The Changing Context of Rural America: A Call to Examine the Impact of Social Change on Mental Health and Mental Health Care

Carpenter‐Song, Elizabeth; Snell‐Rood, Claire

doi:10.1176/appi.ps.201600024

Cited by 37 publications

(22 citation statements)

References 27 publications

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“…Again, the geographic isolation of rural communities translates to declining rates of health care providers in rural areas with specialized training (Hamilton et al 2018 ; Henning-Smith et al 2017 ; Hung et al 2017 ) in the unique challenges of maternal sleep (e.g., nocturnal infant care) and the risk of comorbid severe psychopathology. Furthermore, the widespread reliance on pharmacologic treatments for behavioral health problems in rural areas (Carpenter-Song and Snell-Rood 2017 ; Metse and Bowman, 2020 ) is problematic in terms of sleep health; behavioral interventions (e.g., CBTi) are considered best-practice for chronic sleep problems (Kalmbach et al 2019 ; Van Straten et al 2017 ). Moreover, pregnant and nursing mothers often prefer non-pharmacologic treatment due to concerns about the potential teratogenic effects on the health of their children (Ceulemans et al 2019 ).…”

Section: Social-level Factorsmentioning

confidence: 99%

“…Geographically, awareness of the rurality of a patient could invite more flexible modes of treatment delivery (e.g., Telehealth services) and coordination with supportive services within their local community. Future research would also benefit from drawing out the context of rural sleep health through community-based participatory methodology (Israel et al 2010 ), including qualitative interviews with mothers and practitioners (Carpenter-Song and Snell-Rood 2017 ) in partnership with local community organizations.…”

Section: Gaps In the Literature And Recommendations For Future Researmentioning

confidence: 99%

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Social-ecological considerations for the sleep health of rural mothers

2020

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Section: Social-level Factorsmentioning

confidence: 99%

Section: Gaps In the Literature And Recommendations For Future Researmentioning

confidence: 99%

Social-ecological considerations for the sleep health of rural mothers

2020

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“…Yet contemporary research on rural women more broadly shows that more women identify their symptoms as depression (Simmons, Huddleston-Casas, & Berry, 2007) and, in Appalachia, use the expression ''nerves'' less often (Keefe & Curtin, 2015). Such a shift may indicate increased medicalization-that clinical categories of depression may be more widely embraced-or it may represent interaction between emic and etic categories of mental health (Kirmayer, 1989) as rural areas have become more exposed to direct-to-consumer advertising and treatment delivered through telemedicine and mobile technologies (Carpenter-Song & Snell-Rood, 2016). Many initiatives have concentrated on increasing care for rural women with depression by expanding access to mental health specialty care in rural settings (Adams, Xu, Dong, Fortney, & Rost, 2006;Fortney et al, 2013).…”

Section: Shifting Meanings Of Distress In Appalachiamentioning

confidence: 99%

Building interventions when distress is under debate: a case study from Appalachia

Snell‐Rood

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Hudson

et al. 2019

Transcult Psychiatry

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Scholarship on idioms of distress has emphasized cross-cultural variation, but devoted less attention to intra-cultural variation—specifically, how the legitimacy of distress may vary according to the context in which it is expressed, social position, and interaction with medical categories of distress. This variation can pose challenges for interventionists seeking to establish culturally acceptable ways of identifying distress and creating relevant resources for recovery. We describe efforts over three years (2014–2016) to identify and adapt a culturally appropriate evidence-based intervention for depressed rural Appalachian women. Though the prevalence of depression among rural women is high, limited services and social barriers restrict treatment access. Formative research revealed varied understandings of distress. Depression was (a) medicalized as a treatable condition, (b) stigmatized as mental illness, (c) accepted as a non-pathological reaction to regional poverty and gendered caregiving responsibilities, (d) rejected as a worthy justification for seeking individual care, and (e) less represented in comparison to other competing forms of distress (i.e., multiple morbidities, family members’ distress). In a small pilot trial, we applied an implementation science perspective to identify and implement appropriate evidence-based programming for the context. We outline how we reached Appalachian women despite these diverse understandings of depression and established a flexible medicalization of depression that enabled us to legitimize care-seeking, work with varied rural healthcare professionals, and engender culturally relevant support. Our adaptation and implementation of the concept of “mental health recovery” enabled the development of programming that furthered non-pathological communicative distress while resisting the normalization that silences women in the context of deep health disparities.

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“…Further, rural individuals being treated for their mental health have fewer mental health visits and are less likely to see a specialist for their mental health than their urban counterparts 4. Stigma, lack of mental healthcare specialists and an overall insufficient healthcare workforce have been frequently cited as common barriers to delivering mental health services to rural populations 4–9…”

Section: Introductionmentioning

confidence: 99%

Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study

2019

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ObjectivesIndividuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who have both physical and mental comorbidities, few studies have examined rural, chronically-ill older adults’ experiences accessing mental health services. The aim of the study was to determine barriers to finding, receiving and adhering to mental health treatments in this population to inform future interventions delivering services.DesignWe conducted a qualitative study of barriers and facilitators to mental healthcare access. 19 interviews were analysed deductively for barriers using a modified version of Penchansky and Thomas’s theory of access as an analytical framework.SettingThis study was conducted remotely using telephonic interviews. Patients were located in various rural Iowa towns and cities.Participants15 rural Iowan older adults with multiple physical comorbidities as well as anxiety and/or depression.ResultsWe found that while patients in this study often felt that their mental health was important to address, they experienced multiple, but overlapping, barriers to services that delayed care or broke their continuity of receiving care, including limited knowledge of extant services and how to find them, difficulties obtaining referrals and unsatisfactory relationships with mental health service providers.ConclusionsOur findings indicate that intervention across multiple domains of access is necessary for successful long-term management of mental health disorders for patients with multiple chronic comorbidities in Iowa.

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The Changing Context of Rural America: A Call to Examine the Impact of Social Change on Mental Health and Mental Health Care

Cited by 37 publications

References 27 publications

Social-ecological considerations for the sleep health of rural mothers

Social-ecological considerations for the sleep health of rural mothers

Building interventions when distress is under debate: a case study from Appalachia

Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study

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