Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Wayne Sanderson, MS, CIH, Ph.D.

Committee Member

Erin Abner, Ph.D.

Committee Member

David Mannino, MD



High rates of depression are widespread globally and are among the leading causes of disability. To better understand the effects of depression on health outcomes, more research is necessary. This study examines the associations between depression and adverse respiratory outcomes among a cohort of Iowa residents living in a rural county. This study also investigates differences in the reporting of chronic and incident respiratory outcomes.


Data were obtained from the Keokuk County Rural Health Study (1994-2004) for individuals 18 years of age or older (N=1012). The primary outcome, poor respiratory health (PRH), was based on self-reported diagnoses for emphysema, bronchitis, asthma, a clinical spirometry test, and self-reported persistent cough, phlegm, or wheezing. Covariates included depression, age, gender, education, employment status, marital status, farming status, residence location, smoking status, alcohol use, and stressful events. The associations between reporting PRH and these covariates were determined by performing logistic regressions.


This study showed that 31.9% of individuals in Round 1 and 33.9% of individuals in Round 2 reported depression, and 37.3% of individuals in Round 1 and 39.9% of individuals in Round 2 reported PRH. Significant predictors (p<0.05) of incident PRH in our model were gender, age, employment, and smoking. Significant predictors of chronic PRH in our model were age, education, and residence.


The prevalence of depression and PRH among participants is considerably higher than what has been found previously among adults in the United States. We found depression to be significantly lower among current farmers at baseline compared to individuals who had never farmed. Rural residence was associated with increased odds of chronic PRH. Further studies should examine the temporal relationship between depression and PRH in the context of employment status and occupational exposures.

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