Emily J. Hauenstein

Rurality, Gender, and Mental Health Treatment

Mental health problems are common and costly, yet many individuals with these problems either do not receive care or receive care that is inadequate. Gender and place of residence contribute to disparities in the use of mental health services. The objective of this study was to identify the influence of gender and rurality on mental health services utilization by using more sensitive indices of rurality. Pooled data from 4 panels of the Medical Expenditure Panel Survey (1996–2000) yielded a sample of 32,219 respondents aged 18 through 64. Variables were stratified by residence using rural–urban continuum codes. We used logistic and linear regression to model effects of gender and rurality on treatment rates. We found that rural women are less likely to receive mental health treatment either through the general healthcare system or through specialty mental health systems when compared to women in metropolitan statistical areas (MSA) or urbanized non-MSA areas. Rural men receive less mental health treatment than do rural women and less specialty mental health treatment than do men in MSAs or least rural non-MSA areas. Reported mental health deteriorates as the level of rurality increases. There is a considerable unmet need for mental health services in most rural areas. The general health sector does not seem to contribute remarkably to mental health services for women in these areas.

Rurality and Mental Health Treatment

Diversity within rural areas renders rural–urban comparisons difficult. The association of mental health treatment rates with levels of rurality is investigated here using Rural–Urban Continuum Codes. Data from the 1996–1999 panels of the Medical Expenditure Panel Survey are aggregated to provide annual treatment rates for respondents reporting mental health problems. Data show that residents of the most rural areas receive less mental health treatment than those residing in metropolitan areas. The adjusted odds of receiving any mental health treatment are 47% higher for metropolitan residents than for those living in the most rural settings, and the adjusted odds for receiving specialized mental health treatment are 72% higher. Findings suggest rural community size and adjacency to metropolitan areas influence treatment rates.

Feasibility, acceptability, and effects of gentle Hatha yoga for women with major depression: Findings from a randomized controlled mixed-methods study

Major depressive disorder (MDD) is a common, debilitating chronic condition in the United States and worldwide. Particularly in women, depressive symptoms are often accompanied by high levels of stress and ruminations, or repetitive self-critical negative thinking. There is a research and clinical imperative to evaluate complementary therapies that are acceptable and feasible for women with depression and that target specific aspects of depression in women, such as ruminations. To begin to address this need, we conducted a randomized, controlled, mixed-methods community-based study comparing an 8-week yoga intervention with an attention-control activity in 27 women with MDD. After controlling for baseline stress, there was a decrease in depression over time in both the yoga group and the attention-control group, with the yoga group having a unique trend in decreased ruminations. Participants in the yoga group reported experiencing increased connectedness and gaining a coping strategy through yoga. The findings provide support for future large scale research to explore the effects of yoga for depressed women and the unique role of yoga in decreasing rumination.

Depression in Adolescence

Major depressive disorder is a common problem for adolescents. It has a wide array of symptoms affecting somatic, cognitive, affective, and social processes. Academic failure, poor peer relationships, behavioral problems, conflict with parents and other authority figures, and substance abuse are some of the consequences of major depressive disorder in this age group. Effective treatments include nontricyclic antidepressants and coping skills training. The nurse is key to depression detection and suicide prevention, especially in primary care settings. Through psychoeducation, nurses can promote recovery from depression by encouraging a healthy lifestyle, enhancing social skills, and assisting the adolescent to identify and use sources of social support. These measures can prevent premature death and promote long-term well-being of the adolescent.

Prevalence of major depressive episodes in rural women using primary care.

Women carry a disproportionate burden of depression in part because situational and other factors enhance their risk. Rural women may be at particular risk because of poverty and lack of treatment opportunities. For this study we investigated the rate of current major depressive episodes (MDE) in impoverished rural women seeking care in a community health center (CHC) in the rural South. We screened 982 women for MDE during a routine primary care visit: about half were positive for depressive symptoms. Of women positive at screening, 194 were then assessed for psychiatric disorder. A current MDE was observed in 14.3% of women screened for depression and 72.2% of women assessed for psychiatric disorder. Recognizing that neither of these percentages reflects the likely rate of MDE among the larger population of rural impoverished women, we used probability theory and binary logistic regression to estimate a depression rate that could be applied as one factor associated with unmet need in this population of women. We estimate that 44.3% of the population of women using the CHC had MDE. These findings underscore the need for mental health services in rural primary care, especially in facilities serving impoverished women.

Race and Ethnicity and Rural Mental Health Treatment

Objective. Research has shown that there is less use of mental health services in rural areas even when availability, accessibility, demographic, and need factors are controlled. This study examined mental health treatment disparities by determining treatment rates across different racial/ethnic groups. Methods. Data from the first four panels of the Medical Expenditure Panel Survey (MEPS) were used for these analyses. The sample consisted of 36,288 respondents yielding 75,347 person-year observations. The Economic Research Service’s Rural-Urban Continuum was used as a measure of rurality. Results. Findings show that rural residence does little to contribute to existing treatment disparities for racial/ethnic minorities living in these areas. Conclusions. Findings suggest that characteristics of the rural environment may disadvantage all residents with respect to mental health treatment. In more populated areas where mental health services are more plentiful, complex racial and service system factors may play a greater role in evident ethnic/racial treatment disparities.

A nursing practice paradigm for depressed rural women: Theoretical basis

Depression is common among disadvantaged, rural women. Few of these women are treated because of access barriers or because treatment does not meet their needs. A treatment program for major depressive disorder (MDD) was designed based on biopsychosocial perspectives of the cause of MDD and practice roles of psychiatric nurses. The Nursing Practice Paradigm for Depressed Rural Women (NPP) guides a structured short-term nursing care program for MDD, the Womens Affective Illness Treatment Program (WAIT). The NPP and its theoretical basis are described.

A nursing practice paradigm for depressed rural women: The women's affective illness treatment program

Major depressive disorder (MDD) results from a complex interplay of biological, psychological, and social factors that act as historical and contemporary antecedents. To promote and maintain recovery from depression women with MDD must understand their depression risk, act to reduce symptoms, and maintain a lifetime program of relapse prevention. This requires self-care skills including self-assessment, stress response reduction, and health behavior modification. The Womens Affective Illness Treatment Program (WAIT) is a skill-based depression recovery program that addresses the complex cause of major depressive disorder in women. WAIT is based on the Nursing Practice Paradigm described in a previously published article.

Electronic Screening for Mental Health in Rural Primary Care: Implementation

The goals of this study were to develop a computer-based electronic screening tool (eScreening) and determine the feasibility of implementing eScreening for rural users of primary care. This descriptive pilot adapted existing screening measures for depression and alcohol abuse to a portable computer-based format and examined the feasibility of its adoption and use. This was a three-step design using convenience samples for (1) a focus group with providers, (2) usability testing with selected rural patients using the computerized touch screen, and (3) implementing the touch screen platform with a small sample in primary care to determine feasibility. This paper reports on Phase III, which assessed consumer response to eScreening.

Psychiatric assessment and confirmation of dual disorders in rural substance abusing women

Accurate diagnosis of a comorbid or dual disorder in substance abusing women is critical to treatment and recovery. However, accurate diagnosis of comorbid disorders is difficult. Factors such as instrumentation and timing of diagnostic interview make results highly variable. This article describes difficulties encountered in screening and diagnosing dual disorders in a sample of rural, substance abusing women. The efficacy of screening and diagnostic measures in detecting depression and substance abuse is evaluated, and factors affecting diagnosis are described. The implications of those findings for case finding and management in psychiatric nursing practice are discussed.