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A Rural Perspective on Perinatal Depression: Prevalence, Correlates, and Implications for Help-Seeking Among Low-Income Women


  • This project was funded through the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (no. 1-H78-MC-00014) and the Missouri Foundation for Health (no. 02-0199-03). The authors wish to recognize and acknowledge the staff and community advisory panel members of the Women's Wellness Initiative of Missouri Bootheel Healthy Start for their guidance throughout the project and thank Kia J. Bentley, PhD, for her support with manuscript preparation. For further information, contact: Sarah Kye Price, PhD, MSW, School of Social Work, Virginia Commonwealth University, 1001 W. Franklin Street, P.O. Box 842027, Richmond, VA 23284; e-mail


ABSTRACT: Context/Purpose: To examine a low-income sample of women in the rural Midwest (N = 1,086) who were screened for perinatal depression through the outreach and education activities within a Healthy Start Initiative project. Specifically, we describe the frequency and severity of depressive symptoms, explore social and demographic correlates of depression, and examine help-seeking through patterns of self-referral to a Healthy Start perinatal depression project in a rural, medically underserved community. Methods: Depression screening data using the Primary Care Evaluation of Mental Disorders (PRIME-MD) as well as intake records from the project were analyzed in a retrospective analysis to identify important demographic and psychosocial characteristics associated with elevated levels of depressive symptoms and help-seeking patterns. Findings: Thirty-six percent of screened women met criteria for major, minor, or subthreshold depression, with 13% meeting diagnostic criteria for major depression alone. Less than 8% were currently receiving any type of mental health services or treatment at screening. The most significant correlate of self-referral to the Healthy Start project was meeting symptom criteria for major depression, although minor depression, subthreshold depression, and status as low-income/Temporary Aid to Needy Families (TANF)-eligible were all significantly associated with self-referral. Conclusions: The findings from this study highlight the potential significance of identifying and addressing the unmet mental health needs of low-income rural women during and around pregnancy. In addition, the study illustrates that low income, in addition to depressive symptoms, impacts mental health service delivery in this rural community with a fragmented mental health service infrastructure.