Determinants of Depressive Symptoms Among Rural Health Workers: An Application of Socio-Ecological Framework

Abstract

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 (χ²=14.06, df=14, χ²/df=1.00, CFI=0.967, RMSEA=0.032). The highest direct contribution to depressive symptoms was found from the personal factors component (β=−2.32). Also, “work load and roles interference” (from organizational level, β=−0.76) and “family/colleague support” (from community level, β=−1.28) made significant direct contributions towards depressive symptoms. Besides the SEF components, female gender (β=1.69), family history of mental illness (β=−1.48), having chronic illnesses (β=−1.64) and being religious (β=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

Ethical Approval and Consent to Participate

Ethical approval for the study was received from the Ethics Committee in Research Affairs, Tabriz University of Medical Sciences. All respondents were informed about the aim of study and assured about the confidentiality of the data, and all signed a consent form.

Acknowledgments

We thank all the rural health workers who participated in our study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no potential competing interests for this work.

Additional information

Funding

No funds were received for this work.