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

OBJECTIVE: Rural 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. METHOD: Using 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). RESULTS: Odds 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. CONCLUSION: Findings 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.