An Approach to Determine the Prevalence of Poor Mental Health among Urban and Rural Population in Serbia Using Propensity Score Matching.

Objective: Studies about mental health among urban and rural residents are scarce. A limited number of studies report somewhat better mental health in rural settings, despite higher rates of suicides. The main objective of this study was to describe social conditions of the population of Serbia in rural and urban settlements and to assess the differences in the prevalence of mental health disorders. Methods: Propensity score matching of urban and rural persons (2 x 3,569 persons) has eliminated confounding effects from social variables (age, gender, wealth index, education level, employment, family status) and self-rated health. Thus, any statistical differences concerning mental health variables (five-item Mental Health Inventory and clinically diagnosed chronic anxiety or depression) between the two populations were not a result of differences in the matching variables. Results: After matching all variables, the estimated prevalence rate of poor mental health was significantly higher among residents of urban (52.2%) than rural (49.1%) settlements (p = 0.012). Conclusions: Almost half of the Serbian population suffers from poor mental health, therefore, there is a need to increase efforts on mental health promotion, prevention and treatment. Our study findings also support the importance of promoting benefits of rural settings for people with mental distress.