P ostpartum depression is an internationally recognized health concern for women and their families. Depression during the perinatal period is associated with serious negative consequences for both mother and baby, particularly if the depression is untreated.1 Outcomes among women include impaired functioning, poor quality of life and death.2 Outcomes for infants include developmental delay, poor growth, malnutrition and illness.3-5 Numerous risk factors for postpartum depression have been identified; low levels of social support and history of depression are among the variables most consistently associated with postpartum depression.6-8 However, previous reports are inconsistent as to whether geographical size or location is associated with the risk of postpartum depression. 9 In Canada, about 30% of the population lives in rural or remote areas, a large proportion live in several large urban areas, and the remainder live in smaller urban settings. 10 To design appropriate supports and services for the prevention and treatment of postpartum depression among Canadian women, it is important to identify and target geographical variation in the risk of postpartum depression.Our primary objective was to compare the risk of postpartum depression among Canadian women living in rural and urban areas. Our secondary objective was to identify factors that could explain any associations between place of residence and risk of postpartum depression. We used multiple definitions of rural and urban locations to more accurately reflect differences between communities and to account for the level of social and occupational connectivity of smaller areas to more urban areas. Methods Study designWe used a population-based Canadian survey of women who had recently given birth (the Mater- The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women. Relation between place of residence and postpartum depression