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Rural Health Information Hub

Factors that Affect Mental Health in Rural Communities

In the United States, approximately 1 out of 5 adults living in rural areas experience mental illness. Although the prevalence of mental illness and psychiatric disorders is similar in rural and urban areas, people living in rural areas experience unique influencing factors when it comes to managing their mental health.

The American Mental Wellness Association identifies many risk and protective factors for mental health conditions. Protective factors help promote positive mental health and make it less likely for mental health conditions to emerge or become problematic. Risk factors can make it more likely that individuals develop certain mental health conditions.

These factors are especially important to consider when developing and implementing programs. Understanding the influences of these factors on community members will help determine each rural community's specific needs for mental health services. Risk and protective factors can be societal, community, inter-personal, or individual characteristics.

  • Societal
    • Poverty
    • Stigma
    • Racism and discrimination
  • Community
    • Availability of community resources
    • Housing instability
    • Economic security
    • Educational opportunities
  • Interpersonal
    • Adverse Childhood Experiences (ACEs) and other traumatic life experiences
    • Reliable support from peers and family members
    • Parental involvement and supervision
    • Family mental health and substance use
    • Social isolation
  • Individual
    • Biological/genetic factors
    • Chronic medical conditions
    • Healthy diet and exercise
    • Coping skills

At the societal level, lack of resources related to poverty and limited educational opportunities are risk factors for developing mental health conditions. Overall, rural populations have lower median household incomes, levels of employment, and educational attainment than the general population. Historical trauma may also affect mental health conditions across generations of affected groups, including tribal communities in rural areas.

At the community level, individuals living in rural areas are less likely to have access to mental health services and treatment, such as therapy and medication, due to a shortage of mental health workforce professionals.

COVID-19 Pandemic

In evaluating risk and protective factors for mental health, it is important to recognize the significant impact of the COVID-19 pandemic on health outcomes, including mental health, in the U.S. Research has linked the pandemic to increased rates of anxiety and depression, substance use, drug and alcohol-related deaths, and suicide deaths which have persisted after the end of the public health emergency. These mental health concerns have been exacerbated by other challenges that continue to affect rural communities. For example, rural communities are particularly vulnerable to changes in economic conditions, including the pandemic's economic impact. Many rural residents dealing with unemployment reported that the pandemic negatively affected their mental health.

Additional factors that impacted mental health conditions during and in the wake of the COVID-19 pandemic include:

  • Workforce burnout
  • Economic uncertainty
  • Isolating public health precautions
  • Concerns about serious illness
  • Ongoing health impacts
  • Loss of life

For more information about providing mental health services in rural areas, visit our Rural Mental Health topic guide.

Resources to Learn More

A Call to Action to Address Rural Mental Health Disparities
Describes how the National Institute on Minority Health and Health Disparities research framework can be applied to understand and address the complexity of rural mental health disparities.
Author(s): Morales, D.A., Barksdale, C.L., & Beckel-Mitchener, A.C.
Citation: Journal of Clinical Translational Science, 4(5), 463-467
Date: 10/2020

National Rural Health Association Policy Brief: Mental Health in Rural Areas
Provides an overview of the mental health landscape in rural America and offers policy recommendations.
Author(s): Mack, B., Whetsell, H., & Graves, J.
Organization(s): National Rural Health Association
Date: 2/2022

The Rural Mental Health Crisis
Offers quick facts on the various issues affecting the state of mental health in rural America.
Organization(s): Mental Health America, Rural Minds
Date: 10/2022

Rural Mental Health's Stressors, Barriers, and Protective Factors: Q&A with Dr. Dawn Morales
Discusses challenges to rural mental healthcare delivery and considerations for providing culturally competent care for rural and tribal populations.
Author(s): Mead, A.
Organization(s): Rural Health Information Hub
Citation: Rural Monitor
Date: 4/2023

Social Determinants of Mental Health: Where We Are and Where We Need to Go
Summarizes literature regarding social determinants of health and their impact on mental health outcomes. Discusses what was learned from current interventions and offers recommendations on collecting and analyzing data to identify the social determinant interventions most effective.
Author(s): Alegría, M., NeMoyer, A., Falgas Bague, I., Wang, Y., & Alvarez, K.
Citation: Current Psychiatry Reports, 20(11), 95
Date: 9/2018