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Winning Abstracts from the 2014 Medical Student Abstract Competition: The Prevalence and Correlates of Lifetime Mental Disorders and Trauma Exposures in Urban and Rural Settings: Results from the National Comorbidity Survey Replication (NCS-R)

Winning Abstracts from the 2014 Medical Student Abstract Competition: The Prevalence and Correlates of Lifetime Mental Disorders and Trauma Exposures in Urban and Rural Settings: Results from the National Comorbidity Survey Replication (NCS-R)

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.

Back to December 2014 Issue of IMpact

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