Rural-urban differences in the mental health of perinatal women: a UK-based cross-sectional study

Samuel Ginja,Raghu Lingam,Katherine Jackson,James J Newham,Emily J Henderson,Debbie Smart

doi:10.1186/s12884-020-03132-2

Abstract

BackgroundInternational data suggest that living in a rural area is associated with an increased risk of perinatal mental illness. This study tested the association between rurality and risk for two mental illnesses prevalent in perinatal women - depression and anxiety.MethodsUsing a cross-sectional design, antenatal and postnatal women were approached by healthcare professionals and through other networks in a county in Northern England (UK). After providing informed consent, women completed a questionnaire where they indicated their postcode (used to determine rural-urban status) and completed three outcome measures: the Edinburgh Postnatal Depression Scale (EPDS), the Whooley questions (depression measure), and the Generalised Anxiety Disorder 2-item (GAD-2). Logistic regression models were developed, both unadjusted and adjusted for potential confounders, including socioeconomic status, social support and perinatal stage.ResultsTwo hundred ninety-five participants provided valid data. Women in rural areas (n = 130) were mostly comparable to their urban counterparts (n = 165). Risk for depression and/or anxiety was found to be higher in the rural group across all models: unadjusted OR 1.67 (0.42) 95% CI 1.03 to 2.72, p = .038. This difference though indicative did not reach statistical significance after adjusting for socioeconomic status and perinatal stage (OR 1.57 (0.40), 95% CI 0.95 to 2.58, p = .078), and for social support (OR 1.65 (0.46), 95% CI 0.96 to 2.84, p = .070).ConclusionsData suggested that women in rural areas were at higher risk of depression and anxiety than their urban counterparts. Further work should be undertaken to corroborate these findings and investigate the underlying factors. This will help inform future interventions and the allocation of perinatal services to where they are most needed.

Highlights

International data suggest that living in a rural area is associated with an increased risk of perinatal mental illness
The aim of the present study was to assess the association between rurality and the risk for two common mental illnesses during the antenatal and postnatal periods, i.e. perinatal period, in women from a county in Northern England (UK)
Excluded participants did not differ significantly from others in age and perinatal stage; whether they differed in terms of index of multiple deprivation (IMD) or urban/rural status cannot be determined due to missing postcodes

Summary

Introduction

International data suggest that living in a rural area is associated with an increased risk of perinatal mental illness. Other negative outcomes have been reported to be more frequent in women from rural areas including later initiation of prenatal care [4], later and less use of contraceptives [5], as well as higher chances of a small-for-gestational-age birth and low birth-weight [6], all of which may add to stress levels and increase the risk of mental illness Possible mediators for these rural-urban differences include difficulties in accessing healthcare services, regional variations in cultural practices, sociodemographic and lifestyle factors [3, 6, 7], as well as varying levels of hazardous environmental, occupational and transportation conditions [8]. Social support and socioeconomic status are important because they are related to many of the above factors [3, 9, 10]

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