Urban-rural differences in the prevalence of mental health problems: An explanation for discrepant findings

There is a substantial level of inconsistency in the mental health literature regarding whether mental health problems such as anxiety and mood disorders are more prevalent in urban or rural areas. Several large-scale studies in Australia, the UK and US have suggested that mental health problems are similarly prevalent in both types of areas, and this view seems to have some general consensus in the field. However, there are several recent studies that either suggest that there are significant differences in problem prevalence (e.g., with mental health problems in general being more prevalent in urban areas), or at least there is a difference in the types of problems that exist in each type of area (e.g., greater prevalence of social phobia in rural areas). In this presentation, a model is presented to attempt to explain why many studies have failed to identify differences in problem prevalence between urban and rural areas. The underlying rationale is that by adding a third population density, one can more clearly see mental health trends; in particular, the presenters argue that inconsistencies in what constitutes a “rural” area have masked differences in the prevalence of certain types of problems—most notably anxiety, substance abuse, and domestic violence. The model will show data from Idaho mental health providers that suggest that if differentiations are made between “rural” and “frontier” (or “super-rural”) areas, differences in the prevalence of mental health problems may be more easily recognized. The policy implications of this finding are discussed.