Spatiotemporal dynamics of depression-related health service attendance in Thailand (2018-2023): A provincial-level spatial clustering analysis
TL;DR
Findings indicate substantial service expansion alongside emerging geographic fragmentation, underscoring the need for spatially targeted mental health policy in Thailand.
Abstract
Depressive disorders impose a substantial global burden, yet the spatiotemporal distribution of depression-related service use in Thailand remains unexamined. This study aimed to examine the spatiotemporal trends and geographic clustering of depression-related mental health service attendance across Thailand’s 77 provinces from 2018 to 2023.This retrospective study analysed province-level mental health service attendance rates (ICD-10: F32, F33, F34.1, F38, F39) across all 77 Thai provinces from 2018 to 2023. Attendance rates per 100,000 population were derived from Department of Mental Health administrative data. Temporal trends were assessed using Friedman and Wilcoxon signed-rank tests; and spatial structure using global Moran’s I and Local Indicators of Spatial Association (LISA) with a queen contiguity weights matrix (99,999 permutations) in GeoDa. National mean attendance rose 58.3% from the 2019 pre-pandemic baseline (429 per 100,000) to 679 in 2023 (Friedman χ²(5) = 204.9, p < 0.001), with attendance increasing even during COVID-19 restrictions. Global Moran’s I shifted from non-significant positive clustering (2018-2021) to significant spatial dispersion in 2022 (I = -0.155, p = 0.031). LISA revealed a transition from mild northern hotspots toward a post-pandemic checkerboard of spatial outliers, with Low-Low clusters disappearing entirely by 2022. These findings indicate substantial service expansion alongside emerging geographic fragmentation, underscoring the need for spatially targeted mental health policy in Thailand.