Depression and Rural Women: Challenges, Barriers, and Opportunities

Groh, Carla


This presentation will share the results of a study that examined the prevalence rate of depression in women living in rural Michigan, and perceived barriers to accessing mental health services.


Rural women have significantly higher rates of depression than their urban counterparts, and experience unique challenges and barriers such as geographic isolation; lack of transportation; higher rates of joblessness and poverty; lack of educational and/or vocational opportunities; and, inadequate numbers of health professionals. Moreover, the stigma associated with depression might have different implications for those living in small rural communities where it is harder to maintain privacy.


This was a cross-sectional descriptive study. A convenience sample of 152 adult women was recruited from rural settings in Michigan. Variables measured included depression (CES-D), physical health problems, health insurance and disability status, treatment for depression, desirable treatment options for depression, barriers to treatment, and demographic data.


The mean age was 44 (SD 15.4). The majority were white (98.7), married (65%), and employed less than 30 hours/week (53%). The aggregate mean score on the CES-D for all subjects (N=137) was 13 (SD 10.3). For those who reported being currently depressed (n=42), the mean score was 25.5 (SD 7.9) compared to 7.5 (SD 5.1) for those not currently depressed (n=95). The difference was statistically significant (F=14, df=135, p=.000). Cronbach‟s alpha for the CES-D was .90. The most common physical health problems reported were: arthritis (30.5%) hypertension (29%), headaches (28.5%), and back problems (23%). Perceived barriers to obtaining services were lack of insurance (45%), living in a small town (37%), unsure how to access services (33%), embarrassed to seek care (32%), and not comfortable seeking services (31%) in addition to other barriers.


The implications of these findings include education, practice, research and advocacy. Advanced practice nurses are in key positions to provide leadership and vision in transforming how rural women view depression and treatment. With almost a third of the women reporting current depression in this study, it is critical for primary care nurse practitioners in rural communities to be vigilant in assessing for depression.