Expressions of depression in rural women with chronic illness.
BACKGROUND
Globally, chronic conditions have become the most prevalent and costly of health problems, imposing a growing drain on healthcare delivery systems and healthcare financing. Depressive symptoms and disorders are one of the most common complications of chronic illness and negatively impact one's perceived quality of life. In recent years, depression has been recognized as a major health problem for rural women. The purpose of this article is to describe the experience of depression in a sample of chronically ill rural women who participated in an online social-support and health education research project.


METHODS
Middle-aged rural women with at least one chronic condition were recruited from the western USA to participate in the Women to Women (WTW) project, a 22 week computer-based intervention of virtual support and health education. The presence of depression was measured quantitatively using the Center for Epidemiologic Studies Depression Scale (CES-D). Messages posted by the women (n=82) to the online support forum were carefully examined for evidence of depressive symptomatology, perceptions of the relationship of depression to their chronic illnesses, and their strategies for coping with their depression.


RESULTS
Of the 82 women who participated in the support intervention, 47 (57%) demonstrated clinically significant psychological distress at the time of enrollment into the WTW project by scoring 16 or above on the CES-D (range=0-48; x=19.27; sd=11.25). At the end of the computer intervention, complete data were available on 57 women. Of these, 24 (42%) scored 16 or above on the CES-D (range=0-49; x=15.74; sd=11.55) indicating continuing psychological distress. In all, 59 messages were coded 'depression'. The women's messages included descriptions of symptoms consistent with the literature (feelings of worthlessness and guilt; helplessness and hopelessness; alterations in sleep patterns; loss of energy). The interrelationship of depression and illness, pain, and seasonal weather variations was acknowledged; traditional and complementary healthcare treatments were discussed; relationships with healthcare providers and family and friends were described; and a variety of strategies used in coping with their depression were shared.


CONCLUSIONS
Rural women with chronic illness struggle with depression. The description of their depressive symptomatology provides insight into the experience and may facilitate healthcare providers' ability to recognize depression and identify strategies to ameliorate the negative impact of depression in chronically ill rural women.
Montana State University College of Nursing, Missoula, Montana, USA. winters@montana.edu
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Cudney
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D000223:Adaptation, Psychological; D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D019035:Rural Health Services / Q000458:organization & administration; D012424:Rural Population / Q000706:statistics & numerical data*; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration