Rates of Depression and Anxiety in Urban and Rural Canada

Background: Studies of urban-rural differences in rates of non-psychotic psychiatric disorders have produced contradictory results, with some finding higher urban rates and others no difference.

Aims: This study aimed to compare geographic variability of rates of depression and three anxiety disorders in a large, random community sample of Canadian residents.

Method: Data from the 2002 Canadian Community Health Survey 1.2 were analyzed, using a four-category classification of urban-rurality.

Results: Significant bivariate urban-rural differences were found for age, marital status, country of birth, ethnicity, education, household income, income adequacy, employment, home ownership, physical activity, perceived stress, and physical health. In addition, participants in the urban core and urban fringe had a weaker sense of belonging to their community and reported lower social support. There was a modest urban excess of depression in the previous 12 months but no difference in rates of agoraphobia, panic disorder or social phobia across the geographical areas. The multivariate modeling showed a lower prevalence of depression for people living in the most rural environment only (odds ratio = 0.76, 95% confidence interval = 0.59, 0.98). Factors associated with an increased rate of depression in the model were female gender, younger age, being not married, being born in Canada, white ethnicity, higher education, unemployment, not owning one's home, and poor physical health. Also, participants with a stronger sense of belonging to their community and higher social support reported lower rates of depression.

Conclusions: These results confirmed a lower risk of depression amongst rural dwellers, which was associated with a stronger sense of community belonging. Further research on this topic could usefully include community-level variables, usually subsumed under the rubric of social capital.