- Based on the CES-D score (16 or higher), 2.8% of males and tion accounted for 51.6%, and 90.4% were married. Subjects 7.6% of females were classified as having depression, and 10.7% who earned 30 million Korean won or higher per year repre- of males and 16.5% of females answered that they had had sui- sented 55.4%.
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