Rural mental health最新文献

Firearms are the leading cause of death for youth in the US. Safe firearm storage is an evidence-based risk reduction technique, yet many families with children maintain unsecured firearms. In rural areas where gun ownership is common and rates of firearm-related suicides are increasing, developing culturally acceptable and feasible safe storage prevention strategies may have promise for reducing morbidity and mortality. This pilot study used a community-based participatory approach to develop a culturally tailored multi-component online safe storage preventive intervention called Store Safely. Participants were 45 rural firearm owning parents representing 45 unique families (35% male, 65% female, M age = 37.88, SD = 6.14) who had at least one child living at home. Acceptability, feasibility, and preliminary impact on firearm storage behaviors were measured via pre-test and post-test self-report surveys. Of the 43 parents (43 families) retained at follow-up, 97.7% completed the intervention and 86% utilized a home safety checklist. 40% of participants reported improving their storage, offering examples such as purchasing gun locks, safes, or lockboxes; separating ammunition from weapons; reviewing or discussing the safety of current storage; and relocating firearms to reduce child access. 84% found the website culturally sensitive and would recommend the materials to other parents. This firearm safe storage preventive intervention, developed in partnership with a rural community and tailored to reflect community norms and values, was associated with high levels of parental acceptability, engagement, and behaviors in support of safe firearm storage, suggesting its promise as a firearm injury prevention strategy.

Suicide is a pressing public health concern. Identifying risk factors and understanding their interplay is vital for effective prevention and intervention. This study examined the association of alcohol misuse, veteran status, and urbanization on suicide risk among U.S. adults. Using data from the 2015-2020 National Survey on Drug Use and Health (NSDUH), a cross-sectional analysis was conducted on a representative sample of U.S. adults. To determine overall risk for suicide, adjusted odds ratios were calculated through multivariable adjusted multinomial logistic regression. The study utilized self-report survey data collected from noninstitutionalized U.S. population. The NSDUH utilized a stratified multistage probability sampling method to ensure representative data collection. Suicide risk did not differ significantly between urban and rural areas. Heavy drinking increased risk for suicide ideation and attempts among urban veterans and nonveterans. Binge drinking had a positive association with suicide ideation in urban nonveterans. In rural areas, alcohol misuse did not significantly influence suicide risk among veterans. Alcohol misuse is a significant risk factor for suicide among both veterans and nonveterans in urban settings. Tailored suicide prevention strategies that account for urbanization and veteran status are critically needed.

Research suggests that farmer suicide rates are at least two-fold higher than the general population. In estimating rates, prior research considered suicide events among farmers together with farmworkers, fishing, and forestry occupations and included non-farming populations in the defined at-risk populations (i.e., denominators). In this study, we sought to define and differentiate farmer suicide decedents from other agricultural occupations, estimate U.S. farmer suicide rates, and evaluate rate time trends. Farmer suicide decedents were ascertained from the 36 states in the National Violent Death Reporting System (NVDRS) from 2003-2017 using NVDRS occupation data. Farmers were defined as persons responsible for day-to-day farm decisions and operations. An expert panel was convened to classify farmer occupations. Rates were calculated using Census of Agriculture-identified farmers as the rate denominator, and time trends were evaluated using regression. Due to a low number of female decedents, female farmer suicide rates were not estimated. We identified1,575 male farmer suicide decedents and 77 female farmer decedents from the NVDRS during the study period. Aggregated age-specific male farmer suicide rates were highest among farmers ages 65 years and older (22.0/100,000). Estimated suicide rates for male farmers were highest during 2003 (31.8/100,000) and lowest during 2005 (19.2/100,000). Trend analysis revealed a statistically significant 2.4% annual percent change (APC) in rates over the 15-year study period. Suicide rates among male farmers showed evidence of an increase from 2003-2017. Farmer suicide rates parallel the rates of the U.S. population; thus, farmer suicide remains a public health concern.

There is growing concern about the availability of healthcare services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health conditions in North America. Using PRISMA guidelines, we used four electronic databases (Pubmed, Cochrane, PsychInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus non-rural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle Ottawa Scale was used. Our initial search returned 491 studies and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), PTSD (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities while eleven (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in person outreach to these rural communities may be alternatives to impact these outcomes.

Mental illness and suicide are significant public health problems. Limited resources put individuals at greater risk, particularly in rural areas with fewer health providers. Community pharmacists are the most accessible health professionals in rural communities and are interested in addressing mental health concerns. Research is limited on how to implement mental health interventions in community pharmacy settings. The objectives of this study were to assess community pharmacists' perceptions of mental health interventions and barriers and facilitators to implementation and prioritize interventions to be pilot tested. Qualitative interviews were conducted with community pharmacists (N=17). Interviews focused on perceptions of mental health interventions in pharmacy settings. Data were analyzed using template analysis. A stakeholder meeting reviewed data and prioritized interventions to be pilot tested. Pharmacists viewed implementing mental health interventions positively. Barriers included lack of mental health knowledge, time, diagnosis, and concerns about workflow. Facilitators included accessible settings, knowing the community, and seeing patients frequently. The most common needs for implementation were education and payment. Pharmacists preferred progress monitoring in collaboration with a prescriber and mental health first aid training. Further research is needed to gather feedback from prescribers to inform implementation.

Appalachia is uniquely impacted by healthcare disparities. Outpatient dropout rates remain a significant barrier for individuals necessitating specialty eating disorder (ED) treatment. We explored factors impacting patient continuation in specialty outpatient care for EDs. Participants (N=138; 89.9% female) were patients with EDs attending specialty outpatient treatment in a geographically isolated, under-resourced Appalachian community. Patient dropout rate was 26.8%. Dropout rates did not significantly differ across any sociocultural factors except patient age and BMI; patients who discontinued were older and had higher BMIs at intake, perhaps due to longer duration of illness or treatment-related misconceptions. Implications and future directions are discussed.

Immigration worksite raids-in which dozens to hundreds of individuals are detained-often target food processing plants or other warehouse-based operations, primary sources of employment for immigrants in rural communities. Drawing on interviews with 77 adults who provided support following six worksite raids, we describe three challenges to identifying resultant mental health impacts: 1) amid poverty and family disappearance, mental health is not the priority; 2) untrained practitioners misidentify signs of declining mental health; and 3) mental health care is linguistically limited, expensive, and inaccessible to working families. We end by discussing how practitioners and advocates can address these challenges.

This pilot study examined associations between prenatal individual and socioenvironmental determinants of health and symptoms of perinatal maternal distress (PMD) in women enrolled in midwifery practice and living in a rural state. Pearson's correlations between prenatal predictors and PMD scores were calculated. Having experienced emotional abuse in one's lifetime, total number of past year stressors, and everyday discrimination score were all statistically significant predictors of PMD at study enrollment and follow-up. Result suggest shifting to a multi-symptom, life course assessment and intervention paradigm, tailored to the context of specific populations, may improve perinatal care and reduce disparities.

Poor access to care has made western North Carolina vulnerable to an outbreak of hepatitis C viral infection (HCV), particularly among persons who inject drugs (PWID). As substance use disorder (SUD) treatment providers could potentially improve linkage to HCV testing and treatment, we sought to understand SUD providers, clinic and client characteristics; referral patterns; HCV knowledge; willingness to participate in additional trainings; and local linkage-to-care pathways for treatment of substance use and HCV. Online survey data were collected from 78 SUD providers serving PWID in eight western rural North Carolina counties. Providers' attitudes toward working with HCV+ clients were very positive. One-third of providers reported a low fund of knowledge regarding HCV, HCV treatment, and financial assistance opportunities. Non-prescribing providers rarely initiated discussions about HCV testing/treatment, but were receptive to training. Respondents indicated that HCV testing and treatment were best delivered at local health departments or primary care clinics but were open to other venues where PWID access care. The vast majority of prescribing and non-prescribing providers expressed interest in obtaining training in HCV treatments, how to obtain HCV medications and topics on advanced liver disease. Data from prescribing and non-prescribing SUD providers suggest opportunities to develop or expand integrated care models for HCV testing/treatment in PWID in rural Appalachian North Carolina.

The Migrant Farmworker Stress Inventory (MFWSI) was developed to measure the distinct stressors faced by migrant farmworkers. The most appropriate measurement and factor structure, however, has been primarily examined with exploratory methods with no studies of confirmatory factor analyses to date. The current study built on prior exploratory factor analytic approaches using the MFWSI by applying confirmatory factor analyses and other tests of validity to better delineate the component parts of migrant farmworker stress that contribute to anxiety and depression. Participants were 241 Latino migrant farmworkers recruited from rural farmworker campsites in Nebraska. Neither of the previously identified factor structures fit the data well initially. Following model respecification, only three factors remained from the original exploratory approaches. These models produced both common and unique factors, which were combined to produce a four-factor model. Results suggest that rural migrant farmworker stress may operate with at least four distinct domains: 1) economic difficulties, 2) immigration and legal status, 3) parenting and child difficulties, and 4) social isolation and related challenges. Finally, only economic difficulties predicted depression and anxiety scores, such that those reporting more stress around economic difficulties reported higher depression and anxiety symptoms. Results point to the need for additional measurement and construct refinement to inform empirical, clinical, policy, and social advocacy work.