title: Does a rural residence predict the development of depressive symptoms in older adults?
abstract: OBJECTIVE
  We sought to determine whether adults aged 65 years or older living in rural areas who are without depressive symptoms have a lower risk of developing depressive symptoms over 5 years than their urban counterparts, and to determine the factors that predict the development of depressive symptoms in older adults in rural and urban areas.
  
  
  METHODS
  We conducted a secondary analysis of an existing data set, the Manitoba Study of Health and Aging (MSHA.) We studied a population-based random sample of 807 people without depressive symptoms or cognitive impairment who were residing in Manitoba communities in 1991/92 and 5 years later in 1996/97. We defined "rural" as a census subdivision with a population of less than 20,000, and "urban" as a population of 20,000 or greater. The MSHA investigators measured depressive symptoms using the Center for Epidemiologic Studies Depression scale, using the standard cut-point of 16 or more. Participants reported their age, sex, education, self-rated health, and functional status at the time of their first interview.
  
  
  RESULTS
  Of adults aged 65 years or older living in urban areas, 13.3% developed depressive symptoms, versus 8.9% of those living in rural regions (p = 0.047). In multivariate analyses, a rural residence was not associated with the development of depressive symptoms. In rural areas, factors predicting depressive symptoms were female sex and poor self-rated health at the time of the first interview.
  
  
  CONCLUSIONS
  A rural residence is only weakly protective for the development of depressive symptoms over 5 years, and this association was not seen after we accounted for potential confounding variables. As well, these results underscore the strong association between poor health and depressive symptoms.
authors.affiliation: Department of Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, Man., and the Centre on Aging, University of Manitoba, Winnipeg, Man. pstjohn@hsc.mb.ca
authors.forename: Philip D
authors.initials: PD
authors.lastname: St John
authors.forename: Audrey A
authors.initials: AA
authors.lastname: Blandford
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Strain
mesh_terms: D000368:Aged; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008350:Manitoba; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D014505:Urban Population