Call to Action: Family Therapy and Rural Mental Health

Rural Suicide: Demographics, Causes, and Treatment Implications

Suicide rates in rural areas are higher than urban areas and growing, with current treatment developments only exacerbating this discrepancy. Within individual factors, both age and gender relate to and intersect with personal values related to self-reliance and attitudes toward mental health difficulties and treatment to increase suicide risk. The lethality ubiquitous in rural environments and occupations is a leading factor in rural suicide rates, with other factors such as race alternately noted to be a key factor but with more mixed findings. The cultural values of rural communities as typically negative toward mental health disclosure and treatment contribute to the disengagement of rural communities from treatment that may otherwise prevent suicides, exacerbating the physical lack of treatment access many rural communities experience. Working within the primary care system alongside increased telehealth utilization are suggested to reduce rural suicide rates.

Measuring rurality in health services research: a scoping review

Purpose

This study is a scoping review of the different methods used to measure rurality in the health services research (HSR) literature.

Methods

We identified peer-reviewed empirical studies from 2010–2020 from seven leading HSR journals, including the Journal of Rural Health, that used any definition to measure rurality as a part of their analysis. From each study, we identified the geographic unit (e.g., county, zip code) and definition (e.g., Rural Urban Continuum Codes, Rural Urban Commuting Areas) used to classify categories of rurality. We analyzed whether geographic units and definitions used to classify rurality differed by focus area of studies, including costs, quality, and access to care. Lastly, we examined the number of rural categories used by authors to assess rural areas.

Findings

In 103 included studies, five different geographic units and 11 definitions were used to measure rurality. The most common geographic units used to measure rurality were county (n = 59, 57%), which was used most frequently in studies examining cost (n = 12, 75%) and access (n = 33, 57.9%). Rural Urban Commuting Area codes were the most common definition used to measure rurality for studies examining access (n = 13, 22.8%) and quality (n = 10, 44%). The majority of included studies made rural versus urban comparisons (n = 82, 80%) as opposed to focusing on rural populations only (n = 21, 20%). Among studies that compared rural and urban populations, most studies used only one category to identify rural locations (n = 49 of 82 studies, 60%).

Conclusion

Geographic units and definitions to determine rurality were used inconsistently within and across studies with an HSR focus. This finding may affect how health disparities by rural location are determined and thus how resources and federal funds are allocated. Future research should focus on developing a standardized system to determine under what circumstances researchers should use different geographic units and methods to determine rurality by HSR focus area.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08678-9.

Integrated Behavioral Health Implementation Patterns in Primary Care Using the Cross-Model Framework: A Latent Class Analysis

Primary care has increasingly adopted integrated behavioral health (IBH) practices to enhance overall care. The IBH Cross-Model Framework clarifies the core processes and structures of IBH, but little is known about how practices vary in the implementation of these processes and structures. This study aimed to describe clusters of clinics using the IBH Cross-Model Framework for a large sample of primary care clinics, as well as contextual variables associated with differences in implementation. Primary care clinics (N = 102) in Minnesota reported their level of implementation across 18 different components of IBH via the site self-assessment (SSA). The components were mapped to all five principles and four of the nine structures of the IBH Cross-Model Framework. latent class analysis was used to identify unique clusters of IBH components from the SSA across the IBH Cross-Model Framework's processes and structures. Latent classes were then regressed onto context variables. A four-class model was determined to be the best fit: Low IBH (39.6%), Structural IBH (7.9%), Partial IBH (29.4%), and Strong IBH (23.1%). Partial IBH clinics were more urban than the other three classes, lower in SES risk than Structural IBH clinics, and located in smaller organizations than Strong IBH clinics. There were no differences between classes in race/ethnicity of the clinic area or practice size. Four groups of IBH implementation were identified representing unique profiles of integration. These clusters may represent patterns of community-based implementation of IBH that indicate easier and more challenging aspects of IBH implementation.

The Role of Telemedicine in Rural Mental Health Care Around the Globe

Purpose: Through a qualitative systematic literature review (n = 12), this article seeks to better understand how telemedicine is used globally to address mental health needs within rural areas. This article highlights common barriers and advantages to providing this type of care, arguing that telemedicine services may be quite impactful in addressing mental health care needs in rural areas, but barriers, risks, and other cultural considerations must be considered when designing and implementing telemental health intervention programs. Methods: A search was conducted using PubMed, Google Scholar, PsychINFO, Medline, and SocINDEX. The inclusion criteria: (1) studies published between the years 2012 and 2019; (2) studies that met rigorous methodological criteria or analyzed telemedicine programs rigorously with evidence-based approaches; and (3) studies that specifically address or discuss tested telemedicine intervention programs for mental health in rural areas. Twelve articles of the 143 reviewed met the inclusion criteria. Findings: Themes included: (1) advantages (cost-effectiveness; accessibility, feasibility, and addressing disparities; privacy/confidentiality; integrative/collaborative care with primary care providers); (2) barriers and challenges (digital divides and infrastructure; ongoing care); (3) need for evaluation, evidence-based programs, and sustainability; and (4) across-cultural considerations. Conclusions: Future research examining the use of telemedicine in mental health intervention programs for rural areas should focus on various types of rural communities across the globe, diversifying the scope of this type of research and allowing for a better understanding of how to implement programs that address specific needs and barriers unique to rural communities across the globe.

Family Medicine Physicians' Perspectives Regarding Rural Behavioral Health Care: Informing Ideas for Increasing Access to High-Quality Services

Primary care settings often function as the front lines for behavioral health services in rural areas. The lack of formal behavioral health care in rural areas is also well documented. Rural family practice physicians were interviewed regarding the state of behavioral health care in their communities and their ideas for increasing access to quality care. Thirteen family practice physicians in rural locations participated in in-depth semi-structured interviews. Interviews were transcribed, coded, and analyzed following a phenomenological design. Physicians described a lack of quality behavioral health services and challenges for integrating and collaborating with those that do exist. Participants also described the changing role of stigma, service delivery strategies that are currently working, and the unique role primary care plays in rural behavioral health care. Several ideas for increasing access to and efficacy of services are discussed; these ideas are informative for future research and interventions.

Attitudes of rural communities towards the use of technology for health purposes in New Zealand: a focus group study

OBJECTIVES

Examine attitudes to using online health and wellness services, and determine what barriers may exist to this in two rural communities in New Zealand.

DESIGN

A thematic analysis informed by a social constructivist paradigm explored the attitudes of youth and adults to give voice to these communities. Eighteen focus groups-nine in each region-were held for an hour each, with between three and nine participants in each group.

SETTING

Two rural areas at the Northern and Southern ends of New Zealand were chosen. In each area, we partnered with a local health centre providing primary care services. Three localities were identified within each region where we conducted the data collection.

PARTICIPANTS

Participants were youth aged 12-15 years, aged 16-20 years and adults over 21 years. Overall, 74 females and 40 males were recruited. Recruitment occurred through schools, community organisations or personal contacts of the facilitators, who were youth workers in their respective communities. Ethnicity of the participants was representative of each area, with a higher percentage of Māori participants in Northland.

RESULTS

Eight themes were identified which described participants' attitudes to technology use in healthcare. Themes covered accessibility, cost, independence, anonymity and awareness issues: technology makes health information easily accessible; access to technology can be limited in rural communities; technology can reduce the cost of healthcare but it is too expensive for some; technology increases independence and autonomy of people's own health; independent healthcare decisions come with risks; anonymity encourages people to seek help online; technology can help raise awareness and provide peer-support for people with health issues; technology impacts on social relationships.

CONCLUSIONS

Participants-particularly youth-were generally positive about the role of technology in healthcare delivery, and interested in ways technology could improve autonomy and access to health and wellness services.