Anxiety, Depression, and Access to Mental Health Care by Sexual Orientation and Rurality

Date: June 30, 2022

Anxiety, Depression, and Access to Mental Health Care by Sexual Orientation and Rurality

The purpose of this policy brief is to illustrate the differences in two of the most common mental health disorders (anxiety and depression) and in access to mental health care by sexual orientation and rurality.

Key Findings

  • Rural lesbian, gay, and bisexual (LGB) adults reported the highest rates of depression and anxiety disorder diagnosis, as well as the highest levels of depressed feelings, compared with urban LGB adults and rural and urban heterosexual adults.
  • Urban LGB adults reported the most barriers to accessing health care.
  • Both rural and urban LGB adults were more likely to have delayed mental health care in the past 12 months because of cost, compared with their heterosexual counterparts.

Contact Information:

Carrie Henning-Smith, PhD, MPH, MSW
University of Minnesota Rural Health Research Center
Phone: 612.626.4512
henn0329@umn.edu

Additional Resources of Interest:

New Case Studies on LGBTQ+ Health in Rural Areas

Date: June 30, 2022

Small-Town Pride Celebrations Supporting Social Connectedness & Well-Being for LGBTQ+ Rural ResidentsFeelings of social connectedness and belonging vary by sexual orientation and gender identity. For example, lesbian, gay, and bisexual (LGB) adults report lower social cohesion in their neighborhoods, which may be perpetuated by discrimination and homophobia from members of their community. In addition, recent research found that rural LGB adults reported the lowest levels of having their social and emotional needs met, compared with urban LGB adults, urban heterosexual adults, and rural heterosexual adults. This case series highlights examples of two small-town Pride celebrations that contribute to social connectedness and belonging for rural lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) community members.

Rural Community Organizations Building Inclusive Environments for LGBTQ+ ResidentsCommunity organizations play a key role in providing services and programming in rural communities. This case study series highlights examples of rural community organizations providing LGBTQ+ welcoming and inclusive programming and services from different regions across the U.S.

Improving Access to LGBTQIA+-Friendly Care in Rural AreasLesbian, gay, bisexual, transgender, queer/questioning, and asexual/agender (LGBTQIA+) individuals face many barriers to accessing health care, including lack of health insurance, a shortage of health care providers that are skilled in treating LGBTQIA+ patients, as well as stigma and discrimination in health care settings. This case study series features two organizations that are working toward improving health care for rural LGBTQIA+ patients.

Contact Information:

Mariana Story Tuttle, MPH
University of Minnesota Rural Health Research Center
Phone: 612.626.8401
tuttl090@umn.edu

Additional Resources of Interest:

Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers

Date: June 16, 2022

Non-Metropolitan and Metropolitan Trends in Mental Health Treatment Availability in Community Health and Community Mental Health Centers

Community mental health centers (CMHCs) and community health centers (CHCs) are two types of federally funded sites where persons may seek mental health treatment. The purpose of this study was to show how the supply of CMHCs and CHCs delivering mental health services changed over time, in non-metropolitan and metropolitan areas.

It was found that the supply of CMHCs decreased substantially from 2000 to 2019 in non-metropolitan counties. However, the supply of CHCs offering mental health services increased substantially over the same time period. These gains were pronounced in both non-metropolitan and metropolitan counties, although growth was faster in metropolitan counties.

Contact Information:

Ty Borders, PhD
Rural and Underserved Health Research Center
Phone: 859.218.2041
ty.borders@uky.edu

Additional Resources of Interest:

Click to view Research Alerts.

Northern Border Regional Commission State and Region Chartbooks – A Health-Focused Landscape Analysis

Date: June 7, 2022

Upcoming Webinar: Northern Border Regional Commission State and Region Chartbooks – A Health-Focused Landscape Analysis

Date: June 21, 2022
Time: 10:00 AM Pacific, 11:00 AM Mountain, 12:00 PM Central, 1:00 PM Eastern
Duration: Approximately 60 minutes
Website: ruralhealthresearch.org/webinars/northern-border-region-chartbooks

During this webinar, Dr. Katherine Ahrens will describe a project compiling the most recent publicly available data related to health and healthcare access at the county-level and state-level for the Northern Border Region: ME, NH, NY, and VT. Dr. Ahrens will discuss healthcare professional shortage areas and will highlight counties with worse health outcomes, as compared to the rest of the counties in the region.

Registration is free and required. Attendance of the live webinar is limited to 500 persons. If you are unable to attend, you will be able to access the recording, archived on the Gateway website.

Registration

Presenters

Katherine Ahrens, PhD, MPH

Additional Resources of Interest:

Click to view Research Alert.

Racial and Ethnic Diversity of the Family Physician Workforce in Non-Metropolitan and Metropolitan Counties

Date: June 6, 2022

The Racial and Ethnic Diversity of the Family Physician Workforce in Non-Metropolitan and Metropolitan Counties

In general, physicians are disproportionately White and male compared to the U.S. workforce and population, but little is known about racial and ethnic distribution of family physicians (FPs) according to rurality and how this compares to urban FPs. The objective was to determine the distribution of FPs in rural areas by race/ethnicity and also whether rural minority physicians were more likely to be in underserved rural areas.

Key Findings

  • The family physician workforce is becoming more racially diverse; however, non-metropolitan family physicians are not.
  • Early career family physicians are more diverse than later career physicians.
  • Minority non-metropolitan family physicians, particularly Black and Native American/Alaska Native physicians, are more likely to practice in persistent poverty counties.

Contact Information:

Lars E. Peterson, MD, PhD
Rural and Underserved Health Research Center
Phone: 859.538.7180
lpeterson@theabfm.org

Additional Resources of Interest:

Click to view Research Alert.

Trends in Revenue Sources among Rural Hospitals

Date: June 1, 2022

Trends in Revenue Sources among Rural Hospitals

This study estimates changes in outpatient care as a source of revenue for rural hospitals. It uses 2011-2019 data from the Healthcare Cost Report Information System to analyze trends in the percent of patient revenue coming from outpatient care.

For the average hospital in the sample of 1,866 rural hospitals, the percent of revenue coming from outpatient services increased from 66.5% in 2011 to 74.2% in 2019. Furthermore, total outpatient revenue for the average rural hospital increased by 56.4% from 2011-2019, after inflation adjustment. Conversely, total inpatient revenue for the average rural hospital only increased by 9.3% from 2011-2019, after inflation adjustment.

The findings suggest that many rural hospitals now receive most of their revenue from outpatient sources.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.843.2728
gpink@email.unc.edu

Additional Resources of Interest:

Click to view Research Alert.

Association Between Rural Hospital Service Changes and Community Demographics

Date: May 31, 2022

Association Between Rural Hospital Service Changes and Community Demographics

This brief investigated the association between the proportion of a rural community belonging to an Agency for Healthcare Research and Quality-identified priority population and local hospital service changes. The results suggest that recent trends in service availability are often similar when comparing hospitals in non-metro counties with larger versus smaller priority populations. In aggregate, from 2011-2017, hospitals in non-metro counties generally experienced a net decrease in the availability of obstetric services and skilled nursing services and a net increase in the availability of oncology services, hospital-based outpatient services, orthopedic services, and emergency psychiatric services. Aggregate changes in the availability of home health and chemotherapy were generally smaller in magnitude. These aggregate results are consistent with previous work on rural hospital-based service availability.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.843.2728
gpink@email.unc.edu

Additional Resources of Interest:

Click to view Research Alert.

Community Characteristics and Financial and Operational Performance of RHCs

Date: May 24, 2022

Community Characteristics and Financial and Operational Performance of Rural Health Clinics in the United States: A Chartbook

This chartbook provides an overview of Rural Health Clinic (RHC) characteristics and issues using data from the Centers for Medicare and Medicaid Services’ (CMS) Provider of Services file, Medicare cost reports, and the Robert Wood Johnson Foundation’s County Health Ranking and will be useful to policymakers and others interested in the performance of RHCs nationally. It can also be useful to RHC administrators to benchmark staffing patterns, productivity, and efficiency. Finally, it provides a discussion of the challenges related to collection and reporting of RHC quality data.

Contact Information:

John A. Gale, MS
Maine Rural Health Research Center
Phone: 207.228.8246
john.gale@maine.edu

Additional Resources of Interest:

 

Prehospital Emergency Medical Services Personnel Study

Date: May 24, 2022

Prehospital Emergency Medical Services Personnel: Comparing Rural and Urban Professional Experience and Provision of Evidence-Based Care

This study describes the relationship between prehospital emergency medical services (EMS) providers’ levels of experience and provision of evidence-based care for rural and urban populations. Using electronic prehospital EMS patient care record data, Washington, Wyoming, Alaska, Montana, Idaho (WWAMI) Rural Health Research Center examined four EMS Compass performance measures of evidenced-based care for seizure, stroke, hypoglycemia, and trauma.

Compared with EMS agencies serving predominantly urban patient populations, rural-serving agencies less often provided evidence-based care according to performance measures for stroke, hypoglycemia, and trauma. The rural/urban difference was more pronounced with increasing rurality. Using daily 911 encounters and total time spent on 911 encounters as measures of accumulated experience, WWAMI Rural Health Research Center found that EMS professionals at rural agencies had lower levels of accumulated experience than professionals at urban agencies. Experience levels decreased as agency rurality increased. Patients were more likely to receive evidenced-based care for seizure and trauma when the lead EMS professional at the encounter had accumulated more total time responding to 911 encounters. Measures of experience were not associated with evidence-based care for stroke or hypoglycemia.

Contact Information:

Davis Patterson, PhD
WWAMI Rural Health Research Center
Phone: 206.543.1892
davisp@uw.edu

Additional Resources of Interest:

Racial/Ethnic Differences in Adverse and Positive Childhood Experiences Across Rural Communities

Date: May 23, 2022

Racial/Ethnic Differences in Adverse and Positive Childhood Experiences Across Rural Communities: Results from the National Survey of Children’s Health

Both positive and adverse events that occur during childhood and adolescence have been shown to be associated with physical and mental health outcomes in adulthood. This study examined whether adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) exposure varied by race/ethnicity among rural children. Key findings include:

ACEs

  • There were higher rates of four or more ACEs among racial/ethnic minority children living in rural areas.
  • Asian/Pacific Islander rural children had the highest rates of three out of six ACEs: parental death, witnessing neighborhood violence, and economic hardship.
  • Economic hardship was prevalent among rural children, with 26.2% of this population experiencing economic hardship, and over 40% of Black and Asian/Pacific Islander children experiencing economic hardship.

PCEs

  • There were lower rates of each type of PCE among racial/ethnic minority rural children.
  • Asian/Pacific Islander children had the lowest proportion of each of the following PCEs: after school activities (60.5%), community volunteer (33.4%), guiding mentor (85.7%), supportive neighborhood (34.8%), and resilient family (80.4%).

Contact Information:

Elizabeth Crouch, PhD
Rural and Minority Health Research Center
Phone: 803.576.6055
crouchel@mailbox.sc.edu

Additional Resources of Interest:

Click to view Research Alert