Urban-rural differences in determinants of mental health among primary healthcare workers in China.

The study recruited 3,769 primary healthcare workers across all 31 provinces in mainland China, with the majority working in rural settings.

• 1,006 (26.7%) PHWs worked in urban areas and 2,763 (73.3%) worked in rural areas
• Participants were recruited from 44 urban community health service centers and 27 rural township hospitals
• Data collection occurred between 1 May and 31 October 2022
• Workers included family physicians, nurses, public health professionals, pharmacists, and other medical staff
• The Bayesian Additive Regression Tree (BART) model was employed to identify risk factors

Occupational satisfaction significantly influenced anxiety in both urban and rural primary healthcare workers.

• Occupational satisfaction was identified as a key factor for anxiety across both urban and rural settings
• The BART model was used to identify this as a shared determinant regardless of urbanicity
• Occupational satisfaction was also associated with depression for all PHWs

Living with family was a significant protective factor against anxiety and depression specifically for urban primary healthcare workers.

• For urban PHWs, living with family was associated with reduced anxiety (OR: 0.42, 95% CI: 0.28–0.62)
• Living with family was also associated with reduced depression in urban PHWs (OR: 0.51, 95% CI: 0.34–0.75)
• This factor was identified as a key determinant specifically for urban, not rural, practitioners

Self-rated health was a significant protective factor against anxiety for urban primary healthcare workers.

• Fair self-rated health was associated with reduced anxiety in urban PHWs (OR: 0.31, 95% CI: 0.23–0.42)
• Good self-rated health was associated with even greater reduction in anxiety (OR: 0.13, 95% CI: 0.09–0.20)
• Self-rated health was also associated with depression for all PHWs

After-work exercise played a critical role in anxiety specifically for rural primary healthcare workers.

• Rare after-work exercise was associated with reduced anxiety in rural PHWs (OR: 0.28, 95% CI: 0.11–0.76)
• Frequent after-work exercise was associated with further reduced anxiety in rural PHWs (OR: 0.15, 95% CI: 0.05–0.44)
• After-work exercise was also associated with depression for all PHWs
• This factor was identified as a key determinant specifically for rural practitioners

Organizational support satisfaction was a significant protective factor against depression specifically for urban primary healthcare workers.

• Being satisfied with organizational support was associated with reduced depression in urban PHWs (OR: 0.28, 95% CI: 0.19–0.42)
• This factor was identified as significant for urban practitioners specifically
• Organizational support satisfaction was not highlighted as a key factor for rural PHWs

Depression was associated with after-work exercise, self-rated health, and occupational satisfaction across all primary healthcare workers regardless of urbanicity.

• These three factors were identified as common determinants of depression for both urban and rural PHWs
• Additionally, living with family (OR: 0.51, 95% CI: 0.34–0.75) and organizational support satisfaction (OR: 0.28, 95% CI: 0.19–0.42) were significant specifically for urban practitioners
• The BART model was used to identify these associations