Rural mental health最新文献

Residents of rural areas face significant barriers to substance use disorder (SUD) treatment, including poor access, stigma, lack of confidentiality, and distrust of mental health services, which may inhibit treatment engagement. Mobile health (mHealth) approaches offer personalized, private, and easily accessible SUD treatment for rural residents, but differences in treatment mechanisms and efficacy across rural and urban regions are unknown. The present study investigates rural versus urban differences in the efficacy an mHealth SUD treatment via the theorized treatment mechanisms: protective behavioral strategies, readiness to change, and peer network health. The study leverages the results of a randomized clinical trial of an mHealth SUD treatment called Peer Network Counseling-txt (PNC-txt) conducted among a sample of young adults (age 18-25) with cannabis use disorder (CUD). We hypothesize that the impact of PNC-txt treatment on the treatment mechanisms will be stronger in rural, as compared to urban, regions, consequently leading to significantly greater reductions in cannabis use among rural residents. Results indicate that while PNC-txt reduces past 30-day cannabis use at 6 months via 1-month increases in both protective behavioral strategies and readiness to change, these indirect effects of treatment do not differ significantly between rural and urban residents. Our findings suggest that readiness to change and protective behavioral strategies are effective treatment targets for reducing the frequency of young adult cannabis use and support mHealth as an important SUD treatment approach for addressing treatment barriers in rural regions.

Rural youth face significant mental health challenges, and persistent disparities in access to services exist. Yet, there is limited research on the implementation of evidence-based practices (EBPs) for youth mental health problems in rural community mental health (CMH) centers. This study employed a rapid ethnographic assessment to explore determinants of EBP implementation in a rural CMH agency in the Pacific Northwest. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews with 11 clinic staff and completed site visits to understand the unique contextual factors influencing EBP use. Findings revealed complex challenges in rural mental health service delivery. While respondents generally viewed EBPs positively, they highlighted limitations in traditional EBP models when addressing the multifaceted needs of their high-acuity, socioeconomically disadvantaged client population. Reported barriers included staffing shortages, high clinician burnout, limited local resources, and transportation challenges. Respondents reported offering comprehensive services that extended beyond EBPs to address their clients' challenges. The rural context also significantly impacted EBP implementation, characterized by intergenerational trauma, substance use, and limited community resources. By illuminating the challenges of EBP implementation in rural settings, this research provides critical insights for developing more responsive and comprehensive approaches to supporting EBP implementation and improving rural youth mental health.

The COVID-19 pandemic worsened mental health. This study aimed to: (1) measure the prevalence of loneliness, anxiety, depression, suicidal ideation or behavior, and stress in primary care patients, and physicians, healthcare providers, and healthcare staff; and (2) measure the association of socio-demographic and employment characteristics with mental health measures. A cross-sectional survey measured the prevalence of mental health outcomes in healthcare providers and staff and primary care patients in Idaho during the COVID-19 pandemic from January 18 - July 7, 2021. Descriptive statistics and multivariate linear regression models with robust standard errors were used to assess the association between mental health measures and demographic characteristics, employment status, healthcare occupation type, financial security, and local COVID-19 hospitalizations. Each outcome was modeled separately. 3,646 participants completed the survey, including 1,687 patients and 1,959 healthcare providers and staff. Participants were 73.5% female, 92.5% White, and 6.6% Hispanic, with a mean age of 46.8 (SD: 15.6). Overall, 32.2% of patients and 29% of healthcare providers and staff reported moderate to high levels of at least one measure of mental distress. Male sex, older age, larger household size, not caring for dependents, being a healthcare provider or staff, and being financially secure were associated with better mental health conditions, with financial security being the association of largest magnitude. Understanding which sociodemographic factors were associated with disproportionate adverse mental health outcomes from COVID-19 may inform how mental health support is prioritized in future public health emergencies.

Farmers are disproportionately affected by suicide, necessitating culturally appropriate interventions. This analysis sought to identify factors related to suicides among United States farmers and farm workers from 2014-2021 and examine seasonality trends compared to those in the general population. Data from the National Violent Death Resources System (NVDRS) Restricted Access Database were used. Bivariate statistics and logistic regression investigated correlates (month, meteorological season, sex, race/ethnicity, marital status, education level, stressors, and age) predicting farmer versus nonfarmer suicides. After filtering occupation codes and death dates, 3,410 farming and 207,501 nonfarming individuals were included. In unadjusted models, farmer decedents were significantly more likely than nonfarmers to be older, male, White, and married or in a domestic partnership or civil union, with lower educational attainment. Spring and summer showed the highest prevalence of suicide among both groups. In unadjusted models, farmers were significantly more likely to have experienced a physical health problem but not more likely than nonfarmers to have experienced a financial stressor. In adjusted models, meteorological season, month of death, and physical or financial problems were not significant predictors for farmer versus nonfarmer suicide, but age, race, marital status, sex, and education level were. The peak of suicides in warmer seasons and socio-demographic differences are consistent with previous findings. Financial stressors were no different than those of the general population, suggesting farmers require coping strategies beyond financial ones. The findings provide implications for future research and public health interventions aimed at reducing farmer suicide, especially the timing.

Coordinated Specialty Care (CSC) programs for early psychosis (EP) have expanded rapidly in the United States (US) in recent years due to evidence supporting early intervention and subsequent federal funding. The majority of CSC programs are located in major urban and surrounding suburban areas, although many states are expanding or planning to expand CSC services to rural and remote areas. Despite ongoing implementation efforts, little is known about effective implementation of CSC in rural and remote communities. The present article uses the "scale out" model as a guiding framework to consider how CSC can be implemented in rural areas and describes considerations relevant to infrastructure for rural CSC: defining rurality, priority population, workforce, financing, telehealth, strengths of rural communities, culture and social determinants of health. We then discuss two overarching challenges of: a) integrating alternative bottom-up, community partnership approaches, such as community-based participatory research (CBPR), into the scale out model and b) using the scale out model for an implementation effort that is already underway. We argue that successful rural CSC implementation will involve integrating the scale out model with rigorous CBPR to incorporate theory with real-world needs and learn in real-time from ongoing implementation efforts.

This paper reports on results from a pilot study to assess the feasibility of surveying rural county fair attendees about their social well-being. We collected survey data from attendees at two Midwestern rural county fairs in the summer of 2022 (n=56). The survey included questions on loneliness, social isolation, and social engagement, as well as demographic and health characteristics. We analyzed overall rates of social well-being, as well as differences by age, among respondents from rural areas. Respondents scored 4.8 (out of 9.0) on the UCLA Loneliness Scale, below the threshold for being classified as lonely. Respondents scored 17.2 (out of 30.0) on the Lubben Social Network Scale and identified various forms of social support. The highest rates of loneliness and smallest social networks were observed among younger adults (ages 18-34; n=12), while the best social well-being was among older adults (age 65+; n=9). The most common place for respondents to socialize was a restaurant/coffee shop (60% weekly or more often), followed by private homes (31-38% weekly or more often across own or others' homes). Respondents indicated a variety of barriers to social engagement, such as work schedules for younger adults and transportation for older adults. This survey instrument was successful at illuminating various dimensions of social well-being and engagement among rural residents. The social health of younger adults in rural areas needs more attention, including addressing barriers related to work schedules and financial resources.

Objective: Rural Hispanic Veterans experience elevated suicide rates when compared to urban counterparts. Group differences remain poorly understood. This study evaluates a rurality-stratified sample of Hispanic Veterans Affairs (VA)-patients, leveraging unstructured electronic health record (EHR) data to refine population-specific suicide risk prediction metrics.

Method: The study utilized a rural and urban Hispanic VA-patient dataset, including all suicide decedents from 2015-2018 (cases). Each case was matched with four patients who shared demographics and treatment year and remained alive (controls). After extracting and preprocessing all unstructured EHR text data, the corpus was analyzed using 500+ variable semantic analysis package. Least Absolute Shrinkage and Selection Operator and Logistic Regression were used to develop prediction models and area under receiver operating characteristic curve (AUC) was used to examine models' predictive accuracy.

Results: The final datasets included 39 rural cases and 148 controls, alongside 273 urban cases and 1090 controls. The predictive models offered considerable accuracy (rural AUC = 0.86; urban AUC = 0.67). While rural models emphasized dislocation from community and communal resources, urban models emphasized alienation and identity challenges.

Conclusions: This study enhances understanding about rural and urban Hispanic suicide decedents and could inform suicide prediction and preventive services.

Veterans are at increased risk of experiencing postpartum depression yet are understudied. Environmental factors like rurality and resource richness are associated with various health outcomes, although environmental relations to mental health outcomes, such as postpartum depression (PPD), have not been explored thoroughly. The current study aimed to examine the relation between living environment utilizing two indices (Area Deprivation Index and Rural Urban Commuting Area) and postpartum depressive symptom severity in postpartum Veterans. The study sample included postpartum Veterans that were recruited for an online CBT intervention. We utilized screening data from this recruitment effort. Depressive symptom severity was measured via the Patient Health Questionnaire-9. Individual Veteran-level administrative data included age, race, ethnicity, and residential address. Linear regression was used to determine whether resource richness and rurality were associated with depressive symptom severity when adjusting for race. Black Veterans had greater depressive symptom severity than White Veterans (β = 0.12, t = 3.39, p < .001). Rural-dwelling Veterans had lower depressive symptom severity than non-rural dwelling Veterans. Resource richness was not significantly associated with depressive symptom severity. There was not a significant interaction between race and rurality. The results of this study indicate that Black postpartum Veterans enrolled in VA care experienced greater depressive symptom severity. Additionally, rural-dwelling postpartum Veterans reported lower depressive symptom severity. Many postpartum Veterans in this sample were experiencing high symptom burden. Screenings for depressive symptom severity in the postpartum period should be provided to all childbearing individuals, but among Veterans, this may be particularly important.

Increases in emergency department (ED) presentations for mental health conditions continue to challenge the national mental healthcare infrastructure, often resulting in ED boarding. However, limited prior studies capture the perspectives on mental healthcare of those experiencing prolonged boarding in the ED (≥ 24 hours stay) for mental health conditions. We aimed to assess patient perspectives on acute mental healthcare among individuals boarding in a general ED in a rural state. We performed semi-structured interviews of adults (≥18 years old) presenting with a primary mental health condition boarding in a general ED for at least 24 hours. An interview guide was developed a priori, and a trained study team performed the interviews. A thematic analysis was conducted by two independent coders. A coding tree was developed through an iterative process that included double-coding transcripts and monitoring of inter-rater reliability. Fifteen patients were interviewed to reach saturation. Ages ranged from 22 to 65. Analysis revealed several key themes including the environment of the ED, interactions with family members and staff, communication regarding the plan of care, patient perceptions of autonomy and respect, and mental healthcare services provided outside the ED. Our study revealed that adults encounter significant challenges to access timely acute mental healthcare in the ED in a rural state. Participant recommendations for improvement included increasing the availability of therapy while in the ED and providing a physical environment that is more welcoming. Community, hospital-based, and statewide quality improvement and public policy strategies should be considered to address the identified challenges.

Suicide rates are higher in rural areas of the United States, especially among veterans, and rural areas face many challenges that can affect the health of residents. This is the first known effort to identify priority areas for rural community suicide prevention among veterans from the perspective of those living in high-risk areas. Qualitative interviews (n = 28) were conducted with veterans residing in rural communities in Oregon, which were previously identified as areas with higher-than-expected suicide rates (i.e., hotspots). Veteran participants were asked questions about their experiences living in their communities, levels of community awareness of veteran suicide, and their perspectives on how to address suicide in their communities. Data were analyzed using inductive, open coding. Initial findings were discussed with two stakeholder groups, and findings were then distilled into a set of priority recommendations. Findings indicated three main recommendations for future research and programing for rural veteran suicide prevention: (a) increase capacity, accessibility, and awareness of socioeconomic resources, (b) strengthen access to person-centered health care, and (c) build a stronger sense of community cohesion. Identifying ways to enhance socioeconomic resources by supporting and expanding the currently available resources and organizations within rural communities should be further explored. Methods to increase access to care while retaining a person-centered approach may help ensure rural veterans seek care when needed. Finally, striving to support a stronger psychological sense of community among residents in rural areas should be considered important for rural community suicide prevention.