Behavioral Health Problems Presented to Integrated Pediatric Behavioral Health Clinics: Differences in Urban and Rural Patients

Abstract

Behavioral health diagnoses and service use may differ based on rurality. The purpose of this study was to examine the patterns of mental disorder diagnoses of urban, rural, and remote pediatric populations. This retrospective study used electronic medical records from integrated behavioral health clinics in Nebraska from 2012 to 2013. Bivariate and multivariable models were used to examine the differences in diagnoses. Adolescents with attention deficit and related disorders were more likely to be male, younger, have public insurance and rural/remote residents. Adjustment disorders were associated with being female, older, and urban residents. Adolescents with anxiety disorder had a significant interaction between age and gender, with both genders being older, having private insurance, and urban residents. Adolescents with mood disorder were more likely to be female, older, and urban residents. Demographic and clinical differences among patients in urban and rural/remote settings have implications for care in rural settings.

Socioenvironmental drivers of adolescent suicide in the United States: A scoping review.

“…Experiencing discrimination was associated with greater depressive symptoms, and living in a disadvantaged neighborhood was associated with an increased risk for anxiety among minority adolescents (Lopez et al, 2016). In more extensive statewide studies, specific internalizing conditions, such as anxiety, depression, and major affective disorder, were common among older and female adolescents (Watanabe-Galloway et al, 2017). Conditions like substance abuse, bullying, and a previous history of suicide ideation were notable mental health risk factors and are described in further detail below.…”

“…Adolescents with attention deficit disorder (ADD) were more likely to come from a rural background. In contrast, adolescents with adjustment, mood, and anxiety disorders predominantly occurred in urban areas (Watanabe-Galloway et al, 2017). This urban–rural disparity in mood disorder trends may occur because urban adolescents are two times more likely to be screened for a mood disorder than their rural counterparts (Sekhar et al, 2019).…”

Health disparities among rural individuals with mental health conditions: A systematic literature review.

“…The methods of classification of rurality were diverse; however, most studies used some variation of a classification system developed for use by national governmental agencies. For example, five of the studies defined rurality by comparing the zip code of residence to a U.S. government rural designation developed by either the U.S. Census Bureau, U.S. Department of Agriculture (USDA), or U.S. Veterans Health Administration (VHA; Abel et al, 2018; Brooks, 2012; Elhai et al, 2004; McCarthy et al, 2012; Watanabe-Galloway et al, 2017). Three studies used the U.S. Census Bureau County level statistics to determine urban/rural areas, and Parikh et al used an assignment for rurality based upon Statistics Canada guidelines for rural strata within Ontario’s 42 Public Health Units.…”

“…Disparities based on race and other demographic factors were measured in six of the included studies (35.2%; Lehman et al, 1998; McCarthy et al, 2012; NAMI, n.d.; Onoye et al, 2013; Rost et al, 2011; Weaver, Himle, et al, 2015). Watanabe-Galloway measured differences by rurality and baseline demographics and reported that the percentage of patients covered by Medicaid was highest in rural children (Watanabe-Galloway et al, 2017). Brooks found that rural women veterans were less likely to present to the Veterans Affairs *VA) for women’s specific care and mental health care than urban women (Brooks, 2012).…”

“…HEALTH DISPARITIES AMONG RURAL INDIVIDUALS 2015). Watanabe-Galloway measured differences by rurality and baseline demographics and reported that the percentage of patients covered by Medicaid was highest in rural children (Watanabe-Galloway et al, 2017). Brooks found that rural women veterans were less likely to present to the Veterans Affairs * VA) for women's specific care and mental health care than urban women (Brooks, 2012).…”