Rurality and Mental Health

Background: Despite the concern that rural residents may be at greater risk of mental health problems, national research has not been able to thoroughly study rural-urban disparities in mental health. This research examines whether rurality relates to poor mental health.

Methods: Data came from the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 354,591 adults aged 18 to 64 from 2007 BRFSS and 38,855 adults from 2008 BRFSS. Outcomes included K6 measures of nonspecific psychological distress, binary indicators for serious mental illness and frequent mental distress, mentally unhealthy days, and PHQ-8 measure of current depression. We estimated multivariate linear regression, logit and count data models based on the distribution of outcome variables. Our main independent variables were rural and non-metropolitan urban residence. Metropolitan residence served as a reference category. The residence variables were constructed using a rural-urban continuum classification scheme developed by the U.S. Department of Agriculture. To isolate the independent effect of rural and urban residence, we controlled for comprehensive demographic and socio-economic factors. All models were adjusted for the complex survey design of BRFSS.

Results: Compared to residents in metropolitan and rural areas, non-metropolitan urban residents were significantly more likely to experience psychological distress (p < 0.05), serious mental illness (p < 0.001), and mentally unhealthy days (p < 0.001). The degree of current depression was found to increase with rurality. However, this relationship was statistically insignificant.

Conclusion: Non-metropolitan urban residents are more likely to have mental health problems than metropolitan and rural residents.