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Rural residence and risk for perinatal depression: a Canadian pilot study

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Abstract

Few studies have examined whether rural residence is associated with increased or decreased risk for postpartum depression (PPD). To address this research gap, this pilot study examined rates of depressive symptoms and perceived social support among women living in rural (population <10,000), semi-rural (population 10,000–20,000), and urban (downtown Toronto, population approximately 2.5 million) areas. Women were consecutively recruited at 25–35 weeks gestation from midwifery clinics and hospital-based prenatal care practices in two catchment areas and asked to complete a demographic questionnaire including postal code. On the basis of their responses, rural, semi-rural, and urban mothers were contacted by telephone at 36 weeks gestation (baseline) and 6–8 weeks postpartum (primary outcome). During each assessment, participants completed standardized measures of social connectedness, mental health, and health service utilization, including the Edinburgh Postnatal Depression Scale (EPDS) and the Medical Outcome Study Social Support Scale. A total of 87 participants [N = 23 rural (R), N = 23 semi-rural (SR), N = 41 urban (U)] were recruited into the study. There were no statistically significant differences between groups in mean EPDS scores during pregnancy (U = 7.1, SR = 5.3, R = 5.3, p = 0.15) or at 6 weeks postpartum (U = 5.3, SR = 4.4, R = 4.2, p = 0.43). The proportion of women with EPDS scores >12 similarly did not differ between groups. There were few statistically significant differences between groups on indicators of social connectedness; however, urban women reported significantly lower scores on measures of social network diversity and social capital than either the semi-rural or rural groups. This pilot study is limited by its small sample size; however, our data do not support the hypothesis that there are clinically important differences in risk for PPD associated with rural residence. Further studies examining potential relationships between indicators of social connectedness and perinatal mental health may be warranted.

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Acknowledgements

We wish to acknowledge the women and their families who participated, as well as the participating recruitment sites, whose time and commitment made this research possible.

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Authors and Affiliations

  1. Social Equity and Health Research Section, Centre for Addiction & Mental Health, 455 Spadina Ave. Suite 300, Toronto, ON, M5S 2G8, Canada

    Lori E. Ross, Laura Villegas & John Cairney

  2. University of Toronto, Toronto, Canada

    Cindy-Lee Dennis, Sophie Grigoriadis & Mark H. Yudin

  3. University of Ottawa, Ottawa, Canada

    Ivy Lynn Bourgeault

  4. McMaster University, Hamilton, Canada

    John Cairney

  5. St. Michael’s Hospital, Toronto, Canada

    Leah S. Steele & Mark H. Yudin

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  1. Lori E. Ross
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Correspondence to Lori E. Ross.

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Funding and support

This study was supported by an operating grant from the Canadian Institutes of Health Research, award number FRN-83384. L. Ross is supported by a New Investigator Award from the Canadian Institutes for Health Research and the Ontario Women's Health Council, Award NOW-84656. J. Cairney was supported by an endowed professorship from the department of family medicine at McMaster University. In addition, support to CAMH for salary of scientists and infrastructure has been provided by the Ontario Ministry of Health and Long Term Care. The views expressed here do not necessarily reflect those of the Ontario Ministry of Health and Long Term Care. Dr. S. Grigoriadis holds a New Investigator Award in Women's Health Research from the Canadian Institutes of Health Research in partnership with the Ontario Women's Health Council. Dr. L. Steele is supported as a Career Scientist by the Ontario Ministry of Health and Long Term Care and by the Department of Family and Community Medicine at the University of Toronto and St. Michael's Hospital.

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Ross, L.E., Villegas, L., Dennis, CL. et al. Rural residence and risk for perinatal depression: a Canadian pilot study. Arch Womens Ment Health 14, 175–185 (2011). https://doi.org/10.1007/s00737-011-0208-4

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