Rural-Urban Differences In The Use, Type, And Quality Of Depression Treatment

Funder:	Office of Rural Health Policy (ORHP)
Research center:	WICHE Center for Rural Mental Health Research Phone: 303.541.0311
Lead researcher:	John C. Fortney, PhD , 501.257.1726, fortneyjohnc@uams.edu
Project funded:	September 2006
Project completed:	December 2008
Topics:	Aging Health disparities Mental health Minority health

As access to evidence-based treatment for affective disorders (major depressive disorder, dysthymia, and bipolar disorder) improves in urban areas, it is critical to monitor rural-urban differences in the use and quality of treatment over time to identify and address rural disparities, especially for vulnerable populations such as the elderly and ethnic minorities. Private managed care organizations have begun to disseminate evidence-based treatments for affective disorders, especially depression. However, these dissemination programs tend to target primarily urban areas, especially those populations covered by employer-sponsored insurance. As a result, disparities for rural, minority and elderly populations might actually be increasing over time. Thus, it is critical to monitor disparities with respect to the receipt of high quality treatments for affective disorders, especially pharmacotherapy (which has been the focus of most dissemination programs). If disparities continue to exist or are found to be increasing over time, it will provide evidence for policy makers about the need to develop specialized programs to disseminate evidence-based practices into rural areas (targeting vulnerable populations).

Publications

• 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
  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)
  Author(s): John Fortney, Jeffrey Harman, Stan Xu, Fran Dong
  Date: 05 / 2009
  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.
• Rural-Urban Differences in Depression Care (Working Paper)
  Author(s): John C. Fortney, Jeffrey S. Harman, Stanley Xu, Fran Dong
  Date: 10 / 2009
  Assesses the association between rurality and depression care. Reports that rural individuals are more reliant on pharmacotherapy than psychotherapy.