Mental Health and Mental Health Care in Rural America: The Hope of Redesigned Primary Care

Disease-a-month: DM (Impact Factor: 0.95). 11/2012; 58(11):629-38. DOI: 10.1016/j.disamonth.2012.08.004
Source: PubMed
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    • "Individuals living in rural communities may face multiple disadvantages associated with edentulism. For example, in addition to the difficulty in accessing oral health care as already noted, rural residents must also deal with significant deficits in mental health care regardless of the source or impetus for poor mental health [26]. Depressive symptom severity predicts lactobacillus counts independent of saliva pH, saliva flow rate, medication use (psychiatric, xerogenic and other medications), and sweet consumption [27]. "
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    ABSTRACT: Oral health is an integral component of general health and well-being. While edentulism has been examined in relation to socioeconomic status, rural residency, chronic disease and mental health, no study that we know of has examined edentulism and these factors together. The objective of this study was to determine whether depression and rural residency were significantly associated with partial and full edentulism in US adults after controlling for potential confounders. 2006 Behavioral Risk Factor Surveillance Survey (BRFSS) data were analyzed to identify factors associated with increased odds of partial or full edentulism. This year of BRFSS data was chosen for analysis because in this year the standardized and validated Personal Health Questionnaire-8 (PHQ-8) was used to measure current depression. This measure was part of the optional questions BRFSS asks, and in 2006 33 states and/or territories included them in their annual surveillance data collection. Bivariate and logistic regression analyses were performed on weighted BRFSS data. Logistic regression analysis using either full or partial edentulism as the dependent variable yielded that rural residency or living in a rural locale, low and/or middle socioeconomic status (SES), depression as measured by the PHQ-8, and African American race/ethnicity were all independent risk factors when controlling for these and a number of additional covariates. This study adds to the epidemiological literature by assessing partial and full edentulism in the US utilizing data from the CDC's Behavioral Risk Factor Surveillance System (BRFSS). Examining data collected through a large national surveillance system such as BRFSS allows for an analysis that incorporates an array of covariates not available from clinically-based data alone. This study demonstrated that current depression and rural residency are important factors related to partial and full edentulism after controlling for potential confounders.
    BMC Public Health 01/2014; 14(1):65. DOI:10.1186/1471-2458-14-65 · 2.26 Impact Factor
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    • "Other important disparities in social determinants of health have also been detected for rural U.S. residents including higher poverty levels and lower levels of attained education. Finally, rural communities bear a heavier mental health burden than urban communities and research has repeatedly shown that poorly treated depression and other mental health conditions contribute to a higher burden of subjective pain and disability [20] [21] [22] [23] . A recent publication points out that rurality itself should be considered a fundamental or root cause of poor health [11] . "
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    ABSTRACT: Introduction: More than 21% of adults in the United States (U.S.) have self-reported physician diagnosed arthritis with the prevalence increasing to 70% for adults aged 75 years and older. Despite significant disease burden of arthritis, little research has been conducted to examine health service deficits experienced by U.S. adults with this disease. Since U.S. rural residents experience more disease and greater health and health care disparities than urban residents, this study sought to ascertain the prevalence of health service deficits in U.S. adults with arthritis and to explore whether rural residents experienced greater deficits than urban residents. Methods: Multivariate techniques were performed on 2011 Behavioral Risk Factor Surveillance System data to determine if there were differences in the prevalence of health service deficits in rural versus urban adults with arthritis and if rural residency was an independent risk factor for health service deficits after controlling for socioeconomic status and race/ethnicity. The population of interest was U.S. adults who self-reported having arthritis diagnosed by a health care provider. Results: Bivariate analysis revealed and logistic regression confirmed that among U.S. adults > 45 years of age, rural residency was a predictor for a higher prevalence of arthritis as well as for health service deficits among those with arthritis. Overall about 1 in 3 individuals > 45 years of age suffering from arthritis experienced a health deficit. The two most common health service deficits were not having a routine medical checkup within the last 12 months and deferring health care because of cost. Rural residency emerged as an independent risk factor for health service deficits after controlling for socioeconomic status and race/ethnicity. Conclusions: Many individuals with arthritis experience a health service deficit and rural residents are at greater risk when compared to their urban counterparts. Given the burden of disease from arthritis the results suggest that there is considerable potential for improving services and perhaps improving outcomes for individuals with arthritis. The finding that the most common health service deficits were delaying care because of cost and not having seen a provider within the last 12 months suggests that finances rather than simply the availability of services is a key factor.
    04/2013; 3(11):43-53. DOI:10.5430/jnep.v3n11p43
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    • "Finally, living in a rural community shows significantly increased odds of health service deficits, albeit more modestly relative to SES and race/ethnicity. This adds to the growing literature that identifies rural residency as an independent risk factor for health service deficits in general and specific to mental health [3] [21]. Multiple barriers discourage patients from self-disclosing depressive symptoms to primary care physicians [22]. "

    Health 01/2013; 5(04-4):774-782. DOI:10.4236/health.2013 · 0.51 Impact Factor
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