RURAL-URBAN DIFFERENCES IN-SERVICE USE AND COURSE OF ILLNESS IN BIPOLAR DISORDER

Policy analysts have long been concerned that the reduced availability of mental health professionals in rural areas prohibits rural individ uals from getting the care they need for serious psychiatric condition s like bipolar disorder. Through a community-based telephone survey, t he researchers recruited 54 subjects with bipolar disorder who were cu rrently experiencing depressive episodes. Forty-six (85.1%) of them we re reinterviewed one year after the first survey. Multivariate models indicate that while rural subjects were just as likely to receive nona cute services for mental health problems as their urban counterparts, the rural residents had 22.1 times the odds (95% confidence interval 2 .5 to 198.3, P=0.006) of receiving such services exclusively from a ge neral medical provider. Rural subjects had 5.8 times the odds (95% con fidence interval 0.8 to 40.7, P=0.07) of using hospital or emergency r oom services and 4 times the odds (95% confidence interval 0.8 to 20.5 , P=0.10) of experiencing a manic episode during the year following ba seline. While rural individuals with bipolar disorder have a comparabl e likelihood of receiving care for their mental health problems, they utilize more acute services and experience worse outcomes. Further res earch is warranted to determine what causes these differences before d eveloping cost-effective ways to improve the care delivered to individ uals with this serious illness.