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

ArticleinDisease-a-month: DM 58(11):629-38 · November 2012with28 Reads
DOI: 10.1016/j.disamonth.2012.08.004 · Source: PubMed
    • "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]. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Jan 2014
    • "OA is linked to a poor quality of life [5] and pain associated with suboptimal management likely impacts the quality of life for those with this type of arthritis. As noted in the introduction, there is a close interdependence between untreated pain and depressive symptoms, both of which can contribute to poor quality of life and disability20212223 . Planned care that optimizes quality of life, prevents progression of the disease, manages acute flare-ups and judiciously manages coexisting conditions can benefit individuals with OA [38] . "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2013
    • "These findings suggest that those adults in rural communities who have mental health concerns with a limited support system may be particularly vulnerable to perceiving a stigma regarding their mental health issues. Other studies suggest the possibility that perceived stigma in relation to mental health might act as a barrier to mental health care [6,17] . Identifying those populations at greatest risk of perceiving stigma may help to determine groups also at greatest risk for the negative aspects of not receiving mental health care such as chronic disease, decreased quality of life and worsening mental illness. "
    Full-text · Article · Jan 2013
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