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Women in big cities at higher risk of postpartum depression than rural women

Aug. 6, 2012

By Patricia Nicholson

Canadian women in large urban centres are more at risk for postpartum depression than those living in smaller communities or rural areas, a new study shows.

Postpartum depression is a depressive episode that occurs within one year of giving birth. It can have a negative effect on not only the mother, but also her baby. There are some established risk factors – such as poor social support and a history of depression – but it hasn’t been clear whether there is any association between postpartum depression and the geographical area where the mother lives.

To clarify the issue, a research team that included scientists from Women’s College Hospital, Women’s College Research Institute, the Centre for Addiction and Mental Health (CAMH) and the University of Toronto used data from the 2006 Canadian Maternity Experiences Survey. The survey collected information from 6,126 new mothers across Canada, between five and 14 months after they gave birth.

The researchers divided the women into four categories based on where they lived:

  • Rural – communities of fewer than 1,000 people, or a population density of fewer than 400 people per square kilometer
  • Semi-rural – communities that are larger than rural, but have fewer than 30,000 people
  • Semi-urban – 30,000 to 499,000 inhabitants
  • Urban – 500,000 people or more

They then compared prevalence of postpartum depression in these four categories. Postpartum depression was assessed using scores from the Edinburgh Postnatal Depression Scale, the most widely used screening tool for this condition.

The results, which were published in the Canadian Medical Association Journal on Aug. 6, 2013, showed that women in urban areas had higher rates of postpartum depression than women in more rural areas. The percentage of women with postpartum depression in urban areas was 9.16 per cent, compared to 6.07 per cent in rural areas, 6.96 per cent in semi-rural areas, and 5.31 per cent in semi-urban areas.

“In the rural group, the semi-rural group and the semi-urban group, their rates of postpartum depression were all about the same,” says study author Dr. Simone Vigod, a psychiatrist at Women’s College Hospital. “The rate of postpartum depression among women living in the large urban centres was greater than nine per cent.”

Not only was the prevalence higher in urban centres, but the urban rate of postpartum depression affected the national rate for Canada.

“That’s what’s driving an overall postpartum depression rate for the country of about eight per cent: it’s the large urban areas with the large populations that are driving a higher rate,” Dr. Vigod says. “It also tells us that living in a large urban area is a marker for increased risk.”

To find a possible explanation for the increased rates in urban areas, the researchers looked at known risk factors for postpartum depression. They found that some risk factors – such as poor social support and coming from outside of Canada – were more common in urban areas.

“We were able to explain almost all of the difference by focusing on variables like urban populations having higher percentages of women who are not Canadian-born, larger percentages of people reporting very poor social support postpartum. It’s this lack of social support and other characteristics that are explaining why women in urban areas may have higher rates of postpartum depression,” Dr. Vigod says.

“It’s not like breathing the air in an urban area does something to you,” she adds. “It’s the characteristics of living there.”

This indicates a need to target groups of urban women who may be at high risk, such as women who are new to Canada, and to be aware that despite current services, women in urban areas have less support.

“Living in an urban area is kind of a marker of less support and potentially higher risk of postpartum depression,” Dr. Vigod says. “That’s pretty significant from a policy point of view.”

 

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