Global Prevalence of Perinatal Depression and Its Determinants Among Rural Women: A Systematic Review and...

Background: Perinatal depression (PND) in low-resource areas is a significant concern that imposes a substantial burden on both families and societies. Although many studies have explored rural PND, there is a lack of systematic synthesis of the existing research. This study aimed to estimate the global prevalence of PND among rural women and to summarize its determinants. Methods: Comprehensively electronic searches were performed across eight English databases. Two reviewers independently assessed the eligibility of the study and extracted the relevant data. Any inconsistencies were resolved through discussion with a third reviewer. Prevalence estimates were calculated using a random-effects meta-analysis model. Subgroup analysis, sensitivity analysis, and meta-regression were employed to examine the source of heterogeneity. In addition, a narrative synthesis of the influence factors reported in the included studies was provided. Results: The search identified 17,810 studies, of which 86 were included in the analyses. The pooled prevalence of PND in rural areas was 22.1% (95% CI 19.0%-25.3%, p < 0.001, I ² = 99.2%). Subgroup analyses indicated higher PND prevalence in low-income (24.5%) and lower middle-income countries (22.8%). Additionally, PND prevalence was greater when assessed using self-reported screening instruments (22.8%) compared to diagnostic interviews (17.6%). Major risk factors included violence, antenatal psychiatric disorder, low family income, male-child preference, and food insecurity, while positive social support and higher levels of education were protective factors. Conclusions: Our findings suggest that the prevalence of PND is higher in rural areas compared to global data, particularly in low-income and lower middle-income countries. To improve rural maternal mental health, it is essential to develop measures targeting modifiable risk factors for PND, including promoting gender equality, implementing antiviolence initiatives, and strengthening economic support systems. Addressing these factors can help reduce the burden of PND and enhance the well-being of mothers in rural communities.