Mental Health

Availability of primary care results in better mental health for rural residents

Each year, one in four Americans suffers from a mental disorder. Although much is known about the link between individual factors and mental illness, there is little information on how people's surroundings affect their mental health. A new study focusing on rural and urban environments has identified some striking contextual associations with mental health status. Researchers analyzed data from the 1998 Ohio Family Health Survey of households in rural and urban counties. They also examined Mental Component Summary (MCS) scores of mental health status and used multiple data sources to obtain relevant contextual data. Overall, the study looked at 6,311 individuals residing in 49 rural counties and 9,950 individuals living in 39 urban counties.

In rural areas, an increase in MCS scores (better mental health) was associated with the availability of primary care providers. Decreased MCS scores were associated with the proportion of individuals living in poverty or being unemployed, the degree of income inequality, and the proportion of female-headed households. None of these factors were associated with MCS scores in urban settings. In urban communities, an increase in MCS score was associated with average educational attainment and the availability of psychiatrists. More hospital-based psychiatric services were associated with a decrease in MCS score. Among socioeconomic variables, only the proportion of unemployed was significantly associated with MCS scores.

The association between better mental health and the number of primary care providers in rural areas may reflect the front-line role these practitioners play in mental health care. Likewise, the association between better mental health status and the number of psychiatrists in urban areas may reflect the preference of these providers to practice in the city, note the researchers. The study was supported in part by the Agency for Healthcare Research and Quality (HS00059).

See "Rural-urban comparison of contextual associations with self-reported mental health status," by Lars E. Peterson, Ph.D., Alexander C. Tsai, M.D., Ph.D., Stephen Petterson, Ph.D., and David G. Litaker, M.D. in Health & Place 15, pp. 125-132, 2009.

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