Abstract
Rural residents in the USA experience significant disparities in mental health outcomes even though the prevalence of mental illness in rural and metropolitan areas is similar. This is a persistent problem that requires innovative approaches to resolve. Adopting and appropriately modifying the National Institute on Minority Health and Health Disparities research framework are the potential approaches to understanding how these disparities might be addressed through research. Using this research framework can facilitate interrogation of multiple levels of influence, encompassing complex domains of influence and consideration of the entire life course trajectory, which is consistent with several National Institute of Mental Health priorities.
Highlights
One-fifth of the US population live in a rural area, and about one-fifth of those living in rural areas, or about 6.5 million individuals, have a mental illness [1,2]
Though the prevalence of serious mental illness and most psychiatric disorders is similar between US adults living in rural and urban areas [3,4], adults residing in rural geographic locations receive mental health treatment less frequently and often with providers with less specialized training, when compared to those residing in metropolitan locations
The uptake of innovative approaches to mental health care has not been as consistent in rural areas as it has in metropolitan areas, exacerbating already wide differences in access and quality of care [7]
Summary
One-fifth of the US population live in a rural area, and about one-fifth of those living in rural areas, or about 6.5 million individuals, have a mental illness [1,2]. Alex’s path to wellness is affected by multiple dimensions which each likely contribute to risk of poor health outcomes, some of which may combine in a more-than-additive fashion Using this example, a researcher may focus on how domains of influence (Fig. 1) such as cultural identity (sociocultural environment/ individual influence), insurance coverage (health care system/ individual influence), and community norms (sociocultural environment/community influence) combine to exacerbate mental health disparities in rural places, and what interventions can be developed to reduce them. It is estimated that the NHSC has provided more than 1100 mental and behavioral health professionals to rural settings across the USA, and that one in three NHSC clinicians provides behavioral health care in high-need areas [17] While these efforts are laudable and help build the behavioral health safety net and service capacity for underserved populations, the outcomes are variable. While stigma related to mental disorders and seeking treatment for has been a welldocumented factor associated with rural disparities, it is especially pronounced among racial and ethnic minorities [39,40], for whom issues of cultural mistrust are high [41,42,43] and the acceptability of psychological and psychiatric forms of treatment is low [44]
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