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Rural‐Urban Differences in Service Use and Course of Illness in Bipolar Disorder
Author(s) -
Rost Kathryn,
Owen Richard R.,
Smith Jeffrey,
Jr. G. Richard Smith
Publication year - 1998
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/j.1748-0361.1998.tb00860.x
Subject(s) - bipolar disorder , odds ratio , medicine , confidence interval , mental health , odds , psychiatry , mental illness , rural area , family medicine , logistic regression , cognition , pathology
Policy analysts have long been concerned that the reduced availability of mental health professionals in rural areas prohibits rural individuals from getting the care they need for serious psychiatric conditions like bipolar disorder. Through a community‐based telephone survey, the researchers recruited 54 subjects with bipolar disorder who were currently experiencing depressive episodes. Forty‐six (85.1%) of them were reinterviewed one year after the first survey. Multivariate models indicate that while rural subjects were just as likely to receive nonacute services for mental health problems as their urban counterparts, the rural residents had 22.1 times the odds (95% confidence interval 2.5 to 198.3, P=0.006) of receiving such services exclusively from a general medical provider. Rural subjects had 5.8 times the odds (95% confidence interval 0.8 to 40.7, P=0.07) of using hospital or emergency room services and 4 times the odds (95% confidence interval 0.8 to 20.5, P=0.10) of experiencing a manic episode during the year following baseline. While rural individuals with bipolar disorder have a comparable likelihood of receiving care for their mental health problems, they utilize more acute services and experience worse outcomes. Further research is warranted to deter‐mine what causes these differences before developing cost‐effective ways to improve the care delivered to individuals with this serious illness.