Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2026
[Regional distribution of depressive disorders among adults in Bavaria: A multivariable analysis of socioeconomic, settlement-structural and environmental factors].
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Anderle Laura, Brettner Johannes, Tauscher Martin, Geigl Christoph, Blank-Matthes Daniela
Аннотация
BACKGROUND: Depressive disorders contribute substantially to the burden of disease in Germany and may be associated with serious health consequences. Regionally, the prevalence of depressive disorders varies across Bavaria. Therefore, this analysis aimed to examine associations between socioeconomic, settlement-structural, and environmental factors and the rate of depressive disorders among adults at the regional level in Bavaria.
METHODS: This cross-sectional study was based on outpatient billing data on depressive disorders (F32, F33) from the Association of Statutory Health Insurance Physicians of Bavaria (KVB) for statutorily insured patients at the level of all 96 Bavarian districts and independent cities from 2018 to 2023. Predictors included the German Index of Socioeconomic Deprivation (socioeconomic factor), settlement-structural type of district (settlement-structural factor), and the proportion of areas designated for sports, leisure, and recreation area, and green spaces (environmental factor) at the district level. Demographic characteristics were included to control for potential confounders. Associations between these factors and the rate of depressive disorders in 2023 were analyzed using multivariable negative binomial regression in both an overall model and models stratified by sex.
RESULTS: In the multivariable analysis, increasing socioeconomic deprivation was associated with higher rates of depressive disorders. The strongest effect was found in quintile 5 (RR=1.17; 95% CI=1.08-1.28) compared to quintile with the lowest deprivation (Q1). Quintiles 1-4 of the environmental area showed lower Rate Ratios for depressive disorders compared to Q5 (highest proportion of area). No significant effects were observed for settlement-structural type of district.
CONCLUSION: Socioeconomic and environmental factors were associated with the rate of depressive disorders documented in outpatient care at the regional level in Bavaria. To reduce regional inequalities, particular attention should be given to socioeconomically deprived districts. Further small-area analyses of other environmental areas as well as their characteristics are necessary for targeted structural preventive measures.
METHODS: This cross-sectional study was based on outpatient billing data on depressive disorders (F32, F33) from the Association of Statutory Health Insurance Physicians of Bavaria (KVB) for statutorily insured patients at the level of all 96 Bavarian districts and independent cities from 2018 to 2023. Predictors included the German Index of Socioeconomic Deprivation (socioeconomic factor), settlement-structural type of district (settlement-structural factor), and the proportion of areas designated for sports, leisure, and recreation area, and green spaces (environmental factor) at the district level. Demographic characteristics were included to control for potential confounders. Associations between these factors and the rate of depressive disorders in 2023 were analyzed using multivariable negative binomial regression in both an overall model and models stratified by sex.
RESULTS: In the multivariable analysis, increasing socioeconomic deprivation was associated with higher rates of depressive disorders. The strongest effect was found in quintile 5 (RR=1.17; 95% CI=1.08-1.28) compared to quintile with the lowest deprivation (Q1). Quintiles 1-4 of the environmental area showed lower Rate Ratios for depressive disorders compared to Q5 (highest proportion of area). No significant effects were observed for settlement-structural type of district.
CONCLUSION: Socioeconomic and environmental factors were associated with the rate of depressive disorders documented in outpatient care at the regional level in Bavaria. To reduce regional inequalities, particular attention should be given to socioeconomically deprived districts. Further small-area analyses of other environmental areas as well as their characteristics are necessary for targeted structural preventive measures.