Edwards Alyssa, Hung Rina, Levin Jennifer B, Forthun Larry, Sajatovic Martha, McVoy Molly
Case Western Reserve University School of Medicine and University Hospitals of Cleveland Medical Center.
Family, Youth and Community Sciences, University of Florida.
Rural Ment Health. 2023 Jul;47(3):163-178. doi: 10.1037/rmh0000228. Epub 2023 May 11.
There is growing concern about the availability of healthcare services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health conditions in North America. Using PRISMA guidelines, we used four electronic databases (Pubmed, Cochrane, PsychInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus non-rural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle Ottawa Scale was used. Our initial search returned 491 studies and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), PTSD (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities while eleven (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in person outreach to these rural communities may be alternatives to impact these outcomes.
农村患者获得医疗服务的情况日益受到关注。本系统文献综述评估了北美农村和城市心理健康状况人群健康差异的原创性研究。我们遵循PRISMA指南，使用了四个电子数据库（PubMed、Cochrane、PsychInfo、Web of Science）并进行了手工检索，纳入了2021年7月之前在美国或加拿大进行的原创性研究，这些研究比较了农村和非农村地区患有任何精神疾病患者的健康结局。提取了定性和定量数据，包括人口统计学、心理健康状况、健康差异衡量指标、农村定义、健康结局衡量指标/主要发现以及提供方式。为评估研究质量，使用了改良的纽卡斯尔渥太华量表。我们最初的检索返回了491项研究，17项研究符合最终纳入标准。精神疾病包括精神分裂症（4项研究）、创伤后应激障碍（10项）、情绪障碍（9项）和焦虑症（6项）。总样本量为5314818，其中大多数是退伍军人。六项研究（35.2%）显示农村与城市之间没有显著差异，而十一项研究（64.7%）发现至少存在一项差异。其中，九项研究报告农村患者的结局更差。最常见的差异是诊断差异、自杀率上升和就医问题。本综述发现农村精神疾病患者的结局存在不同结果。在自杀风险和获得服务方面发现了差异。除了亲自深入这些农村社区外，远程医疗可能是影响这些结局的替代方案。
