Why rural women miss out on mental health care

"We need to improve access to mental health care in rural communities," says Jennifer S. McCall-Hosenfeld, "and we need to address the stigma of mental health issues by helping rural women understand that being depressed is not something to be ashamed of." (Credit: Steve Snodgrass/Flickr)

Many women in America’s rural communities don’t receive sufficient mental health care. Social stigma and limited access are often reasons why, interviews show.

For a new study published in Mental Health in Family Medicine, researchers interviewed 19 primary care physicians who provide care to rural women in central Pennsylvania.

The physicians answered questions that focused on screening and diagnosis of mental health conditions, barriers to treatment among rural women, management of mental illnesses in rural women, and ideas to improve care for this population.


Questions focused on practicing medicine in rural areas and specifically about providing care to rural women.

“We asked rural primary care physicians about how they care for women’s mental health,” says Jennifer S. McCall-Hosenfeld, assistant professor of medicine and public health sciences and primary care physician at Penn State College of Medicine.

“Theirs is an important perspective because rural primary care physicians provide a substantial proportion of mental health services for their patients.”

‘Someone’s got to do it’

As of 2005, only 7.4 percent of all US psychiatrists practiced in a rural area. Primary care physicians in rural communities experience significant barriers in providing care to rural women with mental health problems and commonly report caring for mental health conditions that are often outside the scope of their training.

“I do a lot of psychiatry in my practice that I really wish I didn’t have to do, but I do it because someone’s got to do it,” according to one of the primary care physicians interviewed.

Stigma surrounding mental health issues presents another problem. “Rural women may not want to be seen walking into the office of a mental health care provider due to fear of judgment by family and friends,” the researchers write.

Identification of mental illnesses is another challenge. About one-third of physicians report that they routinely screen for depression, while others say that time constraints and competing priorities don’t allow them to regularly screen patients.

PTSD underreported

Identification of post-traumatic stress disorder among rural women may be particularly challenging because some rural doctors don’t feel that PTSD is likely to affect rural women. Most physicians note that many patients are underinsured and don’t have mental health coverage.

“Despite the barriers to optimal healthcare, we found that many of the physicians are seeking creative solutions and developing informal networks with mental health care professionals for consultation,” McCall-Hosenfeld says.

“This study reinforced the fact that there are problems with access to health care in rural communities, but also provided some examples of potential solutions to those access issues, such as formalizing and expanding existing consulting networks.

“We need a two-pronged approach. We need to improve access to mental health care in rural communities and we need to address the stigma of mental health issues by helping rural women understand that being depressed, for example, is not something to be ashamed of.”

Researchers from Brown University contributed to the study, which was funded in part by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Source: Penn State