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Epidemiol Psychiatr Sci. 2020 Jan 13;29:e92. doi: 10.1017/S204579601900088X.

Distance to health services and treatment-seeking for depressive symptoms in rural India: a repeated cross-sectional study.

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Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Department of Geography, Birkbeck University of London, London, UK.
MRC Tropical Epidemiology Group, Epidemiology & Population Health Faculty, London School of Hygiene & Tropical Medicine, London, UK.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Centre for Mental Health, Public Health Foundation of India, New Delhi, India.
Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
Department of Population Health, Epidemiology & Population Health Faculty, London School of Hygiene & Tropical Medicine, London, UK.



Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India.


We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression.


We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small.


Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.


Depression; cross cultural psychiatry; health service research; minority issues; primary care

[Indexed for MEDLINE]

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