Mental Health Treatment for Rural Poor and Minorities
National Institute of Mental Health
MH65709
Principal Investigator:
Emily J. Hauenstein, PhD, LCP, MSN, RN, Thomas A. Saunders, III, Family Professor of Nursing,
Director of Southeastern Rural Mental Health Research Center
Phone: 434-924-0093 – E-mail: ejh7m@virginia.edu
McLeod Hall Box 800782
Charlottesville, Virginia 22908-0782
March 2006
Introduction
The Mental Health Treatment for Rural Poor and Minorities research grant, funded by the National Institute of Mental Health (MH65709) examines disparities in mental health treatment experienced by rural residents, with specific emphasis on the rural poor and members of racial and ethnic minorities
Headed by the Principal Investigator, Emily J. Hauenstein, PHD, LCP, MSN, RN, Professor of Nursing and Director of the Southeastern Rural Mental Health Research Center, University of Virginia, the research team (see Faculty) have completed analyses of urban-rural disparities in any type of mental health treatment, and mental health specialty care by residence, gender and race, and by access to treatment.
The sources of data for this research are the Medical Expenditure Panel Survey 1996-1999, the National Health Interview Survey 1995-1998, and the Area Resource File.
Understanding Rurality
Rurality is defined using the Rural-Urban Continuum Codes (RUCC) developed by the Department of Agriculture (Butler & Beale, 1994).
This ordinal scale groups all counties in the United States into 9 categories according to three criteria: absolute population size, population dispersion, and physical proximity to Metropolitan Statistical Areas (MSAs) (1 being most urban and 9 least—Table 1 below).
In our papers we use these codes in two ways. Whenever possible we use all 9 codes to describe our samples. When comparing specific rural sub-populations and when conducting multivariate logistic analyses the 9 RUCC categories were further divided into three distinct groups of counties: metropolitan or MSA, least rural Non-MSA, and most rural Non-MSA. The research sample included 26,567 respondents reside in MSA counties, 4,691 in least rural Non-MSA counties, and 2,447 in most rural Non-MSA counties.
Table 1: Rural-Urban Continuum Codes
| Codes | Description |
| Metropolitan Counties (MSA) | |
| 1 | Counties in metropolitan areas with a population of 1 million or more |
| 2 | Counties in metropolitan areas with a population of 250,000 to 1 million |
| 3 | Counties in metropolitan areas with a population of less than 250,000 |
| Nonmetropolitan Counties (Non-MSA) | |
| Least rural | |
| 4 | Urban population of 20,000 or more, adjacent to a metro area |
| 5 | Urban population of 20,000 or more, not adjacent to a metro area |
| 6 | Urban population of 2,500 to 19,999, adjacent to a metro area |
| Most Rural | |
| 7 | Urban population of 2,500 to 19,999, not adjacent to a metro area |
| 8 | Completely rural or with an urban population of less than 2,500 adjacent to a metro area |
| 9 | Completely rural or with an urban population of less than 2,500 not adjacent to a metro area |
Butler MA, Beale CL. Rural–urban continuum codes for metro and nonmetro counties, 1993. Washington, D.C.: U.S. Department of Agriculture, Economic Research Service.
Major Findings
The findings of our research clearly point to different rates and patterns of mental health treatment for residents of remote rural areas when compared with urban areas.
Overall Urban-Rural Observations
- Rural residents are more likely to be poor, unemployed and uninsured when compared to residents of metropolitan areas.
- Persons in the most rural areas are about half as likely as persons in metropolitan areas to be enrolled in a managed care plan (21.6% compared to 42.3%).
- Fewer rural residents report “very good” or “excellent” mental health when compared to urban dwellers.
- Residents of metropolitan areas are 1.5 times more likely to receive mental health treatment than are those living in rural areas with a population of 2,500 residents or less.
- Residents of metropolitan areas are more likely to characterize their mental health treatment as “psychotherapy/mental health counseling” than are residents of rural areas.
Gender-Specific Findings
- While women obtain more mental health treatment than men, urban women are 1.5 times more likely to receive mental health treatment when compared to women living in the most remote rural areas.
- Urban men are almost twice more likely to obtain specialty mental health treatment than are men from the most remote rural areas.
- Both rural men and women receive more mental health treatment than urban residents when they also report that they are experiencing a marital separation.
Racial/Ethnic Findings
- There are no rural-urban differences in rates of treatment for African Americans or Mexican Americans. Overall, members of these ethnic groups receive less mental health treatment than do non-Hispanic whites, but in rural areas that disparity does not exist.
- Rural-urban disparities in mental health treatment can be largely attributed to less treatment of rural non-Hispanic whites when compared to urban non-Hispanic whites.
Other
- Unlike urban dwellers, rural residents who report poor physical health are nearly 3.6 times more likely to obtain mental health treatment than are those who report excellent physical health.
Publications
- Hauenstein EJ, Petterson S, Merwin E, Rovnyak V, Heise B, Wagner D. Rurality and mental health treatment. Administration and Policy in Mental Health and Mental Health Services Research, 1-13.
- Hauenstein EJ, Petterson S, Merwin E, Rovnyak V, Heise B, Wagner D. Gender, rurality, and mental health treatment. Family and Community Health. 2006;29(3):169-185.
- Hauenstein, E. J. & Peddada, S. Prevalence of major depressive disorder in rural women using primary care. Journal of Health Care for the Poor and Underserved. 2007:18(1): 185-202.
Manuscripts Under Review
- Petterson, S., Hauenstein, E.J., Rovnyak, V., Merwin, E., Wagner, D. Racial and Ethnic Disparities in Rural Mental Health Treatment.
Manuscripts in Progress
- Defining Rurality: Effects on Mental Health Treatment Rates
- Characteristics of Mental Health Visits in Rural Areas
- Rurality and Access to Care for Mental Health Treatment
- Area Poverty, Access to Care and Mental Health Treatment in Rural Areas
- Mental Health Treatment and Co-morbidity across Levels of Rurality: Different Pathways to Care
Faculty
Emily J. Hauenstein, PhD, LCP, RN, Principal Investigator, Thomas A. Saunders III, Family Professor, University of Virginia School of Nursing and Director, Southeastern Rural Mental Health Research Center
Elizabeth Merwin, PhD, RN, FAAN, Associate Dean for Research and Madge Jones Professor of Nursing, University of Virginia School of Nursing and Director, Rural Health Care Research Center
Douglas Wagner, PhD, Professor, Public Health Sciences Administration, University of Virginia School of Medicine
Stephen Petterson, PhD, Senior Researcher American Academy of Family Physicians, Washington, D.C.
Virginia Rovnyak, PhD, Senior Research Scientist, University of Virginia School of Nursing
Sharon Topping, PhD, Professor of Management, The University of Southern Mississippi
Ishan Williams, PhD, Research Assistant Professor, University of Virginia,School of Nursing
Guofen Yan, PhD, Assistant Professor, Public Health Sciences Administration, University of Virginia School of Medicine
CONTACT US
University of Virginia School of Nursing
Box 800782, Charlottesville, VA 22908
nursing.virginia.edu
Kathryn McEldowney
Administrative Assistant
Mental Health Treatment for Rural, Poor and Minorities
434-924-1982 or kwm8n@Virginia.edu
Principal Investigator, Thomas A. Saunders, III Family Professor of Nursing and Director, Southeastern Rural Mental Health Research Center
434-924-0093 or ejh7m@virginia.edu