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The purpose of this study was threefold: (a) to determine what percent of rural women self-report as currently depressed when asked; (b) to explore the congruence between self-report of depression and Center for Epidemiologic Studies-Depression Scale (CES-D) score; and (c) to identify factors associated with congruence between self-report of depression and CES-D score.Self-report data were collected from 140 women who lived in a rural community in the Midwest. The convenience sample was recruited at a Federally Qualified Health Center.The percent of rural women who self-reported as currently depressed was 36.4%. Congruence between self-report of depression and CES-D score was 76.8%, indicating the majority of women were able to identify if they were depressed or not. Women in the incongruent group were significantly more likely to be diagnosed with diabetes, reported more headaches, and received treatment for depression in the past.Dependence on primary care providers to identify and treat depression is the current standard of care for the vast majority of rural women. As more advanced practice registered nurses work in rural areas, they need to be cognizant of the high rates of depression in women and the most effective strategies for identifying and treating.