Mental Health and Substance Use Prevalence, Health Service Usage, and Barriers to Care in South Dakota: Assessing Rural Behavioral Health Needs to Optimize Services

Objectives: To assess disparities in behavioral health condition prevalence and access to care in rural, urban, and reservation counties using a representative survey in a largely rural state; to use community-level data to inform policy and service development.

Methods: Cross-sectional statewide health needs assessment survey from November 2013–October 2014. Mail, phone and in-person surveys were administered to a geographically representative stratified random sample of 17,341 households with oversampling in rural counties and American Indian reservations. Measures assessed prevalence of behavioral health disorders, health service use, barriers to care, and demographic characteristics. Responses were weighted and analyzed for disparities by urban, rural, isolated, and reservation geographic clusters.

Results: We analyzed 7,678 surveys (48% response rate). Adjusted odds ratios revealed no significant geographic differences in prevalence of depression, anxiety, or PTSD; however, we found significant differences in access to care. Compared to urban areas, access to primary care providers was limited in isolated (OR 0.64, 95% CI 0.49, 0.85) and reservation (OR 0.27, 95% CI 0.20, 0.37) counties. Challenges in receiving needed medical care were also greater in reservation areas (OR 2.45, 95% CI 1.00, 6.01). Residents in isolated areas were less likely to know where to go for mental health or substance use treatment. Across the sample stigma in seeking care was high.

Conclusions: Despite simipar prevalence rates of behavioral health disorders across rural, urban, and reservation counties, non-urban areas faced greater barriers to accessing care. Policies and interventions addressing behavioral health disparities should target reservation and isolated counties.