Postpartum depression among rural women from developed and developing countries: a systematic review

Postpartum depression (PPD) is a significant public health problem, with significant consequences for the mother, infant, and family. Available research has not adequately examined the potential impact of sociodemographic characteristics, such as place of residence, on risk for PPD. Therefore, this systematic review and meta-analysis examines the prevalence of and risk factors for PPD in rural communities within developed and developing countries, and where possible, compares rates to those among urban women.

Five databases were searched, from start dates through early May 2010, using key words relevant to PPD and rural residence. Peer-reviewed articles were eligible if a standardized assessment of depression was administered to rural mothers within the first year postpartum. Data on PPD were extracted from 19 articles, of which 17 provided data for meta-analyses.

The overall prevalence of PPD among rural women was 27.0% (95% CI, 18.8%-37.2%). Prevalence was somewhat higher among women in developing countries (31.3%; 95% CI, 21.3%-43.5%) than among women in developed countries (21.5%; 95% CI, 10.9%-38.0%), although there was significant heterogeneity among both groups of studies. Comparisons between rural and urban women yielded conflicting results. Although established PPD risk factors were associated with depression in rural women, additional risk factors were reported for rural women from developing countries, such as having 2 or more young children.

Longitudinal studies with clearly defined "rural" and "comparison" groups are needed to determine whether rural residence is associated with increased risk for PPD. The results can inform prevention and treatment programs tailored to serve rural women.