Urban upbringing and psychiatric disorders in the United States: A racial comparison

Rural US residents recognize anxiety better than urbanites and suburbanites but hold similar stigma

PURPOSE

Recognizing signs of psychological distress is a critical first step in assisting people who are struggling with poor mental health to access help. However, community-level factors that impact recognition and stigma are underexplored. The purpose of this study is to investigate the relationship between rurality, other community-level variables, and individual variables with regard to the recognition and stigma of anxiety.

METHODS

We use a survey of US adults (N = 627), including a rural oversample, and a cloaked vignette approach. We assess the ability to identify anxiety and measure associated stigma. The analysis applies an ecological model in multinomial logistic regressions.

FINDINGS

About half of the respondents recognize anxiety from a list of possibilities when provided with a vignette detailing common anxiety symptoms. Respondents living in rural areas are nearly twice as likely to correctly identify anxiety than nonrural respondents. About one-fifth of respondents agree with a statement designed to measure stigma: that exhibiting the symptoms is a sign of personal weakness. Respondents able to identify anxiety show less stigma. Respondents from counties with high mental health provider access were less likely to endorse the stigma statement.

CONCLUSIONS

Rural areas seem poised to reduce the stigma associated with anxiety, because residents are more adept at identifying anxiety than people living elsewhere. Future work could focus on effective mechanisms for reducing stigma associated with anxiety in rural areas, and whether anxiety recognition and stigma are changing.

Association between Urban Upbringing and Compulsive Internet Use in Japan: A Cross-Sectional, Multilevel Study with Retrospective Recall

The purpose of this study was to show the association between urban upbringing and compulsive internet use (CIU). The interview data of the sample (N = 2431) was obtained from the World Mental Health Japan Second Survey and a multilevel model was used to investigate the association. Multiple imputation was also conducted in this study. Growing up in a large city was significantly associated with higher Compulsive Internet Use Scale (CIUS) scores (γ = 1.65, Standard Error (SE) = 0.45) and Mild CIU + Severe CIU (Exp(γ) = 1.44; 95% Confidence Interval (CI) (1.04-2.00)) compared to growing up in a small municipality after adjusting for both sociodemographic characteristics and psychopathology. This study showed a possible association between urban upbringing and CIU. Future studies with longitudinal design are needed to better understand this association.

The Environment of Birthplace and Self-Reported Mental Health Conditions: Findings from the American Panel of Life

Studies from around the globe have found that urbanicity is associated with greater risk for certain psychiatric disorders, though the association has been less evident in the United States. We analyzed data collected in 2019 from the RAND American Life Panel (n = 2554), which were representative of the general adult population of the United States. Using multivariable logistic regression, we examined the associations between environment of birthplace (large urban, small urban, suburban, rural) and psychiatric disorders, adjusting for sociodemographic characteristics. We found that being born in a large urban area was associated with greater odds of having any psychiatric disorder when compared with being born in a rural area. However, when looking at specific disorders, we found that being born in a large urban area was only significantly associated greater odds of anxiety disorder and post-traumatic stress disorder (PTSD), but was not associated with bipolar disorder, major depressive disorder, attention deficit/hyperactivity disorder, or alcohol/substance use disorder. Being born in a small urban area was marginally associated with anxiety disorder. Future studies should examine why urban birthplace has only been associated with anxiety disorders and PTSD in the United States, and why urbanicity is associated with mood disorders in other parts of the world but not in the United States.