Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Psychological and Brain Sciences

Committee Chair

Mast, Benjamin T.

Author's Keywords

Rural; Health disparities; Older adults; Urban; Depression; Race


Older people--Mental health; Rural health; Urban health


Depression is one of the most prevalent psychiatric conditions experienced by older adults and represents a major public health concern. Rural/urban residence may affect the prevalence of depression as rural older adults differ from their urban counterparts in many respects. One important difference found in the literature is that rural OAs are often faced with more health disparities (HDs) compared to their urban counterparts. The current study investigated the association between HDs and depression in a sample of rural and urban OAs, and examined whether HDs contribute to our understanding of how rurality impacts the prevalence and severity of depression. It was hypothesized that rural OAs would report a greater severity of depression compared to urban OAs, and that a greater severity of HD in rural areas would account for this difference. This study utilized a baseline sample of 3,996 older adults from the Duke Established of Populations for Epidemiologic Studies of the Elderly (EPESE): Piedmont Health Survey of the Elderly. Participants were stratified into separate groups based on level of rurality as defined by the Economic Research Service's Rural-Urban Continuum Codes. The main, overarching hypothesis was not supported by the current study. Level of rurality, in and of itself, was not significantly associated with depression severity or rates of prevalent or incident depression, and other than healthcare utilization, the HD variables investigated (overall medical burden, cumulative vascular risk, and negative health behaviors) did not differ by level of rurality. Although rural/urban status did not directly affect HDs and depression, follow-up analyses indicated this was likely due to the heterogeneity of individuals within rural and urban counties. This finding indicates that the inclusion of individual characteristics may contribute to the understanding of differences in depression between rural and urban OAs. The relationship between level of rurality and depression is more complex than a simple rural/urban distinction and other variables (e.g. ethnicity, income, and place of usual outpatient healthcare services) need to be investigated in conjunction with place of residence to understand how HDs and depression differ across rural and urban groups.