Given that public transportation networks are often worse in rural areas than in urban areas, it is difficult for elderly non-drivers to access health-promoting goods, services, and resources related to mental health. Moreover, geographical location, assessed by elevation, could modify this association in a rural area. The aim of this study was to test whether the association between car driving (being a driver or not) and depression, as measured by the Zung Self-Rating Depression Scale (SDS), varied by elevation. Data were collected from a cross-sectional study conducted in the town of Ohnan located in a rural area of Japan. After excluding participants with missing data (n = 26), 876 participants were analysed in this study. After adjustment for potential confounders, being a non-driver had a significantly higher odds ratio of SDS (40+) among elderly people living at a low elevation (odds ratio = 2.17, 95% confidence interval = 1.28–3.71). However, similar findings were not observed among elderly people living at a high elevation. These results suggest that car driving importantly predicts depression in elderly people living at relatively low elevations in rural areas.
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