Is the rural idyll bad for your health? Stigma and exclusion in the English countryside

Place, health and dis/advantage: A sociomaterial analysis

The substantial literature on interactions between places/spaces and well-being/health often differentiate between physical and social aspects of geographical location. This paper sidesteps this dualism, instead considering places as sociomaterial assemblages of human and non-human materialities. It uses this posthuman and 'new materialist' perspective to explore how place-assemblages affect human capacities, in terms of both health and social dis/advantage. Based on secondary analysis of interview data on human/place interactions, it analyses the physical, sociocultural, psychological and emotional effects of place-assemblages, assessing how these produce opportunities for, and constraints upon human bodies. It than assesses how these emergent capacities affect both social dis/advantage and well-being. This analysis of how place-assemblages contribute positively or negatively to health and dis/advantage offers possibilities for further research and for social and public health policy.

Negotiating the care convoys for a diverse group of older Australians living in rural communities: a large qualitative study

Whilst ageing in place is integral to international policy, there is less understanding of how individuals utilise formal services and informal supports in diverse rural environments to maintain their wellness and independence. Consequently, how older people negotiate their care within rural communities is subject to misconceptions. This paper draws on the convoy of care model to explore how older rural Australians negotiate their preferences and needs in the context of informal networks, availability of community resources, and the health and aged care system. The analysis draws on 60 in-depth interviews in six diverse rural communities across two Australian states. Three distinct care convoys are identified and demonstrate the interaction of multiple factors including individual preferences and needs, availability of family and community supports, and accessibility of local health and aged care services in the context of resource allocation. The findings highlight how families and communities compensate for a lack of accessible formal services. For older people without family and strong social networks, formal services are relied upon despite their inadequacy in some locales. This research has provided evidence that some Australian rural locales have limited resources resulting in challenges for older people to access home care and support. This results in many older people facing challenges to age in place. With aged care and health policy commonly designed for an urban context, our findings illustrate the importance of tailoring policy to respect the strengths and challenges existing in rural communities.

Characterizing Unusual Spatial Clusters of Male Mental Health Emergencies Occurring During the First National COVID-19 "Lockdown" in the East Midlands Region, UK: A Geospatial Analysis of Ambulance 999 Data

The widespread psychological effects of contagion mitigation measures associated with the novel coronavirus disease 2019 (COVID-19) are well known. Phases of "lockdown" have increased levels of anxiety and depression globally. Most research uses methods such as self-reporting that highlight the greater impact of the pandemic on the mental health of females. Emergency medical data from ambulance services may be a better reflection of male mental health. We use ambulance data to identify unusual clusters of high rates of male mental health emergencies occurring in the East Midlands of the United Kingdom during the first national "lockdown" and to explore factors that may explain clusters. Analysis of more than 5,000 cases of male mental health emergencies revealed 19 unusual spatial clusters. Binary logistic regression analysis (χ2 = 787.22, df = 20, p ≤ .001) identified 16 factors that explained clusters, including proximity to "healthy" features of the physical landscape, urban and rural dynamics, and socioeconomic condition. Our findings suggest that the factors underlying vulnerability of males to severe mental health conditions during "lockdown" vary within and between rural and urban spaces, and that the wider "hinterland" surrounding clusters influences the social and physical access of males to services that facilitate mental health support. Limitations on social engagement to mitigate effects of the pandemic are likely to continue. Our approach could inform delivery of emergency services and the development of community-level services to support vulnerable males during periods of social isolation.

Stigma in place: Black gay men's experiences of the rural South

Black gay men (MSM) in the rural United States South are inequitably burdened by stigmatization and the HIV epidemic. Drawing from twelve oral history interviews with middle-aged and older Black gay narrators from rural North Carolina, this research explores the impact of sexual marginalization and the HIV epidemic on lived experiences of the rural South. Despite describing increasingly empowered views of HIV and sexual health, narrators expressed persistent difficulty managing social determinants of HIV vulnerability-sexual stigma and disconnection from LGBTQ collectivity. Narrators reported better managing sexual marginalization over their lifetimes in urban settings and places outside of the South such as New York (NY). This research suggests stressful structural and interpersonal experiences of stigma may define lived experiences of particular settings.

How do Lesbian, Gay and Bisexual Teachers Experience UK Rural School Communities?

This article examines how lesbian, gay and bisexual teachers in rural schools negotiate their sexual identities within the workplace. Although there has been progress towards LGBT (lesbian, gay, bisexual and transgender) inclusion for teachers in urban and suburban schools, this article shows that their rural counterparts often experience their school communities differently. A questionnaire gathered data from school teachers in the United Kingdom identifying as LGBT. Whilst a small number of transgender, gender queer and non-binary teachers completed the questionnaire, it is important to note that these teachers taught only in urban environments. In rural schools, respondents identified only as lesbian, gay or bisexual (LGB). Therefore, LGB is used when referring to the rural respondents in this study and LGBT is used when referring generally to the lesbian, gay, bisexual and transgender community. The experiences of teachers working in rural schools were compared with those working in urban or suburban school settings. Results showed that LGB teachers in rural communities lack the opportunity to speak their identity into existence at school, and often find their personal and professional identities incompatible, leading to low self-worth, depression and anxiety. The article shows that in rural school communities, traditional and conservative rural norms and values are compelling and are often protected at the expense of creating safe and inclusive workplaces for LGB teachers.

Gendered mortality differentials over the rural-urban continuum: The analysis of census linked longitudinal data from England and Wales

BACKGROUND

Previous research shows that mortality varies significantly by residential context; however, the nature of this variation is unclear. Some studies report higher mortality levels in urban compared to rural areas, whereas others suggest elevated mortality in rural areas or a complex U-shaped relationship. Further, the extent to which compositional factors explain urban-rural mortality variation, the extent to which contextual factors play a role and whether and how the patterns vary by gender also remain unclear. This study investigates urban-rural mortality variation in England and Wales and the causes of this variation.

METHOD

The study applies survival analysis to the Office for National Statistics Longitudinal Study; the population aged 20 and older in 2001 is followed for 10 years.

RESULTS AND CONCLUSIONS

The analysis demonstrates a clear urban-rural mortality gradient, with the risk of dying increasing with each level of urbanisation. The exceptions are those living in areas adjacent to London, who consistently exhibit lower mortality than anticipated. Once the models are adjusted to individuals' socio-economic characteristics, the variation across the urban-rural continuum reduces substantially, although the gradient persists suggesting contextual effects. Females are found to be influenced more by their surrounding environment and males by their socio-economic position, although both experience lower mortality in rural compared to urban areas.

Mediating Effects of Social Support and Internalized Homonegativity on the Association Between Population Density and Mental Health Among Gay and Bisexual Men

PURPOSE

Depression negatively impacts the health and well-being of gay and bisexual men (GBM). However, little is known about the contexts in which rural GBM live relative to those living in urban areas and their overall mental health. The aim of this study was to examine associations between population density and depressive symptoms and the role of internalized homonegativity and social support as potential mediators.

METHODS

A nationally representative sample of 1071 GBM (mean age = 40.24) was enrolled. Participants provided their zip codes, which were categorized according to population density and rank-normalized.

RESULTS

In a path analysis model adjusted for race/ethnicity, college education, age, and relationship status, higher population density was significantly associated with increased social support (B = 0.11, P = 0.002) and decreased internalized homonegativity (B = -0.06, P < 0.001). In turn, lower social support (B = -2.93, P < 0.001) and greater internalized homonegativity (B = 4.93, P < 0.001) were significantly associated with greater depressive symptoms. The indirect effects of population density on depression through social support (B = -0.33, P < 0.001) and internalized homonegativity (B = -0.31, P < 0.001) were statistically significant, suggesting evidence for mediation of the effects.

CONCLUSIONS

These results indicate that living in less inhabited areas acts on depressive symptoms through mechanisms of lower social support and higher internalized homonegativity. These findings suggest that social contexts in which GBM live can affect mental health outcomes and indicate the need for further support and inclusion of GBM, especially in less inhabited areas.

Does place of residence matter? Rural-urban differences and the wellbeing of gay men and lesbians

Does place of residence matter for gay men and lesbians? Both conventional wisdom and scholarly literature suggests that it does, and that those living in rural areas are disadvantaged relative to their urban peers. This study explores this issue by comparing gay people's wellbeing in rural and urban areas. Results from a large probability sample show that rural gay people fare no worse than their urban peers. If anything, results suggest living in the largest cities may be detrimental to gay people's wellbeing, although more so for lesbians than for gay men. Results are discussed in light of 4 competing perspectives on rural-urban differences.

Area characteristics and admission rates of people with schizophrenia and affective disorders in a German rural catchment area

BACKGROUND

Studies in urban areas identified environmental risk factors for mental illness, but little research on this topic has been performed in rural areas.

METHODS

Hospital admission rates were computed for 174 rural municipalities in the catchment area of the state psychiatric hospital in Günzburg in years 2006 to 2009 and combined with structural and socio-economic data. Relationships of overall and diagnosis-specific admission rates with municipality characteristics were analysed by means of negative binomial regression models.

RESULTS

Admission rates of patients with a diagnosis of schizophrenia and affective disorder combined decrease with increasing population growth, population density, average income and green areas, while admission rates are positively correlated with commuter balance, income inequality, unemployment rates and traffic areas. Admission rates for schizophrenia are negatively related to population growth, average income and agricultural areas, but positively related to mobility index, income inequality and unemployment rate. Admission rates for affective disorders are negatively related to population growth, population density, average income and green areas, while higher admission rates are correlated with commuter balance, high income inequality, unemployment rate and traffic-related areas.

CONCLUSIONS

Effects of wealth, economic inequality, population density and structural area characteristics influence psychiatric admission rates also in rural areas.

Rural/urban differences in self-rated health: examining the roles of county size and metropolitan adjacency

This research explored the roles of 'rurality' - nonmetropolitan county population size and adjacency to metropolitan areas - on self-rated health among a nationally representative sample of US adults. Using seven years of pooled individual level data from the Behavioral Risk Factor Surveillance System and county-level data from the County Characteristics survey, we found that residents of remote rural counties have the greatest odds of reporting bad health and that the significant differences in self-rated health between metropolitan residents and residents of rural areas can be entirely explained by rural structural disadvantage, including higher rates of unemployment and population loss and lower levels of educational attainment.

Traumatic brain injury, participation, and rural identity

In this article we focus on participation following traumatic brain injury (TBI) in rural and regional Australian contexts, asking how aspects of rurality, such as place identity and rural belonging, impact on participation for the individual living with TBI. We found a preference for country living, despite disadvantages including distance from services and lack of anonymity. A rural identity provides access to an enabling narrative, the "rural idyll," which allows people with TBI to inhabit the realm of social normality. A rural identity is enabling in this regard, because it cooperates with TBI-based preferences for social isolation and a relaxed pace that accommodates fatigue. Thus, people living in rural areas report satisfaction with their quality of life despite restricted access to resources and reduced social participation.

Social capital and health in rural and urban communities in South Australia

OBJECTIVE

This paper seeks to compare the relationships between social capital and health for rural and urban residents of South Australia.

METHODS

Using data from a South Australian telephone survey of 2,013 respondents (1,402 urban and 611 rural), separate path analyses for the rural and urban samples were used to compare the relationships between six social capital measures, six demographic variables, and mental and physical health (measured by the SF-12).

RESULTS

Higher levels of networks, civic participation and cohesion were reported in rural areas. Education and income were consistently linked with social capital variables for both rural and urban participants, with those on higher incomes and with higher educational achievement having higher levels of social capital. However, there were also differences between the rural and urban groups in some of the other predictors of social capital variables. Mental health was better among rural participants, but there was no significant difference for physical health. Social capital was associated with good mental health for both urban and rural participants, but with physical health only for urban participants. Higher levels of social capital were significantly associated with better mental health for both urban and rural participants, but with better physical health only for urban participants.

CONCLUSIONS AND IMPLICATIONS

The study found that social capital and its relationship to health differed for participants in rural and urban areas, and that there were also differences between the areas in associations with socioeconomic variables. Policies aiming to strengthen social capital in order to promote health need to be designed for specific settings and particular communities within these.

Unravelling the extent of inequalities in health across urban and rural areas: evidence from a national sample in England

Studies of inequalities in health between rural and urban settings have produced mixed and sometimes conflicting results, depending on the national setting of the study, the level of geographic detail used to define rural areas and the health indicators studied. By focusing on morbidity data from a national sample of individuals, this study aims to examine the extent of inequalities in health between urban and rural areas, as well as inequalities in health across rural areas of England. Multilevel analyses for poor self-rated health, overweight and obesity, and common mental disorders are reported for a sample of 30,776 individuals aged 18 years and older (obtained from the Health Survey for England years 2000-2003 combined) and distributed across 3645 small areas classed in four categories: two groups of urban areas (Greater London area or 'other cities') and two types of rural settings (semi-rural areas or villages). Results show that rural dwellers were significantly less likely than residents of urban areas to report their health as being fair or poor and to report common mental disorders, independent of their socio-demographic characteristics. However, as for urban settlements, there were significant variations in health across semi-rural areas and across villages, indicating the presence of health inequalities within rural settings in England. These inequalities were not fully explained by the individual composition of the areas or by the available measures of area socioeconomic conditions, indicating that in rural contexts more specific factors may have significance for health. Different policies and services for health promotion and care may need to be targeted to different types of rural areas.