Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 2, pp 171–180 | Cite as

The predictors of depression in a longitudinal cohort of community dwelling rural adults in Australia

  • Tonelle E. HandleyEmail author
  • Jane Rich
  • Terry J. Lewin
  • Brian J. Kelly
Original Paper



Many major studies of depression in Australia are under-representative of rural and remote residents, limiting the generalizability of their findings. This study explores the contributions of a range of individual, social, and community factors to the trajectory of depressive symptoms among a cohort of rural and remote residents.


Data from four waves of the Australian Rural Mental Health Study (baseline n = 2639), a 5 year longitudinal study of rural community residents, were examined within generalized linear mixed models to predict depressive symptoms. Depression was measured using the PHQ-9, with key correlates including social support, employment status, financial wellbeing, neuroticism, and rural community factors.


Moderate-to-severe depression was reported by 6.3% of the baseline sample. Being permanently unable to work resulted in over a threefold increase in the odds of depression at the following survey wave. Self-rated financial hardship was associated with a fourfold increase in the odds of future depression, as was a high level of community concerns. Neuroticism and tobacco use also made a significant independent contribution to future depressive symptoms. Interpersonal support was a protective factor, reducing the odds of next-wave depression by 64%.


Financial and employment-related difficulties appear to be important risk factors for depression, and targeting individuals experiencing such difficulties may be an effective means of reducing depression among certain sub-groups. Strategies to prevent depression in rural and remote Australia may benefit from a focus on interpersonal and community-level support, as the effects of this support are lasting and contribute to a reduced likelihood of depressive episodes in future years.


Rural Depression Social support Employment Financial stress 



We wish to recognise the contributions of the ARMHS investigators: David Lyle, David Perkins, Lyn Fragar, John Beard, Vaughan Carr, Jeffrey Fuller, Helen Stain, Kerry Inder, Prasuna Reddy and Senior Project Co-ordinator Clare Coleman. We also wish to acknowledge the support of the Directors of Mental Health Services in the relevant Local Health Districts during the course of the study: Russell Roberts, Richard Buss and Dinesh Arya, and particularly acknowledge the research site coordinators in each site: Jan Sidford, John Ogle (Broken Hill), Trim Munro, Amy Strachan (Moree), Louise Holdsworth, Kath O’Driscoll (Lismore), Cheryl Bennett, Jannelle Bowler (Orange), along with Fleur Hourihan, Gina Sartore and Denika Novello.


The study was funded by the National Health and Medical Research Council (Project Grants #401241, #631061) and also supported by a Research Capacity Building Grant to the Australian Rural Health Research Collaboration.

Compliance with ethical standards

Conflict of interest

The authors declare no competing interests.

Supplementary material

127_2018_1591_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 KB)
127_2018_1591_MOESM2_ESM.docx (13 kb)
Supplementary material 2 (DOCX 13 KB)


  1. 1.
    World Health Organization (2016) Depression: fact sheet. World Health Organization, GenevaGoogle Scholar
  2. 2.
    Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H (2009) 2007 National Survey of mental health and wellbeing: methods and key findings. Aust NZ J Psychiatry 43(7):594–605. CrossRefGoogle Scholar
  3. 3.
    Jacka F, Pasco J, Henry M, Korn S, Williams L, Kotowicz M, Nicholson G, Berk M (2007) Depression and bone mineral density in a community sample of men: Geelong osteoporosis study. J Men Health Gend 4(3):292–279CrossRefGoogle Scholar
  4. 4.
    Rich JL, Byrne JM, Curryer C, Byles JE, Loxton D (2013) Prevalence and correlates of depression among Australian women: a systematic literature review, January 1999–January 2010. BMC Res Notes 6:424. CrossRefGoogle Scholar
  5. 5.
    Harvey SB, Joyce S, Tan L, Johnson A, Nguyen H, Modini M, Groth M (2014) Developing a mentally healthy workplace. A review of the literature University of New South Wales and the Black Dog Institute, SydneyGoogle Scholar
  6. 6.
    World Health Organization (2011) Global status report on non-communicable diseases 2010. World Health Organization, GenevaGoogle Scholar
  7. 7.
    Trautmann S, Rehm J, Wittchen HU (2016) The economic costs of mental disorders: do our societies react appropriately to the burden of mental disorders? EMBO Rep 17(9):1245–1249. CrossRefGoogle Scholar
  8. 8.
    Sveinbjarnardottir E, Dierckx de Casterle B (1997) Mental illness in the family: an emotional experience. Issues Ment Health Nurs 18(1):45–56CrossRefGoogle Scholar
  9. 9.
    Massak A, Graham K (2008) Is the smoking-depression relationship confounded by alcohol consumption? An analysis by gender. Nicotine Tob Res 10(7):1231–1243. CrossRefGoogle Scholar
  10. 10.
    Soleimani MA, Pahlevan Sharif S, Bahrami N, Yaghoobzadeh A, Allen KA, Mohammadi S (2017) The relationship between anxiety, depression and risk behaviors in adolescents. Int J Adolesc Med Health. Google Scholar
  11. 11.
    Probst JC, Laditka SB, Moore CG, Harun N, Powell MP, Baxley EG (2006) Rural-urban differences in depression prevalence: implications for family medicine. Fam Med 38(9):653–660Google Scholar
  12. 12.
    Inder KJ, Berry H, Kelly BJ (2011) Using cohort studies to investigate rural and remote mental health. Aust J Rural Health 19(4):171–178. CrossRefGoogle Scholar
  13. 13.
    Li LW, Liu J, Xu H, Zhang Z (2016) Understanding rural-urban differences in depressive symptoms among older adults in China. J Aging Health 28(2):341–362. CrossRefGoogle Scholar
  14. 14.
    Romans S, Cohen M, Forte T (2011) Rates of depression and anxiety in urban and rural Canada. Soc Psychiatry Psychiatr Epidemiol 46(7):567–575. CrossRefGoogle Scholar
  15. 15.
    Kim J-M, Stewart R, Shin I-S, Yoon J-S, Lee H-Y (2004) Lifetime urban/rural residence, social support and late-life depression in Korea. Int J Ger Psychiatry 19(9):843–851. CrossRefGoogle Scholar
  16. 16.
    Werner-Seidler A, Afzali MH, Chapman C, Sunderland M, Slade T (2017) The relationship between social support networks and depression in the 2007 National Survey of Mental Health and Well-being. Soc Psychiatry Psychiatr Epidemiol 52(12):1463–1473CrossRefGoogle Scholar
  17. 17.
    Baxter J, Hates A, Gray M (2011) Families in regional, rural and remote Australia (Facts Sheet). Australian Institute of Family Studies, MelbourneGoogle Scholar
  18. 18.
    Kelly BJ, Lewin TJ, Stain HJ, Coleman C, Fitzgerald M, Perkins D, Carr VJ, Fragar L, Fuller J, Lyle D, Beard JR (2011) Determinants of mental health and well-being within rural and remote communities. Soc Psychiatry Psychiatr Epidemiol 46(12):1331–1342. CrossRefGoogle Scholar
  19. 19.
    Inder KJ, Handley TE, Fitzgerald M, Lewin TJ, Coleman C, Perkins D, Kelly BJ (2012) Individual and district-level predictors of alcohol use: cross sectional findings from a rural mental health survey in Australia. BMC Public Health 12:586. CrossRefGoogle Scholar
  20. 20.
    Handley TE, Inder KJ, Kelly BJ, Attia JR, Lewin TJ, Fitzgerald MN, Kay-Lambkin FJ (2012) You’ve got to have friends: the predictive value of social integration and support in suicidal ideation among rural communities. Soc Psychiatry Psychiatr Epidemiol 47(8):1281–1290. CrossRefGoogle Scholar
  21. 21.
    Handley TE, Kelly BJ, Lewin TJ, Coleman C, Stain HJ, Weaver N, Inder KJ (2015) Long-term effects of lifetime trauma exposure in a rural community sample. BMC Public Health 15:1176. CrossRefGoogle Scholar
  22. 22.
    Butterworth P, Handley TE, Lewin TJ, Reddy P, Kelly BJ (2014) Psychological distress in rural Australia: regional variation and the role of family functioning and social support. J Public Health 22(6):481–488. CrossRefGoogle Scholar
  23. 23.
    Kelly BJ, Stain HJ, Coleman C, Perkins D, Fragar L, Fuller J, Lewin TJ, Lyle D, Carr VJ, Wilson JM, Beard JR (2010) Mental health and well-being within rural communities: the Australian rural mental health study. Aust J Rural Health 18(1):16–24. CrossRefGoogle Scholar
  24. 24.
    Wooden M, Freidin S, Watson N (2002) The household, income and labour dynamics in Australia (HILDA) survey: wave 1. Aust Econ Rev 35(3):339–348. CrossRefGoogle Scholar
  25. 25.
    Berkman LF, Syme SL (1979) Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 109(2):186–204CrossRefGoogle Scholar
  26. 26.
    Henderson S, Duncan-Jones P, Byrne DG, Scott R (1980) Measuring social relationships. The interview schedule for social interaction. Psychol Med 10(4):723–734CrossRefGoogle Scholar
  27. 27.
    Chipuer HM, Pretty GMH (1999) A review of the sense of community index: current uses, factor structure, reliability, and further development. J Commun Psychol 27(6):643–658.<643::AID-JCOP2>3.0.CO;2-B CrossRefGoogle Scholar
  28. 28.
    Brugha TS, Cragg D (1990) The list of threatening experiences: the reliability and validity of a brief life events questionnaire. Acta Psychiat Scand 82(1):77–81CrossRefGoogle Scholar
  29. 29.
    Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M (1993) Development of the alcohol use disorders identification test (AUDIT): WHO Collaborative Project on early detection of persons with harmful alcohol consumption-II. Addiction 88(6):791–804CrossRefGoogle Scholar
  30. 30.
    Eysenck SBG, Eysenck HJ, Barrett P (1985) A revised version of the psychoticism scale. Pers Individ Differ 6(1):21–29. CrossRefGoogle Scholar
  31. 31.
    Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613CrossRefGoogle Scholar
  32. 32.
    Liu Y, Wang J (2015) Validity of the Patient Health Questionnaire-9 for DSM-IV major depressive disorder in a sample of Canadian working population. J Affect Disord 187:122–126. CrossRefGoogle Scholar
  33. 33.
    Mitchell A, Yadegarfar M, Gill J, Stubbs B (2016) Case finding and screening clinical utility of the Patient Health Questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies. B J Psych Open 2(2):127–138. CrossRefGoogle Scholar
  34. 34.
    Casey L, Pui-Tak Liang R (2013) Stress and wellbeing in Australia survey 2013. InPsych 35:24–26Google Scholar
  35. 35.
    Sperlich S, Maina MN, Noeres D (2013) The effect of psychosocial stress on single mothers’ smoking. BMC Public Health 13:1125. CrossRefGoogle Scholar
  36. 36.
    Andrews G (2014) We can manage depression better with technology. Aust Fam Phys 43(12):838–841Google Scholar
  37. 37.
    Mansfield S (2014) Patients and technology: improving access to healthcare. Aust Fam Phys 34(12):821Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Tonelle E. Handley
    • 1
    Email author
  • Jane Rich
    • 1
  • Terry J. Lewin
    • 1
    • 2
  • Brian J. Kelly
    • 1
  1. 1.School of Medicine and Public HealthUniversity of NewcastleCallaghanAustralia
  2. 2.Hunter New England Mental HealthNewcastleAustralia

Personalised recommendations