Supporting better mental health services for rural Australians: Secondary analysis from the Australian National Social Survey.

Abstract

People with mental illness experience poorer physical health, less access to physical health care and live shorter lives compared to the general population.1 Managing physical health issues along with mental illness can be difficult, especially for those living in rural locations, given that access to mental health services diminishes as remoteness increases.2 Bridging health service disparities between regional and urban localities must be a national imperative since people with mental illness in rural areas have higher rates of early mortality due to physical illness.3 The aim of the present study was to offer additional evidence for bridging this gap by comparing the prevalence of co-morbid mental and physical illness between urban and rural areas. Participants in the Australian National Social Survey (n = 1265) self-reported demographic, quality of life, chronic disease and health behaviour characteristics. Dichotomous (Yes/No) self-reported chronic disease status including being told by a doctor, they have depression and/or anxiety was recorded. Urban and rural classifications were based on self-report. In this secondary analysis, Chi-square and independent samples t tests were conducted to test differences in proportion of respondents with self-reported depression and/or anxiety in urban and rural areas with co-morbid physical conditions, and the number of co-morbid physical conditions, respectively. Statistical significance was accepted where P < 0.05. Participant characteristics are shown in Table 1. Depression and/or anxiety was reported by n = 216 respondents. Urban residents comprised 74% (n = 159) of the sample. Co-morbid physical illness was reported in n = 109 (69%) and n = 45 (79%) urban and rural residents, respectively (χ2 = 2.215, df = 1, P > .05). Those in urban and rural areas reported 1.6 ± 1.7 (range: 0-9) and 2.1 ± 1.8 (range: 0-7) co-morbid chronic conditions, respectively (t = −1.848, df = 214, P > .05). Participants provided informed consent, and the study was approved by Central Queensland University's Human Research Ethics Committee (Approval No: H14/09-203). There was no difference in the prevalence of at least one other co-morbid chronic condition between people with self-reported depression and/or anxiety who resided in urban versus rural areas. Acknowledging limitations of self-reporting health status, small sample size, and potential confounders such as age, this is a novel finding. Although the prevalence of psychological distress is similar between rural and urban areas, people with mental illness in rural areas have more than 300% greater risk of premature death due to co-morbid physical health conditions, compared to their urban counterparts.3 In part, this can be explained by the reduced access and more barriers to mental health services for people living in rural areas compared to than people living in urban areas.4 Given the common prevalence of co-morbidity, our findings argue strongly for better access to health care services in rural areas that address mental health care but with capacity and capability to address physical health care to reduce disease burden in these communities. Telehealth services may reduce this disparity, but service location remains “urban-centric.” One potential solution may be to develop and implementation multi-skilled practitioners who can provide mental and physical health services simultaneously. Achieving this requires efforts directed at funding, attracting, and retaining medical and allied health professionals to rural communities, especially those who come from and feel connected with rural communities. Recently, the Federal Government announced the Stronger Rural Health Strategy aimed at addressing the higher disease burden and risk of early mortality faced by those in rural areas. However, this strategy has been criticised as being overly focussed on medical professionals, with a relative absence of attention to allied health professionals.5 Together with limited funding for rural health promotion, rural residents may be worse off, thereby widening, rather than bridging, the current disparity in health service provision. Clearly, more needs to be done to develop and support the rural workforce to help communities in need and achieve health service parity with metropolitan areas. The authors have no conflicts of interest to declare.