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

Abstract

There is growing concern about the availability of health care services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health (MH) conditions in North America. Using the Preferred Reporting Items for Systematic Reveiws and Meta-Analyses guidelines, we used four electronic databases (Pubmed, Cochrane, APA PsycInfo, 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 nonrural 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), posttraumatic stress disorder (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 11 (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 alternative to impact these outcomes.

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