Predictors of Mental Health Service Use Among Rural Residents in Eastern Pennsylvania

Background and purpose: It is estimated that 2.6 million rural adults suffer from depression (Probst, Laditka, Moore, Harun, Powell, Baxley, 2006). However, mental health services are less accessible to rural residents due to fewer resources and greater barriers (Goins, Williams, Carter, Spencer, & Solovieva, 2005). It is important to understand the mental health service utilization among rural residents to ensure the rural residents’ needs are met. Guided by the Andersen’s behavioral health model (Andersen & Newman, 1973), the present study explored predictors of mental health service utilization among rural residents.

Methods: This study employed online and in-person survey methodology. Survey questionnaire was developed by the investigators. Using purposive sampling, community-wide data collection was conducted through three school districts, churches, and senior living facilities in summer 2018 in a rural area of Eastern Pennsylvania. The project was approved by the University’s Institutional Review Board (IRB). Final sample size was 664. The outcome variable, mental health service use was coded as 0 = non-use and 1 = use. Predisposing (age, gender, marital status, education, income), enabling (familiarity with services, self-rated health), and need (difficulties in mental health) components were examined as predictors of service use. Descriptive statistics and logistic regression models were calculated using SPSS 25.

Results: 21.6% of the participants showed probable depression in the sample. However, only 9% of the sample had used mental health services in the community. The logistic regression model showed that mental health service use was predicted by marital status, familiarity with services, and mental health needs. A higher likelihood of service use was found among those who were not married (OR=.30, 95% CI= [.15, .58], p < .001), who were familiar with community services (OR= 1.2, 95% CI= [1.1, 1.4], p < .001), and who had difficulties in mental health (OR= 3.6, 95% CI= [1.8, 7.2], p < .001). No interactions between familiarity with services and the other variables were found to be significant.

Implications: The results of the study suggest that familiarity with community services increases the likelihood of service use. Therefore, community organizations in rural areas should strengthen their community outreach efforts. More information-sharing activities in community events would help increase familiarity with available community resources and facilitate service use. Such outreach efforts should also target more vulnerable populations who are unmarried and have mental health needs. In addition, integrated health care programs can be suggested as a way to better identify people with mental health needs.