Bj. Cuffel, VIOLENT AND DESTRUCTIVE BEHAVIOR AMONG THE SEVERELY MENTALLY-ILL IN RURAL-AREAS - EVIDENCE FROM ARKANSAS COMMUNITY MENTAL-HEALTH SYSTEM, Community mental health journal, 30(5), 1994, pp. 495-504
A comparison of rates of violence among admissions to the Arkansas Sta
te Hospital system between urban and rural areas tested the hypothesis
that thresholds for admission to the hospital were greater in rural t
han in urban areas. Data on violent and destructive behavior were reco
rded from the medical records of 609 patients. Logistic regression was
used to model the presence or absence of violent behavior in urban an
d rural admissions controlling for selected demographic and clinical c
haracteristics. Results indicated that rural patients showed increased
likelihood of violent and destructive behavior prior to admission sup
porting the hypothesis that barriers to mental health services in rura
l areas may be creating differential thresholds of service access and
utilization. The increased rate of violence was particularly evident i
n those using substances prior to admission in rural areas suggesting
that community management of the violent, substance abusing patient ma
y be particularly difficult for rural areas.