Title: Mental Health Effects in Rural vs Urban Areas During the COVID-19 Pandemic
Authors: Sage Chase, MAMSc; Emily Nelson, MAMSc; Rachel Simmons, MAMSc
Introduction
The COVID-19 pandemic has had significant impacts on almost every aspect of society in the United States. As this unpredictable virus rampaged across the country, physical health ramifications were predicted. However, it was unknown how severely this pandemic would impact mental health. Both rural and urban areas have had varying levels of restrictions set in place, leaving many to feel isolated due to significantly less social interaction, decreased access to healthcare and access to psychologists. Our study will analyze the effects of the COVID-19 pandemic on anxiety and depression rates in rural versus urban areas of the United States.
Methods
We conducted a literature search using PubMed, Google Scholar, NIH, CDC, and TripPro with combinations of the keywords: rural, urban, mental health, COVID-19, and pandemic. Articles applying to outside of the U.S. and involving participants under the age of 18 were excluded. We identified just 3 articles with a total of 7,384 participants having survey-based data to analyze mental health effects in rural vs. urban areas during the COVID-19 pandemic.
Results
Our search found there is an increase in adverse mental health effects among adults during the COVID-19 pandemic. Anxiety and depression were two specific mental health conditions that were measured in these studies. They were both reported to have increased during the COVID-19 pandemic. A variety of subgroups in the data showed different mental health effects between age, race, education, and financial position. Mental health effect discrepancies among rural and urban areas were surprisingly not significant. However, the sample size from rural areas was much smaller than from the urban areas.
Discussion
These findings illustrate the major impact the COVID-19 pandemic has had on mental health conditions across the U.S. However, the COVID-19 pandemic is a recent and ongoing event with limited studies available. The lack of significant differences in mental health effects between rural and urban areas could well be due to this limited research and short snapshot of data available. More studies should be conducted that specifically look at rural and urban areas, particularly with larger sample sizes in order to accurately assess the mental health effects during the COVID-19 pandemic.
Thanks for exploring an interesting topic. As one of the judges for your poster, I was wondering how you decided on a population of 50,000 as a cutoff for urban versus rural and how does population density figure in to this figure. Also, by some definitions “urban clusters” are areas with 10,000 to less than 50,000 population areas, so how might that affect your definition? Thanks!
Thank you for your question!
The articles we used defined rural and urban populations according to the U.S. Census Bureau and Office of Management and Budget standards of over/under 50,000 people in a county. For our chosen articles they treated these populations as hard lines and did not consider urban clusters in their data.
Urban clusters could potentially affect the outcome of our review as some of the rural data may align better with urban populations due to these clusters. It would be important for future studies to look at urban clusters to determine the significance of mental health effects on these areas during the pandemic.
Thanks for this presentation, I am one of your judges. Based on your investigation of the literature, what were the primary factors that served to balance out the effect of COVID-19 on mental health in rural vs. urban populations?
Hi Dr. Mapes, thank you for your question. Based on our literature investigation, two primary factors that may have balanced out the effect of COVID-19 on mental health effects in rural vs. urban populations are an increase in telehealth access and consideration of “urban clusters” being included in the rural population data. During the COVID-19 pandemic, the United States government worked to increase access to broadband and telehealth services across the country. The CARES Act helped bring broadband to rural areas. This would allow rural communities to have more access to mental health services. Next, the literature we reviewed did not separate “urban clusters”, defined as areas with 10,000 to less than 50,000 people, which include populations that may be near larger metropolitan areas that have more access to healthcare services. It’s important to consider this lack of significant differences in mental health effects between rural and urban areas could be due to the limited research done thus far and more research is needed to assess mental health effect differences between rural and urban areas.
Thank you for your presentation. I am one of the judges for your poster. Did literature you reviewed include metrics for evaluating how the pandemic affected daily life for respondents and/or the infection rates in their regions?
Thank you so much for your question!
We did see in the literature that the pandemic affected daily life in regards to mental health, however it was not significantly different between rural and urban populations.
The second article, (Mueller), reported 28.35% of respondents had direct contact with the virus in rural areas and was compared to the 43.68% respondents reporting a negative mental health impact. This paper used this comparison to show that negative mental health impacts were not only reported in infected individuals.