Hauenstein E, Petterson S, Wagner D, Rovnyak V, Merwin E, Heise B; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 3054.
University of Virginia, School of Nursing, PO Box 800782, Charlottesville, VA 22908 Tel. 434-924-0093 Fax 434-982-1809
RESEARCH OBJECTIVE: To assess urban-rural differences in mental health treatment rates and pathways to care among non-elderly adults using a refined measure of rurality. STUDY DESIGN: We use data from the Medical Expenditure Panel Survey (MEPS) to examine the relationship between rurality and mental health treatment. We exploit the longitudinal design of the MEPS to examine treatment over four-month intervals subsequent to interviews, using up to three observation periods per respondent. Three measures of mental health treatment are examined: any medical visit related to a mental health condition, visits associated with specialized care and the number of visits in the observation period. We use the Urban-Rural Continuum as an ordinal measure of rurality, which classifies metropolitan counties on the basis of the size of the metropolitan area and nonmetropolitan counties on the basis of their urbanization and their adjacency to metropolitan areas. Binary logistic and linear regression analyses are performed to estimate differences in mental health treatment, adjusting for demographic, need, and access variables. Variance estimation is based on the clustered survey design of the MEPS; the weights and design variables take multiple observations of an individual into account. POPULATION STUDIED: The sample consists of adults aged 18 to 64 in the first four panels of the MEPS, covering a period from 1996 to 2000. The MEPS is a large nationally-representative panel survey of households designed to provide estimates of the use of health services, medical expenditures and sources of payment. The sample size is 34,801 respondents, yielding 100,339 person-interview observations. Of these respondents, 10% reside in the three most rural types of counties on the urban-rural continuum. PRINCIPAL FINDINGS: Rural residents are significantly less likely to obtain mental health treatment, especially specialized treatment, than urban residents despite evidence of greater need among rural residents. These disparities persist after controlling for measures of reported mental health, age, marital status, region, schooling, income, and insured status. Other things being equal, the odds of any type of mental health treatment for an urban person were 35% greater than the odds for a rural person; the odds of receiving mental health specialty care were 37% greater for urban residents than rural residents. By contrast, there are no substantial urban-rural differences in the number of visits for the subset of respondents with at least one visit. Our results also suggest different pathways to care. In particular, the association between reported mental health and receipt of treatment is stronger in more urbanized areas, while the association between reported physical health and treatment is stronger in more rural areas. CONCLUSIONS: Limited access to mental health services and other characteristics of rural areas reduces the rural population's receipt of mental health visits, despite higher needs. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Residents living in rural counties may have unique problems that put them at greater risk for mental health problems. Inadequate services and mental health delivery mechanisms may heighten that risk by reducing overall access to treatment.
Publication Types:
Keywords:
- Adult
- Aged
- Delivery of Health Care
- Demography
- Family Characteristics
- Geography
- Health Expenditures
- Health Services Needs and Demand
- Humans
- Interviews as Topic
- Mental Disorders
- Mental Health Services
- Psychotherapy
- Rural Population
- Social Environment
- economics
- hsrmtgs
UI: 103622517
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