Intrarural Variation in Mental Health Status and Help-Seeking of Veterans in the Upper Midwest

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Abstract

Rural-urban disparities in the prevalence of mental disorders and in access to mental health care among veterans have been documented, but no consistent pattern has emerged. Mixed research findings may be because of broad distinctions between rural and urban that mask intrarural variation in veteran mental health. This study explored the extent to which location and veteran status predict lifetime prevalence of mental illness (depression and anxiety or panic attacks), delayed help seeking for an emotional problem, binge drinking, and general health. We analyzed survey data from a regionally representative survey of residents of 9 counties in northeastern Minnesota and northwestern Wisconsin (N = 4,050). Generalized linear models were used to analyze the effects of veteran status, location, and an interaction term on 5 dependent variables. Veterans in the sample (n = 124) were more rural, older, and more male than nonveterans. Within the subgroup of veterans, those who lived in the most rural areas reported the lowest lifetime prevalence of depression and the best general health. Compared with nonveterans, veterans living in the least rural areas reported poorer general health and significantly higher lifetime rates of depression. Our findings show a health advantage for the most rural veterans, extending previous research by analyzing intrarural variation in a community-based sample of veterans. Analyses of more refined geographic categories are needed to identify meaningful disparity patterns and inform community-based interventions to promote veteran mental health.

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