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First Author: Sucharita Mukherjee, Penn State
University College of Medicine, Class of 2014
Introduction: Mental health disorders are a
product of both genetics and environment. Distinctions between
rural and urban environments are likely to produce different
frequencies of traumatic exposures, and thus differences in the
occurrence of mental health disorders. Since rural patients are
more limited in their ability to access appropriate mental
healthcare, it is important to determine the frequency of mental
health disorders and trauma exposures across the rural-urban
continuum. It is hypothesized that the prevalence of lifetime
mental health disorders and frequency of trauma exposures will
differ by placement on the rural-urban continuum.
Methods: The National Comorbidity Survey
Replication was used to assess a range of psychiatric disorders and
related correlates among a nationally representative sample of the
U.S. population (N= 9,282). Rurality was designated using the
Department of Agriculture's 2003 rural-urban continuum codes
(RUCC), which differentiate counties into nine level of increasing
rurality by population density and proximity to metropolitan areas.
Lifetime mental health disorders examined were post-traumatic
stress disorder (PTSD), anxiety disorders, major depressive
disorder, mood disorders, impulse-control disorders, and substance
abuse. Trauma exposures were classified as war-related,
accident-related, disaster-related, interpersonal or other. Ordinal
logistic regression models were used to examine odds of lifetime
mental health disorders and trauma exposures by placement on the
rural-urban continuum, adjusted for relevant covariates.
Results: Seventy-five percent of participants
came from RUCC 1-3 (metropolitan) 12% from RUCC 4-5
(nonmetropolitan, urban population>=20,000), and 13% from RUCC
6-7 (nonmetropolitan, urban population<20,000) counties. The
most common disorder reported was any anxiety disorder (f=38.4%).
Drug abuse was more common for respondents residing in metropolitan
areas (f=8.74%, p=0.018) when compared to nonmetropolitan areas. A
one-category increase in rurality was associated with decreased
odds for war-related trauma (aOR = 0.86, 95%CI 0.78,0.95). Rurality
was not independently associated with risk for any other lifetime
mental health disorders or trauma exposure.
Conclusion: Across the rural-urban continuum,
the frequencies of lifetime mental health disorders and most trauma
exposures are similar. Rural communities suffer from a shortage of
mental healthcare resources, reflecting a relative deficit to
address the mental health needs of rural-residents.
December 2014 Issue of IMpact