Rural-Urban Disparities in Mental Health Access and Quality in the United States

Research center:
Lead researcher:
Project funded:
September 2021
Anticipated completion date:
August 2024

This project will address the following questions:

  • Does access to inpatient, outpatient, and telehealth care for mental health services, and access to facilities offering substance use treatments, vary in urban and rural communities? How are inpatient psychiatric supply, outpatient mental health care settings, and telehealth supply for mental/behavioral health services distributed across rural/urban communities as well as areas with large racial/ethnic minority populations?
  • Does inpatient psychiatric care quality differ between urban and rural facilities? Which facility characteristics and community characteristics are associated with quality of psychiatric care?
  • Does outpatient care quality differ by residence rurality and race/ethnicity? What factors, such as proximity to a nearest outpatient mental health care unit, provider, and individual sociodemographic characteristics, are associated with variation in outpatient care quality?

This project will employ two different knowledge generation approaches. First, using a systematic literature review, we will summarize rural-urban disparities in mental health services across the following domains: spatial accessibility in driving distances (miles and minutes) to inpatient and outpatient mental health care and access to mental health facilities with telehealth capacities. Studies will be included if they provide estimates and variation (e.g., confidence interval, standard error, standard deviation) on the distribution of any mental health domain among rural and urban residents or communities in the United States. We will identify the top three domain measures based on the calculated effect sizes of residence rurality.

Second, using multiple publicly available nationwide datasets, we will profile the extent of disparities in mental health access and care quality by residence rurality and race/ethnicity. Descriptive and multivariable regression analyses will be employed to identify differential associations between rural/urban communities and selected mental health domain indicators by race/ethnicity. Variance inflation factor will be calculated to identify potential multicollinearity between independent variables.