Depression and modernization: a cross-cultural study of women.

BACKGROUND This study concerns depression among women living in developing and developed parts of the world. Using a continuum of environments conceptualized as ranging from traditional to modern, the goal is to explore the hypothesis that the prevalence of depression will be higher among those living in modern compared to traditional societies. This issue is examined among samples from West Africa and North America. METHODS The subjects are 657 women who reside in four locations. An operational definition of modernization is used to place the locales as a continuum in the following order: rural Yorubaland in Nigeria, Yorubas living in urban Nigeria, rural Canada, and urban United States. Variables employed include education, religious orientation, and the role of women as mothers and workers. Depression is assessed using an algorithm based on generally acknowledged criteria. Multivariate logistic regression is used to generate point estimates and confidence intervals for prevalence odds ratios, to adjust for potential confounders, and to assess effect modification. RESULTS The prevalence of depression was lowest among rural Nigerians and highest among urban residents in the United States. The association of depression with the proposed continuum was strongest among women under the age of 45 who had living children (Odds Ratio: 2.1; 95% Confidence Interval: 1.6-2.9). CONCLUSIONS In the areas studied, a traditional way of life seems to offer protection against some of the stresses associated with modernization although it does not appear to compensate for the adversity of childlessness. Level of modernization may be a useful concept for understanding differences in rates of depression in different parts of the world.