Purpose The purpose of this study was to estimate the prevalence of physical and emotional intimate partner violence (IPV) perpetration and victimization among adult, cohabitating couples. The association between IPV and depressive symptoms, as well as the severity of depressive symptoms, was reported for both males and females. Methods In a rural cohort study, 548 couples completed survey items concerning physical and emotional IPV, and mental health. Findings Males and females who perpetrated physical IPV were 17.7 and 11.5 times more likely, respectively, to also be victims of physical IPV. Male and female perpetrators of emotional IPV were 18.7 and 5.2 times as likely, respectively, to also be victims of emotional IPV. Males and females with IPV histories were 3.0 and 2.4 times more likely, respectively, to have depressive symptoms (P < .001) than those without abuse histories. Females reported higher scores than males on the depressive symptoms index. Conclusions This study suggests that many couples in rural areas use physical and emotional violence against each other in their relationships, and that both males and females who report a history of IPV are more likely to report depressive symptoms. These findings support IPV screening for physical and emotional violence among all patients and providing follow‐up intervention programs in health care settings.