Facts & Figures: Mental Health in Rural America

Rural populations experience more adverse living circumstances than urban populations, but the evidence regarding the prevalence of mental health disorders in rural areas is contradictory. So how prevalent is depression in rural areas when compared to urban areas?

According to a 1999 National Health Interview Survey, the prevalence of depression was significantly higher among rural than urban populations (6.1% versus 5.2% ). However, after adjusting for rural/urban population characteristics, the odds of depression did not differ by residence. Depression risk was higher among persons likely to be encountered in a primary care setting: those with fair or poor self-reported health, hypertension, limitations in daily activities, or whose health status changed during the previous year.

Rural residents report difficulty accessing healthcare services and an absence of anonymity when seeking care in the South. A common sentiment among Southerners is that the prevailing stigma and conservative belief system in rural communities can hinder the search for health care. Consequently, rural patients who forego diagnosis and treatment for conditions like substance abuse, sexually transmitted infections, and HIV infection are public health concerns because they are more likely to experience disease progression and infect others.

According to an American Farm Bureau poll, a substantial majority of farmers/farmworkers say the COVID-19 pandemic has impacted their mental health. More than half say they are personally experiencing more mental health challenges than they were a year ago.

The survey of rural adults and farmers/farmworkers explored how the pandemic impacted personal and community mental health and how attitudes and experiences around mental health have changed in rural and farm communities since AFBF conducted its first rural mental health survey in 2019.

Mental and behavioral health conditions can begin in childhood and affect lifelong health and well-being. Rural environments may be less stressful, with less air pollution, and more open spaces for healthful physical exploration. Yet, some large or small rural areas are characterized by geographic isolation with fewer job opportunities, lower socioeconomic status, and limited access to healthcare specialists. These factors can lead to health disparities that are best addressed in the early stages of child development to avoid chronic conditions and lifelong health problems.

From 2000 through 2018, differences in suicide rates between rural and urban areas increased. Rural suicide rates increased 48% from 2000 through 2018 compared with a 34% urban rate increase. In rural and urban areas, suicide rates for males remained higher than for females. The rural male suicide rate was 3.8 times higher than the female rate in 2018, and the urban male suicide rate was 3.6 times higher than the female rate. The rural male suicide rate increased 34% from 2007 through 2018 compared with a 17% urban rate increase. The rural female suicide rate nearly doubled from 2000 through 2018 compared with a 51% urban rate increase.