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Research

Relation between place of residence and postpartum depression

Simone N. Vigod, Lesley A. Tarasoff, Barbara Bryja, Cindy-Lee Dennis, Mark H. Yudin and Lori E. Ross
CMAJ September 17, 2013 185 (13) 1129-1135; DOI: https://doi.org/10.1503/cmaj.122028
Simone N. Vigod
Women’s Mental Health Program (Vigod), Women’s College Hospital; Department of Psychiatry (Vigod, Dennis, Ross), University of Toronto; Women’s College Research Institute (Vigod, Dennis, Ross); Social and Epidemiological Research Department (Tarasoff, Ross), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Tarasoff, Ross), University of Toronto, Toronto, Ont.; Midwives Grey Bruce (Bryja), Owen Sound, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Yudin), St. Michael’s Hospital; Department of Obstetrics and Gynecology (Yudin), University of Toronto, Toronto, Ont.
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  • For correspondence: simone.vigod@wchospital.ca
Lesley A. Tarasoff
Women’s Mental Health Program (Vigod), Women’s College Hospital; Department of Psychiatry (Vigod, Dennis, Ross), University of Toronto; Women’s College Research Institute (Vigod, Dennis, Ross); Social and Epidemiological Research Department (Tarasoff, Ross), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Tarasoff, Ross), University of Toronto, Toronto, Ont.; Midwives Grey Bruce (Bryja), Owen Sound, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Yudin), St. Michael’s Hospital; Department of Obstetrics and Gynecology (Yudin), University of Toronto, Toronto, Ont.
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Barbara Bryja
Women’s Mental Health Program (Vigod), Women’s College Hospital; Department of Psychiatry (Vigod, Dennis, Ross), University of Toronto; Women’s College Research Institute (Vigod, Dennis, Ross); Social and Epidemiological Research Department (Tarasoff, Ross), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Tarasoff, Ross), University of Toronto, Toronto, Ont.; Midwives Grey Bruce (Bryja), Owen Sound, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Yudin), St. Michael’s Hospital; Department of Obstetrics and Gynecology (Yudin), University of Toronto, Toronto, Ont.
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Cindy-Lee Dennis
Women’s Mental Health Program (Vigod), Women’s College Hospital; Department of Psychiatry (Vigod, Dennis, Ross), University of Toronto; Women’s College Research Institute (Vigod, Dennis, Ross); Social and Epidemiological Research Department (Tarasoff, Ross), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Tarasoff, Ross), University of Toronto, Toronto, Ont.; Midwives Grey Bruce (Bryja), Owen Sound, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Yudin), St. Michael’s Hospital; Department of Obstetrics and Gynecology (Yudin), University of Toronto, Toronto, Ont.
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Mark H. Yudin
Women’s Mental Health Program (Vigod), Women’s College Hospital; Department of Psychiatry (Vigod, Dennis, Ross), University of Toronto; Women’s College Research Institute (Vigod, Dennis, Ross); Social and Epidemiological Research Department (Tarasoff, Ross), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Tarasoff, Ross), University of Toronto, Toronto, Ont.; Midwives Grey Bruce (Bryja), Owen Sound, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Yudin), St. Michael’s Hospital; Department of Obstetrics and Gynecology (Yudin), University of Toronto, Toronto, Ont.
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Lori E. Ross
Women’s Mental Health Program (Vigod), Women’s College Hospital; Department of Psychiatry (Vigod, Dennis, Ross), University of Toronto; Women’s College Research Institute (Vigod, Dennis, Ross); Social and Epidemiological Research Department (Tarasoff, Ross), Centre for Addiction and Mental Health; Dalla Lana School of Public Health (Tarasoff, Ross), University of Toronto, Toronto, Ont.; Midwives Grey Bruce (Bryja), Owen Sound, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Dennis), University of Toronto, Toronto, Ont.; Department of Obstetrics and Gynecology (Yudin), St. Michael’s Hospital; Department of Obstetrics and Gynecology (Yudin), University of Toronto, Toronto, Ont.
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Abstract

Background: The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women.

Methods: Female postpartum respondents to the 2006 Canadian Maternity Experiences Survey (n = 6126) were classified as living in rural (< 1000 inhabitants or population density < 400/km2), semirural (nonrural but < 30 000 inhabitants), semiurban (30 000–499 999 inhabitants) or urban (≥ 500 000 inhabitants) areas. We further subdivided women living in rural areas based on the social and occupational connectivity of their community to larger urban centres. We compared the prevalence of postpartum depression (score of ≥ 13 on the Edinburgh Postnatal Depression Scale) across these groups and adjusted for the effect of known risk factors for postpartum depression.

Results: The prevalence of postpartum depression was higher among women living in urban areas than among those living in rural, semirural or semiurban areas. The difference between semiurban and urban areas could not be fully explained by other measured risk factors for postpartum depression (adjusted odds ratio 0.60, 95% confidence interval 0.42–0.84). In rural areas, there was a nonsignificant gradient of risk: women with less connection to larger urban centres were at greater risk of postpartum depression than women in areas with greater connection.

Interpretation: There are systematic differences in the distribution of risk factors for postpartum depression across geographic areas, resulting in an increased risk of depression among women living in large urban areas. Prevention programs directed at modifiable risk factors (e.g., social support) could specifically target women living in these areas to reduce the rates of postpartum depression.

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Canadian Medical Association Journal: 185 (13)
CMAJ
Vol. 185, Issue 13
17 Sep 2013
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Relation between place of residence and postpartum depression
Simone N. Vigod, Lesley A. Tarasoff, Barbara Bryja, Cindy-Lee Dennis, Mark H. Yudin, Lori E. Ross
CMAJ Sep 2013, 185 (13) 1129-1135; DOI: 10.1503/cmaj.122028

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Relation between place of residence and postpartum depression
Simone N. Vigod, Lesley A. Tarasoff, Barbara Bryja, Cindy-Lee Dennis, Mark H. Yudin, Lori E. Ross
CMAJ Sep 2013, 185 (13) 1129-1135; DOI: 10.1503/cmaj.122028
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