title: Living in rural New England amplifies the risk of depression in patients with HIV.
abstract: BACKGROUND
  The importance of depression as a complication of HIV infection is increasingly understood, and people living in rural areas are at increased risk for depression. However, it is not known whether living in rural areas amplifies the risk of depression in patients with HIV.
  
  
  METHODS
  We compared the prevalence of depression between rural and metropolitan HIV patients seen at the Dartmouth-Hitchcock HIV Program in a retrospective cohort study. Using the validated Rural-Urban Commuting Area Score, we categorized patients as living in small town/rural areas, micropolitan or metropolitan towns. Then, using a multivariate logistic regression model to adjust for demographic factors that differed between rural and metropolitan patients, we estimated the impact of living in rural areas on the odds of depression.
  
  
  RESULTS
  Among 646 patients with HIV (185 small town/rural, 145 micropolitan, 316 metropolitan), rural patients were older, white, male, and men who have sex with men (ANOVA, F-statistic < 0.05). The prevalence of depression was highest in rural patients (59.5 vs. 51.7 vs. 41.2%, F statistic < 0.001), particularly rural patients on antiretroviral therapy (72.4 vs. 53.5 vs. 38.2%, F-statistic < 0.001. A multivariate logistic regression model showed that the odds of depression in rural patients with HIV were 1.34 (P < 0.001).
  
  
  CONCLUSIONS
  HIV-infected patients living in rural areas, particularly those on antiretroviral therapy, are highly vulnerable to depression.
authors.affiliation: The Center for Education, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA. Siddharth.H.Sheth@Dartmouth.edu
authors.forename: Siddharth H
authors.initials: SH
authors.lastname: Sheth
authors.forename: Paul T
authors.initials: PT
authors.lastname: Jensen
authors.forename: Timothy
authors.initials: T
authors.lastname: Lahey
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009511:New England / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population