Rural-urban comparison of contextual associations with self-reported mental health status

Abstract

Ample evidence documents the association between individual-level risk factors and mental health status; relatively less is known about associations between features of the context in which individuals live and their mental health. The objective of this study is to assess differences in associations between contextual characteristics of both rural and urban settings and mental health status measured by the mental health component of the SF-12. Using state-representative data, we observed significant rural/urban differences in the association of mental health status with availability of health care resources but no significant associations in other contextual domains. Lack of overlap in contextual associations suggests that contextual influence operates differently in rural and urban settings and that interventions to improve mental health may not translate across settings.

Figure 1 -. Conceptual Model of Effects of Contextual and Individual Level Characteristics on Self-Reported Mental Health Status

Each box identifies domains potentially exerting effects on mental health status. Domain names are in bold while sub-domains appear in italics. Block arrows represent direct additive effects between domains while thin arrow represents interactive effects between contextual and individual characteristics. The star indicates the pathway of main interest in this study.