1. Unmet Mental Health Treatment Needs among Rural and Urban Adults with Depression
Ty Borders, PhD
Director, Rural and Underserved Health Research Center
Professor and Foundation for a Healthy Kentucky
Endowed Chair in Rural Health Policy
University of Kentucky
This project was supported by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement # U1CRH The information, conclusions and opinions expressed in this document are those of the authors and no endorsement by FORHP, HRSA, HHS, or the University of Kentucky is intended or should be inferred. ©2018, Rural & Underserved Health Research Center, University of Kentucky.

2. Background
Rural and urban adults have similar rates of major depression
Little research has investigated unmet mental health treatment needs among rural and urban adults

3. Objectives and Data
Estimate prevalence of major depressive episodes (MDE) among U.S. adults by metropolitan status
Estimate prevalence and correlates of unmet MH treatment needs and utilization
(among metro and non-metro adults with MDE)
National Survey on Drug Use and Health (NSDUH) 2016
Unweighted N for all adults = 42,324
Unweighted N for adults with MDE =3,587

4. Key Variables Major depressive episode (assessed with CIDI)
Unmet treatment need
feeling a perceived need for mental health treatment/counseling that was not received
Any mental health treatment use
Metropolitan status
Large metropolitan (MSA ≥ 1 million)
Small metropolitan (MSA < 1 million)
Non-metropolitan (outside standard MSA)

5. Analysis Chi-square metropolitan differences in MDE
among persons with MDE, differences in unmet MH treatment need and use
Logistic regression
Metropolitan differences in unmet MH treatment need and use
Adjusted for demographic, social, economic, and clinical and health factors
SAS survey procedures accounted for complex sampling scheme and weights

6. Prevalence of MDE, Unmet Need, and Tx Use

7. Unmet Needs
Any Treatment OR
95% CI
Metropolitan status
Large metro (v non-metro)
Small metro
Age category (v >65)
18-25
3.19
(1.75, 5.84)
26-34
2.38
(1.23, 4.58)
35-49
2.12
(1.23, 3.67)
50-64
Male
0.68
(0.54, 0.86)
(0.55, 0.84)
Race/ethnicity (v Hispanic)
White
1.59
(1.12, 2.25)
Black/Afr Amer
Nat Amer/AK Native
Native HI/Oth Pac Isl
0.18
(0.05, 0.65)
Asian
0.36
(0.17, 0.78)
Other race

8. Unmet Needs
Any Treatment OR
95% CI
Marital status (v never married)
Married
1.34
(1.04, 1.73)
Widowed
Divorced/separated
1.45
(1.03, 2.04)
Education (v college grad)
< high school
0.43
(0.30, 0.62)
High school grad
0.68
(0.49, 0.94)
0.50
(0.36, 0.70)
Some college
0.62
(0.47, 0.81)
Employment (v not in labor force)
Full-time
0.61
(0.43, 0.85)
Part-time
Unemployed
Family income (v >$75,000)
<$20,000
$20,000-$49,999
0.65
(0.46, 0.90)
$50,000-$74,999
0.67
(0.46, 0.96)

9. Unmet Needs
Any Treatment OR
95% CI
Health insurance
Private
0.71
(0.56, 0.91)
1.36
(1.04, 1.77)
Medicare
Medicaid
Champus
0.55
(0.31, 0.98)
Clinical and health factors
Health overall (v fair/poor)
Excellent
0.58
( )
Very good
0.65
(0.49, 0.86)
Good
K6 score > 13
2.69
(2.04, 3.54)
1.65
(1.28, 2.12)
Alcohol abuse/dep
1.41
(1.09, 1.82)
Drug abuse/dep
Opioid misuse
1.89
(1.34, 2.67)

10. Conclusions
Treatment continues to be lacking for rural and urban adults alike
Psychiatric distress and substance use problems notably associated with unmet needs

11. Questions and Discussion