WICHE Center for Rural Mental Health Research

Publications

Alphabetical list. You can also view by publication date.

Addressing Suicide Potential and Prevention in Rural and Frontier Areas: Suicide Prevention Toolkit for Rural Primary Care Providers
Date: 08 / 2009
Author(s): Mimi McFaul, Jim Ciarlo, Jean Demmler, Christa Smith, Tamara DeHay
Topics: Frontier health, Mental health
Suicide rates in rural areas are significantly higher than they are in urban areas for men of all ages and for young women. Research shows that many people visit their primary care physician instead of a mental health provider for mental health problems. Includes a Suicide Prevention Toolkit for rural primary care providers.
Are Primary Care Services a Substitute or Complement for Specialty and Inpatient Services?
Date: 2005
Author(s): John C. Fortney, Diane E. Steffick, James F. Burgess Jr., Matt L. Maciejewski, Laura A. Petersen
Citation: Health Services Research, 40(5, Part 1), 1422-42
Topic: Health services
Change in distance to primary care was a significant and substantial predictor of change in primary care visits. Analyses indicated that an increase in primary care service use was associated with increases in the use of all specialty outpatient services and inpatient services, as well as increases in inpatient and outpatient costs. Results provide evidence that health systems can implement strategies to encourage their members to use more primary care services without driving up physical health costs.
Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper)
Date: 02 / 2010
Author(s): Jeffrey S. Harman, Fran Dong, Stan Xu, Nathan Ewigman, John C. Fortney
Topic: Mental health
Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental health care.
Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings (Summary Brief)
Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu
Topic: Mental health
Data from the National Comorbidity Survey Replication show that rural individuals with mental health problems are significantly less likely to receive mental health services than individuals in urban and suburban areas.
Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals with Serious Mental Illness (Findings Brief)
Date: 03 / 2010
Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu
Topics: Health insurance and the uninsured, Mental health
Study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in source of payment vary for the seriously mentally ill relative to all other mental health conditions.
Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Final Paper)
Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong
Topic: Mental health
Rural individuals are more reliant on pharmacotherapy than psychotherapy, which may be a concern if this is due to poor access to psychotherapy rather than a preference for antidepressants.
Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Policy Brief)
Date: 05 / 2009
Author(s): John Fortney, Jeffrey Harman, Stan Xu, Fran Dong
Topic: Mental health
The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression.
Community-Level Risk Factors for Depression Hospitalizations
Date: 09 / 2005
Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Kathryn Rost
Report Number: Working Paper
Topics: Mental health, Rural statistics and demographics
Examines the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics.
Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet)
Date: 09 / 2005
Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost
Topics: Mental health, Rural statistics and demographics
Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates.
Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers
Date: 10 / 2009
Author(s): Scott J. Adams, Stan Xu, Fran Dong
Topics: Children, Mental health, Pharmacy and prescription drugs
Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers.
Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients
Date: 09 / 2005
Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
Topic: Mental health
Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request.
Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients
Date: 2006
Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost
Citation: Journal of Rural Health, 22(4), 343-350
Topic: Mental health
Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients.
Distance Education Training in Behavioral Health: A Rural Primary Care Needs Assessment and Pilot Webcast
Date: 08 / 2009
Author(s): Mimi McFaul, Dennis Mohatt, Jim Ciarlo, John M. Westfall
Topics: Mental health, Technology
Primary care providers (PCPs) are often the first and only resource for rural and frontier residents needing mental health care. Training on mental health issues is not easily accessible for PCPs working in rural settings. Distance education offers a low-cost, convenient alternative for PCPs to obtain the information they need to treat the mental health needs of their patients.
Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?
Date: 2005
Author(s): John C. Fortney, Matt L. Maciejewski, J. Warren, James F. Burgess Jr.
Citation: Inquiry, 42(1), 29-42
Topics: Health services, Veterans
The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inpatient care. Using a quasi-experimental, pre-post study design, the authors examined whether the establishment of CBOCs has affected access, use, and costs for VA patients residing in their catchment areas. Most patients residing in CBOC catchment areas did not receive care at CBOCs, resulting in only small increases in primary care utilization. While CBOCs improved veterans' access, they had little impact on overall patterns of utilization and cost.
Mental Health and Rural America: 1994-2005
Date: 2006
Author(s): Dennis Mohatt, Scott J. Adams, Mimi M. Bradley, Chad A. Morris
Topic: Mental health
Provides a summary of the current knowledge base surrounding mental health issues in America's rural and frontier areas and an overview of the environment of mental health in rural areas over three decades. Includes an annotated bibliography.
One Size Fits Some: the Impact of Patient Treatment Attitudes On the Cost-Effectiveness of a Depression Primary Care Intervention
Date: 2005
Author(s): Jeffrey M. Pyne, Kathryn M. Rost, Farah Farahati, Shanti P. Tripathi, Jeffrey Smith, D. Keith Williams, John Fortney, James C. Coyne
Citation: Psychological Medicine, 35(6), 839-854
Topic: Mental health
Reports the results of a study that estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention.
Preventing Hospitalization in Depressed Rural Patients
Date: 09 / 2005
Author(s): Scott J. Adams, Stanley Xu, Fran Dong , Kathryn Rost
Topic: Mental health
The purpose of this research was to investigate the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas. The study found that depressed rural patients were hospitalized more than their urban counterparts over two years, with statistically greater hospitalization rates at 6 months and statistically greater length of stays at 12 months. These differential hospitalization rates/lengths were not explained by previous outpatient specialty care treatment, which was comparable for rural and urban patients. Insurance barriers predict reduced use of specialty care in depressed urban patients, but not in depressed rural patients. Full report available on request.
Role of Social Support and Stressful Life Events in the Effectiveness of Collaborative Care for Depression: A Rural-Urban Comparison
Date: 2005
Author(s): K. Albright, John C. Fortney, Scott J. Adams, Stanley Xu, F. Dong
Topic: Mental health
Rural-Urban Difference in Health Care Benefits of Community-Based Sample of At-Risk Drinkers
Date: 2003
Author(s): John C. Fortney, Brenda M. Booth, JoAnn E. Kirchner, Xiaotong Han
Citation: Journal of Rural Health, 19(3), 292-298
Topic: Substance abuse
Compares the cost-containment strategies used by health plans of insured at-risk drinkers residing in rural and urban areas.
Rural-Urban Differences in Depression Care (Working Paper)
Date: 10 / 2009
Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong
Topic: Mental health
Assesses the association between rurality and depression care. Reports that rural individuals are more reliant on pharmacotherapy than psychotherapy.
Stakeholder Benefit From Depression Disease Management: Differences by Rurality?
Date: 2006
Author(s): Kathryn Rost, Stanley Xu, Fran Dong, L. Miriam Dickinson
Citation: Manuscript currently in review. Copies may be requested from Dr. Rost at Kathryn.Rost@med.fsu.edu, telephone 850.645.7367, fax 850.645.1773
Topic: Mental health
Background: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. Aims of Study: This paper investigates whether two stakeholder groups (health plans and employer purchasers) in two delivery systems (rural and urban) economically benefit from improved depression treatment by testing whether depression care management results in: (1) a greater reduction of utilization costs in insured rural patients than their urban counterparts (health plan stakeholders), and (2) a greater reduction in work costs in employed urban patients than their rural counterparts (employer purchaser stakeholders). Methods: We examined the main and differential effects of intervention on utilization and work costs over 24 months in a pre-planned secondary analysis of 479 depressed patients from rural and urban primary care practices who participated in a randomized controlled trial of depression disease management. Results: Reductions in work costs were observable in both the rural and urban cohort, while reductions in utilization costs were observable in the urban cohort. Discussion with Limitations: While our small sample size limits definitive conclusions, the economic incentives to assure improved depression treatment may differ across stakeholders in rural and urban delivery systems. Implications for Health Policy: Employers may have more consistent economic incentives than health plans to assure improve depression treatment across rural and urban delivery systems.

Topics Centers Researchers Other Resources Search		WICHE Center for Rural Mental Health Research Publications Alphabetical list. You can also view by publication date. Addressing Suicide Potential and Prevention in Rural and Frontier Areas: Suicide Prevention Toolkit for Rural Primary Care Providers Date: 08 / 2009 Author(s): Mimi McFaul, Jim Ciarlo, Jean Demmler, Christa Smith, Tamara DeHay Topics: Frontier health, Mental health Suicide rates in rural areas are significantly higher than they are in urban areas for men of all ages and for young women. Research shows that many people visit their primary care physician instead of a mental health provider for mental health problems. Includes a Suicide Prevention Toolkit for rural primary care providers. Are Primary Care Services a Substitute or Complement for Specialty and Inpatient Services? Date: 2005 Author(s): John C. Fortney, Diane E. Steffick, James F. Burgess Jr., Matt L. Maciejewski, Laura A. Petersen Citation: Health Services Research, 40(5, Part 1), 1422-42 Topic: Health services Change in distance to primary care was a significant and substantial predictor of change in primary care visits. Analyses indicated that an increase in primary care service use was associated with increases in the use of all specialty outpatient services and inpatient services, as well as increases in inpatient and outpatient costs. Results provide evidence that health systems can implement strategies to encourage their members to use more primary care services without driving up physical health costs. Assessment of the Mental Health Funding Marketplace in Rural vs. Urban Settings (Working Paper) Date: 02 / 2010 Author(s): Jeffrey S. Harman, Fran Dong, Stan Xu, Nathan Ewigman, John C. Fortney Topic: Mental health Rural residents are less likely to have mental health services funded through private insurance and more likely through public sources than urban residents, suggesting that targeting policies through public funding sources could be the most effective method to reduce urban-rural disparities in mental health care. Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings (Summary Brief) Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu Topic: Mental health Data from the National Comorbidity Survey Replication show that rural individuals with mental health problems are significantly less likely to receive mental health services than individuals in urban and suburban areas. Assessment of the Mental Health Funding Marketplace in Urban vs. Rural Settings for Individuals with Serious Mental Illness (Findings Brief) Date: 03 / 2010 Author(s): Jeffrey S. Harman, John C. Fortney, Fran Dong, Stan Xu Topics: Health insurance and the uninsured, Mental health Study was designed to assess the impact of rurality on the source of payment for mental health treatments and determine whether urban-rural differences in source of payment vary for the seriously mentally ill relative to all other mental health conditions. Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Final Paper) Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong Topic: Mental health Rural individuals are more reliant on pharmacotherapy than psychotherapy, which may be a concern if this is due to poor access to psychotherapy rather than a preference for antidepressants. Association Between Rural Residence and the Use, Type, and Quality of Depression Care (Policy Brief) Date: 05 / 2009 Author(s): John Fortney, Jeffrey Harman, Stan Xu, Fran Dong Topic: Mental health The purpose of the project was to assess the association between rurality and the use, type (pharmacotherapy versus psychotherapy), and quality of care among individuals in the Medical Expenditure Panel Survey with self-reported depression. Community-Level Risk Factors for Depression Hospitalizations Date: 09 / 2005 Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Kathryn Rost Report Number: Working Paper Topics: Mental health, Rural statistics and demographics Examines the association between depression hospitalization rates and community-level socio-demographic, economic, and health care system characteristics. Community-Level Risk Factors for Depression Hospitalizations (Fact Sheet) Date: 09 / 2005 Author(s): John Fortney, Gerard Rushton, Scott Wood, Lixun Zhang, Stan Xu, Fran Dong, Kathryn Rost Topics: Mental health, Rural statistics and demographics Overview of findings from a study to identify community-level risk factors for depression hospitalizations and geographic areas with elevated hospitalization rates. Differences in Prescribing Patterns of Psychotropic Medication for Children and Adolescents between Rural and Urban Prescribers Date: 10 / 2009 Author(s): Scott J. Adams, Stan Xu, Fran Dong Topics: Children, Mental health, Pharmacy and prescription drugs Reports that prescriptions of all psychotropic drug categories increased significantly for both urban and rural populations over the 10-year period of the study. Urban youth were far more likely to be prescribed psychotropic medications by psychiatrists as opposed to generalists or other prescribers. In contrast, rural youth were far more likely to have psychotropics prescribed by generalists or other prescribers. Differential Effectiveness of Depression Disease Management for Rural and Urban Primary Care Patients Date: 09 / 2005 Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost Topic: Mental health Examined whether or not there is a differential impact of enhanced depression care on patient outcomes in rural versus urban primary care settings and whether differences any are mediated by receiving evidence-based care (pharmacotherapy and specialty care counseling). Findings indicate that enhanced care for depression improved mental health status over 18 months for urban primary care populations, but not rural patients. Full report available on request. Differential Effectiveness of Enhanced Depression Treatment for Rural and Urban Primary Care Patients Date: 2006 Author(s): Scott J. Adams, Stanley Xu, Fran Dong, John Fortney, Kathryn Rost Citation: Journal of Rural Health, 22(4), 343-350 Topic: Mental health Reports the results of a study that explored whether a depression disease management program has a comparable impact on clinical outcomes over 2 years in patients treated in rural and urban primary care practices and whether the impact is mediated by receiving evidence-based care (antidepressant medication and specialty care counseling). The study found that depression disease management improved the mental health status of urban patients over 18 months but not rural patients. Effects were not mediated by antidepressant medication or specialty care counseling in urban or rural patients. Distance Education Training in Behavioral Health: A Rural Primary Care Needs Assessment and Pilot Webcast Date: 08 / 2009 Author(s): Mimi McFaul, Dennis Mohatt, Jim Ciarlo, John M. Westfall Topics: Mental health, Technology Primary care providers (PCPs) are often the first and only resource for rural and frontier residents needing mental health care. Training on mental health issues is not easily accessible for PCPs working in rural settings. Distance education offers a low-cost, convenient alternative for PCPs to obtain the information they need to treat the mental health needs of their patients. Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs? Date: 2005 Author(s): John C. Fortney, Matt L. Maciejewski, J. Warren, James F. Burgess Jr. Citation: Inquiry, 42(1), 29-42 Topics: Health services, Veterans The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inpatient care. Using a quasi-experimental, pre-post study design, the authors examined whether the establishment of CBOCs has affected access, use, and costs for VA patients residing in their catchment areas. Most patients residing in CBOC catchment areas did not receive care at CBOCs, resulting in only small increases in primary care utilization. While CBOCs improved veterans' access, they had little impact on overall patterns of utilization and cost. Mental Health and Rural America: 1994-2005 Date: 2006 Author(s): Dennis Mohatt, Scott J. Adams, Mimi M. Bradley, Chad A. Morris Topic: Mental health Provides a summary of the current knowledge base surrounding mental health issues in America's rural and frontier areas and an overview of the environment of mental health in rural areas over three decades. Includes an annotated bibliography. One Size Fits Some: the Impact of Patient Treatment Attitudes On the Cost-Effectiveness of a Depression Primary Care Intervention Date: 2005 Author(s): Jeffrey M. Pyne, Kathryn M. Rost, Farah Farahati, Shanti P. Tripathi, Jeffrey Smith, D. Keith Williams, John Fortney, James C. Coyne Citation: Psychological Medicine, 35(6), 839-854 Topic: Mental health Reports the results of a study that estimated the impact of patient receptivity to antidepressant medication on the cost-effectiveness of an evidence-based primary-care depression intervention. Preventing Hospitalization in Depressed Rural Patients Date: 09 / 2005 Author(s): Scott J. Adams, Stanley Xu, Fran Dong , Kathryn Rost Topic: Mental health The purpose of this research was to investigate the substitution of higher cost hospitalization for lower cost outpatient specialty care for depression and the extent to which insurance barriers impact service substitution patterns of outpatient specialty care for depression in rural and urban areas. The study found that depressed rural patients were hospitalized more than their urban counterparts over two years, with statistically greater hospitalization rates at 6 months and statistically greater length of stays at 12 months. These differential hospitalization rates/lengths were not explained by previous outpatient specialty care treatment, which was comparable for rural and urban patients. Insurance barriers predict reduced use of specialty care in depressed urban patients, but not in depressed rural patients. Full report available on request. Role of Social Support and Stressful Life Events in the Effectiveness of Collaborative Care for Depression: A Rural-Urban Comparison Date: 2005 Author(s): K. Albright, John C. Fortney, Scott J. Adams, Stanley Xu, F. Dong Topic: Mental health Rural-Urban Difference in Health Care Benefits of Community-Based Sample of At-Risk Drinkers Date: 2003 Author(s): John C. Fortney, Brenda M. Booth, JoAnn E. Kirchner, Xiaotong Han Citation: Journal of Rural Health, 19(3), 292-298 Topic: Substance abuse Compares the cost-containment strategies used by health plans of insured at-risk drinkers residing in rural and urban areas. Rural-Urban Differences in Depression Care (Working Paper) Date: 10 / 2009 Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong Topic: Mental health Assesses the association between rurality and depression care. Reports that rural individuals are more reliant on pharmacotherapy than psychotherapy. Stakeholder Benefit From Depression Disease Management: Differences by Rurality? Date: 2006 Author(s): Kathryn Rost, Stanley Xu, Fran Dong, L. Miriam Dickinson Citation: Manuscript currently in review. Copies may be requested from Dr. Rost at Kathryn.Rost@med.fsu.edu, telephone 850.645.7367, fax 850.645.1773 Topic: Mental health Background: Despite increasing consensus about the value of depression disease management programs, the field has not identified which stakeholders should absorb the relatively small additional costs associated with these programs. Aims of Study: This paper investigates whether two stakeholder groups (health plans and employer purchasers) in two delivery systems (rural and urban) economically benefit from improved depression treatment by testing whether depression care management results in: (1) a greater reduction of utilization costs in insured rural patients than their urban counterparts (health plan stakeholders), and (2) a greater reduction in work costs in employed urban patients than their rural counterparts (employer purchaser stakeholders). Methods: We examined the main and differential effects of intervention on utilization and work costs over 24 months in a pre-planned secondary analysis of 479 depressed patients from rural and urban primary care practices who participated in a randomized controlled trial of depression disease management. Results: Reductions in work costs were observable in both the rural and urban cohort, while reductions in utilization costs were observable in the urban cohort. Discussion with Limitations: While our small sample size limits definitive conclusions, the economic incentives to assure improved depression treatment may differ across stakeholders in rural and urban delivery systems. Implications for Health Policy: Employers may have more consistent economic incentives than health plans to assure improve depression treatment across rural and urban delivery systems.