Rurality and Risk of Perinatal Depression Among Women in the United States

Abstract

ObjectiveRural populations may experience more frequent and intense risk factors for perinatal depression than their urban counterparts. However, research has yet to examine rural versus urban differences in a population‐based study in the United States. Therefore, this study examined differences in risk of perinatal depression between women living in rural versus urban areas in the United States.MethodUsing 2016 data from the Pregnancy Risk Assessment Monitoring System, we examined the association between rural‐urban status and the risk of depression during the perinatal time period. The total analytical sample included 17,229 women from 14 states. The association between rural‐urban status and risk of perinatal depression was estimated using logistic regression, adjusting for race/ethnicity, maternal age, and state of residence. A second model adjusted for maternal education, health insurance status, and Women, Infants, and Children Special Supplemental Nutrition Program (WIC).ResultsOdds of perinatal depression risk were higher by 21% among rural versus urban women (OR = 1.21, 95% CI: 1.05‐1.41) adjusted for race, ethnicity, and maternal age. This risk difference became smaller and not significant when adding maternal education, health insurance coverage, and WIC participation.ConclusionFindings suggest a rural‐urban inequality in perinatal depression risk. Reducing this inequality may require improving socioeconomic conditions and reducing associated risk factors among rural women.

Treating postpartum depression in rural veterans using internet delivered CBT: program evaluation of MomMoodBooster

“…Women have expressed that they prefer to have depression treatment considered part of prenatal care (Bhat et al, 2018 ). However, with less than one-fifth of rural communities having local obstetrics care (Nidey et al, 2020 ), additional options such as remote care provisions like MomMoodBooster may be vital to closing the rural–urban gap. Having demonstrated similar effectiveness for rural women makes this a promising option.…”

Social-ecological considerations for the sleep health of rural mothers

“…Poor sleep health is a hallmark of perinatal anxiety and depression and it is almost universally present among severe mood disorders and/or postpartum psychosis (Bhati and Richards 2015;Lawson et al 2015;Okun et al 2018). PPD is the most common post-childbirth complication, occurring in approximately 10-15% of US childbearing women (Bauman et al 2020;Bhati and Richards 2015;Chang et al 2012;Hasin and Grant 2015;Nidey et al 2020); it is associated with numerous negative physical and psychological health outcomes in mothers and infants (Slomian et al 2019). Although the literature regarding differences between rural and urban prevalence of sleep and anxiety/depression is mixed, the social context of rural life (e.g., geographic isolation, social stigma) translates to a greater impact on the lives of rural women and their families (Chang et al 2012).…”

“…Future sleep health programs would benefit from using existing social support networks to disseminate sleep health information, integrating behavioral health services into clinical care frameworks, and tailoring culturally-appropriate Telehealth/mHealth programs to enhance the sleep health of rural mothers. Kozhimannil et al 2017;Levin and Hanson 2020;Mollard et al 2016;Nidey et al 2020). Moreover, within rural populations, socio-demographic differences and disparities contribute to elevated risk for poor sleep health and other related health outcomes (Doering et al 2017;Mersky et al, 2020).…”

“…Whereas many women have temporary changes to sleep health while adjusting to motherhood, the intersection of geography, income, education, and race can drastically amplify changes to, and impact from, poor sleep health. In particular, poor health outcomes during the postpartum period are likely compounded in rural women due to the prevalence of financial strain in rural areas, lack of coordinated postnatal care, geographic isolation from medical services and mental health stigma (Hung et al 2017 ; Kozhimannil et al 2017 ; Levin and Hanson 2020 ; Mollard et al 2016 ; Nidey et al 2020 ). Moreover, within rural populations, socio-demographic differences and disparities contribute to elevated risk for poor sleep health and other related health outcomes (Doering et al 2017 ; Mersky et al, 2020 ).…”

Mexican pregnant women show higher depression and anxiety with rising age and in the case of being single

“…In fact, perinatal depression, that is, depression during pregnancy or 12 months postpartum (2) is one of the most frequent complications of pregnancy. However, the percentage of the affected women varies considerably among countries and economic status (3)(4)(5).…”