Background: There is a lack of literature specific to depression in the rural smoking population. The effect of smoking on the fetus and mother combined with the challenges posed by underlying depression make this issue complex and necessary to investigate. In addition, strengths and challenges specific to the rural population need to be considered, but have not been addressed in previous studies.
Purpose: The purpose of this review was to identify the current status of research on the topic of the relationship between smoking status, rurality, and depression in the pregnant population.
Methodology: An integrative review of the literature was conducted using the terms pregnancy, depression, smoking, and rural. Nursing and psychology domains were accessed as well as the Cochrane library. Within the Nursing domain, twelve articles were identified for review. One hundred fifty articles were found within the psychology domain. A search of the Cochrane library yielded one thousand thirty one articles. Inclusion of all four key terms was a criterion for review. Titles and abstracts were reviewed for relevance. Dissertations and opinion papers were excluded.
Results: Twelve articles within the nursing domain were reviewed and did not include all four key terms. Of the one hundred and fifty articles noted in the psychology domain, none contained all four of the key terms. Lastly, no articles stemming from the Cochrane library search addressed all key terms. Aspects such as depression management and depressive disorders were predominant. A total of four articles were deemed appropriate for inclusion. All of these articles stemmed from the nursing domain search. None of the analyzed articles used a theory, model, or conceptual framework to guide their research. Of the four articles, only one was experimental. While rural was defined specifically according to Butler and Beale’s criteria of metropolitan vs. nonmetropolitan in one article, it was not clearly defined in one article that was published in a rural nursing journal. The studies reviewed spanned a large segment of rural populations with samples drawn from various countries around the world.
Conclusions: There is a dearth of research in the area of depression in the rural pregnant smoker. Of the research located, there is limited definition of rural, no use of a theory, and no incorporation of concepts inherent to the rural population. In order to conduct a comprehensive study of this population, efforts must be made to address these concepts via information gathering, study design, and/or implementation processes. Research focusing on these areas will lend a truly holistic view of the topic.
Key Words: Pregnancy, smoking, depression, rural.
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