RURAL-URBAN DIFFERENCES IN DEPRESSION TREATMENT AND SUICIDALITY

OBJECTIVES. Because there are fewer per capita providers trained to de liver mental health services in rural areas, the authors hypothesized that depressed rural individuals would receive less outpatient treatme nt and report higher rates of hospital admittance and suicide attempts than their urban counterparts. METHODS, The authors recruited 74% of eligible participants (n = 470) from a 1992 telephone survey and follo wed up 95% of subjects for 1 year. The authors collected data from sub jects on psychiatric problems and service use and from insurers/provid ers on treatment and expenditures. RESULTS. Although there were no rur al-urban differences in the rate, type, or quality of outpatient depre ssion treatment, rural subjects made significantly fewer specialty car e visits for depression. Depressed rural individuals had 3.05 times th e odds of being admitted to the hospital for physical problems (P = 0. 02) and 3.06 times the odds of being admitted for mental health proble ms (P = 0.08) during the year. Elevated rates of hospital admittance d isappear in models controlling for number of specialty care depression visits in the previous month. Rural subjects reported significantly m ore suicide attempts during the period of I year (P = 0.05), CONCLUSIO NS, Additional work is warranted to determine how to alter barriers to outpatient specialty care if the rural health care delivery system is to provide cost-effective depression care.