title: The Prevalence of Major Depressive Episodes Is Higher in Urban Regions of Canada.
abstract: Major depressive disorder is an important contributor to disease burden. Anticipation of service needs is important, yet basic information is lacking. For example, there is no consensus as to whether major depressive episodes (MDE) are more or less prevalent in urban or rural areas. The objective of this study was to determine whether a difference exists in Canada.
  
  
  
  A series of 11 Canadian national cross-sectional studies were examined from 2000 to 2014, providing much greater precision than prior analyses. Survey-specific MDE prevalence estimates were synthesized into a pooled odds ratio comparing urban to rural areas using meta-analytic methods.
  
  
  
  Differences in the survey-specific estimates were not in excess of what would be expected due to sampling variability. This suggests that inconsistency in the prior literature is due to inadequate power and precision, an issue addressed by the meta-analytic pooling. The pooled odds ratio for Canada is 1.18 (95% confidence interval, 1.12 to 1.25), indicating that urban regions have higher MDE prevalence than rural regions. However, the difference is very small and of uncertain significance for policy and planning.
  
  
  
  Prevalence of MDE is approximately 18% higher in urban compared to rural regions of Canada. The difference is insufficient to impute differing need for services, but the result resolves an inconsistency in the existing literature and may play a role in future needs assessment.
authors.affiliation: 1 University of Calgary, Calgary, Alberta.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Wiens
authors.affiliation: 2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
authors.forename: Jeanne V A
authors.initials: JV
authors.lastname: Williams
authors.affiliation: 2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
authors.forename: Dina H
authors.initials: DH
authors.lastname: Lavorato
authors.affiliation: 2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta.|3 Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.
authors.forename: Andrew G M
authors.initials: AG
authors.lastname: Bulloch
authors.affiliation: 2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta.|3 Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
mesh_terms: D002170:Canada / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*; D014505:Urban Population / Q000706:statistics & numerical data*
keywords: depressive disorders; major depressive episodes; meta-analysis; population studies; prevalence; rural; urban