Access to mental health services is a growing concern in the United States, especially in rural and underserved communities. The purpose of this study was to estimate the prevalence of mental health conditions and compare the utilization of mental health services across rurality in the National Institutes of Health All of Us Research Program (NIH-AOURP). Data were accessed via the NIH-AOURP online workbook environment. Participants were classified as rural if they indicated by survey that they resided too far from a health care provider. Participants reported lifetime history of a mental health or substance use condition and utilization of mental health care within the last 12 months. Demographic characteristics included race, ethnicity, sex, gender identity, insurance status, and age. Logistic regression models estimated the odds of mental health utilization adjusting for sex, age, and insurance status. Among the 105,819 participants, 2.8% identified as rural. Proportionally more rural participants reported a lifetime history of a mental health condition (57.9%) versus nonrural participants (49.9%, p < .01). Adjusting for covariates, rural participants with a history of a mental health condition had significantly greater odds of mental health utilization than nonrural participants (OR: 1.82, 95% CI [1.68, 1.97]). Lifetime history of a mental health condition and last-month mental health utilization varied significantly by rurality. Recent telemental health expansion may have increased rural access to mental health services. Relatively few rural participants were identified in the NIH-AOURP, potentially underrepresenting variation in mental health service needs across U.S. geographies.
Public Health Significance StatementThis study describes the prevalence and utilization of mental health conditions among rural and nonrural participants using data from the National Institutes of Health All of Us Research Program, indicating a higher prevalence of mental health conditions among rural participants, and those with a history of mental health conditions in rural areas exhibit significantly greater odds of mental health service utilization; however, the limitations of the National Institutes of Health All of Us Research Program measure of rurality must be acknowledged. This research underscores the need for reliable, accurate indicators of rurality and highlights the importance of ongoing efforts to ensure equitable access to mental health services for rural residents.