Rural-Urban Differences in Community Participation, Sense of Community and Perceptions of the Built Environment among Individuals with Psychiatric Disabilities

Introduction: There is a lack of research on urban-rural differences in community participation – which multiple studies have found to be predictive of positive health outcomes – and perceptions of the social and built environment, among individuals with psychiatric disabilities (PD). Methods: 209 individuals with PD receiving services at ten community mental health centers throughout the USA have completed questionnaires on their community participation, sense of community and perceptions of the built environment. Of the 209 individuals, 155 were living in urban counties (U.S. Department of Agriculture’s Rural Urban Continuum Code (RUCC) equal to 1 or 2) and the remaining 54 were living in suburban or rural counties (RUCC = 3 or higher). Independent samples t-tests were conducted to examine whether individuals living in urban counties had higher community participation, sense of community and perceptions of the built environment than their suburban and rural counterparts. Results: Even though data collection is ongoing until May 2015, preliminary results have shown that individuals in urban locations reported significantly higher sense of community and greater perceptions of the physical quality of their environments (e.g., presence of sidewalks and ease of transportation access) compared to participants in rural locations.  However, participants in urban locations did not report significantly higher levels of community participation behaviors compared to individuals in rural locations, suggesting that urban dwellers' positive attitudes about their environments did not necessarily increase their utilization of those environments. Implications: The findings suggest the need to consider other individual- and environment-level factors that may explain the lack of differences in participation between urban and rural environments, including psychiatric symptom distress and perceptions of safety. Post hoc analyses will attempt to identify and discuss some of these factors.