Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

Abstract

Background The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. Methods Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. Results A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). Conclusions Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

Genetic and Psychosocial Risk Factors Associated with Suicide Among Community Veterans: Implications for Screening, Treatment and Precision Medicine

“…Other variables in the study included demographic and military factors (eg, age, gender, race, rural residence, warzone deployments, and combat exposure), which were derived from the survey instrument or US Census data, as in the case of rural residence, and used in previous studies. 5 , 24 , 50 Warzone exposures included the Vietnam War, Persian Gulf War, Afghanistan/Iraq War, and “other” recent warzone deployments, as defined by the VA. Global War on Terrorism (GWOT) veterans (n~50) were combined with Iraq/Afghanistan veterans, since these deployments were during the same timeframe and were in supporting theaters of operations.…”

“… 58 , 65 As we had no measure to judge the severity of these events in our survey, we collapsed these into three categories: less than 3 traumatic events, 3–5 events, and 6 or more events, as has been done in other traumatic stress disorder studies. 6 , 24 , 25 , 40 , 59 , 66 , 67 A total of 21% of respondents experienced 6 or more lifetime traumatic events in the current study and we used this to define “high” lifetime traumatic event exposure. 68 This traumatic event scale was developed from other trauma studies, was used in previous research, and has demonstrated good reliability and validity.…”

“…These were introduced with the 2000 Census to improve land area classifications. 24 For the current study, we defined “rural” as an area in which 95% of the households were in a rural land area, which represented 46% in the households in the current study.…”

“…Our assessment includes veterans from different conflicts, which may better represent the “real-world” population of current veterans. 5 , 24 As we note below, our analysis includes veterans that both do and do not use the VA health system. 7 Understanding deployment-related risk factors among veterans is imperative for more effective prevention and treatment of mental health disorders among the veteran population.…”

“… 37 Our tertiary hypothesis is that rural veterans would be at a lower risk of suicidal behaviors. 24 …”