The Association Between Rural Residence and the Use, Type, and Quality of Depression Care

Abstract

Objective: To assess the association between rurality and depression care. Methods: Data were extracted for 10,319 individuals with self-reported depression in the Medical Expenditure Panel Survey. Pharmacotherapy was defined as an antidepressant prescription fill, and minimally adequate pharmacotherapy was defined as receipt of at least 4 antidepressant fills. Psychotherapy was defined as an outpatient counseling visit, and minimally adequate psychotherapy was defined as ≥ 8 visits. Rurality was defined using Metropolitan Statistical Areas (MSAs) and Rural Urban Continuum Codes (RUCCs). Results: Over the year, 65.1% received depression treatment, including 58.8% with at least 1 antidepressant prescription fill and 24.5% with at least 1 psychotherapy visit. Among those in treatment, 56.2% had minimally adequate pharmacotherapy treatment and 36.3% had minimally adequate psychotherapy treatment. Overall, there were no significant rural-urban differences in receipt of any type of formal depression treatment. However, rural residence was associated with significantly higher odds of receiving pharmacotherapy (MSA: OR 1.16 [95% CI, 1.01-1.34; P = .04] and RUCC: OR 1.04 [95% CI, 1.00-1.08; P = .05]), and significantly lower odds of receiving psychotherapy (MSA: OR 0.62 [95% CI, 0.53-0.74; P < .01] and RUCC: OR 0.91 [95% CI, 0.88-0.94; P < .001]). Rural residence was not significantly associated with the adequacy of pharmacotherapy, but it was significantly associated with the adequacy of psychotherapy (MSA: OR 0.53 [95% CI, 0.41-0.69; P < .01] and RUCC: OR 0.92 [95% CI, 0.86-0.99; P = .02]). Psychiatrists per capita were a mediator in the psychotherapy analyses. Conclusions: Rural individuals are more reliant on pharmacotherapy than psychotherapy. This may be a concern if individuals in rural areas turn to pharmacotherapy because psychotherapists are unavailable rather than because they have a preference for pharmacotherapy.

Depression treatment and health-related quality of life among adults with diabetes and depression

“…Antidepressants were identified using the Multum therapeutic codes available in the prescribed medicines events files. Psychotherapy was identified using the MEPS outpatient visit files [25]. …”

Source of prescription drugs used nonmedically in rural and urban populations

“…Counties outside of a metropolitan statistical area (RUCC ¼ 4-9) have been categorized into ''nonmetropolitan counties.'' Similar to other peer-reviewed literature, we use ''urban'' to refer to the metropolitan counties and ''rural'' to refer to nonmetropolitan counties (28)(29)(30)(31).…”

Use of Psychotherapy by Rural and Urban Veterans

“…3 Findings from the nationally representative Medical Expenditure Panel Survey indicate that, while rural residents with depression are significantly more likely to report receiving pharmacotherapy, they are significantly less likely to report receipt of psychotherapy. 4 Distance to a provider is a significant barrier for care, especially for older adults, 5 and recent evidence suggested that distance to a VA facility is significantly related to fewer psychotherapy services for veterans. 6 Travel time and distance are also significant predictors for receiving minimally adequate care, 6,7 which places patients at greater risk for poorer depression outcomes 8 and in some cases increased mortality.…”