She's Gone Country — and She's Happy

Postpartum depression risk slightly higher among women living in cities rather than the country

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) City life can be more chaotic than country living, with the honking horns, sirens and lights late into the night. Perhaps the more hectic environments of urban areas explain recent findings related to postpartum depression.

A recent study found that women living in the country were a little less likely to experience postpartum depression (depression after giving birth) than women living in cities.

The difference was small, and it was partly explained by higher rates of domestic violence or having less social support among some women in the city.

Close to one in ten women are likely to experience depression after having a baby. Knowing whether you are at risk may help you know when to seek help so you can take care of yourself and your child.

"Ask your OB/GYN about postpartum depression risks."

This study, led by Simone N. Vigod, MD, of the Women's Mental Health Program at Women's College Hospital at the University of Toronto in Canada, looked at whether rates of postpartum depression varied according to where a woman lived.

The researchers surveyed 6,126 Canadian women who lived in a variety of different settings, ranging from rural or semi-rural to semi-urban or urban.

Urban areas were defined as having a population of at least 500,000 people per 400/km2. Rural areas were defined as having less than 1,000 people per 400/km2.

The researchers also looked at how closely women were "connected" to larger urban centers, regardless of what environment they personally lived in.

For example, a rural area with a strong connection to a city meant that at least 30 percent of the residents regularly commuted to the city.

A weak connection between a rural area and a city meant that less than 5 percent of the town's residents commuted to the city.

Having no influence from the city meant that no one in the rural town commuted to a large city.

The surveys also asked about other factors that might influence postpartum depression so that these factors could be accounted for in the researchers' analysis.

These factors included the women's age, number of children, marital status, socioeconomic status, level of education, country of birth, history of depression, life stresses, abuse history, social support during pregnancy and after giving birth, distance the woman traveled to give birth, her drug and alcohol use history, the type of healthcare provider she had and any complications she had during pregnancy or birth.

Overall, approximately 7.5 percent of the women surveyed were determined to have postpartum depression, based on an assessment frequently used to diagnose women.

In general, the researchers found that women living in urban areas were at a higher risk for postpartum depression than women living in rural areas or suburban-like areas in between.

About 9.2 percent of the women living in urban areas had postpartum depression, compared to 6.1 percent of women in rural areas, 7 percent in semi-rural areas and 5.3 percent in semi-urban areas.

A semi-urban area meant having between 30,000 and 499,999 people per 400/km2. Semi-rural meant having fewer than 30,000 people per 400/km2 but not living in a rural area.

However, the researchers saw a very small trend toward greater risk of postpartum depression the lower the connection the women had to a large urban center, among women living only in rural areas.

It's possible this last finding was a result of chance, but the researchers could not determine this for certain either way.

"Our findings suggest that women in urban areas with a large population were at increased risk of postpartum depression compared with women in other regions," the researchers wrote.

However, the researchers did find that some of the differences seen in postpartum risk between women in the city and women in the country related to other factors.

These factors that varied between women in rural versus urban areas included a woman's immigration status, whether she was in an abusive situation and how she perceived her health and social support.

The study was published August 6 in the Canadian Medical Association Journal.

The research was funded by the Shirley Brown Clinician Scientists Award, the University of Toronto, the Canadian Institutes of Health Research, the Ontario Women's Health Council and the Ontario Ministry of Health and Long-Term Care.

One author has consulted for Multi-Dimensional Health Care for developing activities related to women's mental health after pregnancy.

Review Date: 
August 6, 2013
Last Updated:
August 7, 2013