Rural Women's Depression Prevalence: What Do We Know and Where Do We Go from Here?

Background/Purpose: Depression is one of the most common and debilitating mental disorders among women, and, when untreated, has devastating effects on work, family, and social life. Rural women’s depression has been understudied. This study reviewed and synthesized existing literature on rural women’s depression prevalence. Results inform our understanding of the relationship between depression and rural residence among women, identify limitations of current scholarship, and present future research opportunities.

Methods: Literature on rural women’s depression prevalence was systematically reviewed in April 2015. For inclusion, studies had to: (1) report depression prevalence among rural women or compare rural and urban women’s depression prevalence; (2) assess depression using established, validated measures; (3) be conducted in the United States; and (4) be published in English in peer-reviewed journals. Articles meeting criteria were identified via searching PubMed, PsycInfo, and GoogleScholar electronic databases. Search terms, alone or in combination, included: depression; Major Depressive Disorder; MDD; prevalence; symptoms; rural; remote; non-metropolitan; urbanicity, women; and mothers.

Results: Twenty-four articles met inclusion criteria for this review. Published between 1976 and 2015, these articles suggest high rates of depression among rural women, and a trend of increasing prevalence rates over time. Of 19 studies assessing depression via symptom measures, thirteen (68.4%) found 30% or more rural women sampled screened positive for current depression. Among five studies assessing rural women’s depression prevalence via diagnostic interviews, two reported lifetime MDD prevalence rates of 37.5% and 62%, respectively, whereas another indicated 14.3% of their sample met criteria for current Major Depressive Episode.

The methodological rigor of articles reviewed must be considered. Though inclusion criteria allowed authors to self-identify their samples as “rural,“ less than half of the articles (N=10; 43.5%) used established classification systems, or provided clear definitions, to operationalize rurality. The majority of articles (N=13; 56.5%) utilized community-based, purposive sampling. Over half (N=13; 56.5%) of these studies were conducted in the rural south; only three (12.5%) used national data. Therefore, the current literature’s comparative utility and generalizability is limited. Only two studies (10.5%) reported adjusted depression prevalence rates, controlling for known covariates. This limits our ability to understand whether high rates of depression among rural women relate to resource disparities common in rural communities or to aspects of the rural context itself.

Conclusions and Implications: This review revealed high rates of depression among rural women; though our current knowledge is primarily based on non-representative community samples that use symptom scales rather than diagnostic criteria to assess depression. These high depression prevalence rates are of particular concern due to limited access to mental health services in rural America, as well as increasing suicide rates and decreasing life expectancy in rural areas and among women. More literature on rural women’s depression prevalence is necessary, particularly studies that acknowledge heterogeneity among rural populations, clearly operationalization rurality, use diagnostic interviews, and present adjusted prevalence rates controlling for known covariates. Results also suggest the need to examine how changes in the rural context (e.g., labor market shifts; women juggling multiple roles) may impact women’s depression prevalence.