Rural-Urban Comparisons of Child and Maternal Mental Health Barriers

Robert B. Penfold, Kelly J. Kelleher, Sarah M. Horwitz, Ruth E.K. Stein, et. al. OCS, CHI, Columbus, OH; OCS, CHI, Columbus, OH; Epidemiology, Case School of Medicine, Cleveland, OH; Pediatrics, AECOM/CHAM, Bronx, NY.

 

BACKGROUND: Little is known about rural pediatricians' attitudes towards mental health care barriers within the health systems context.

 

OBJECTIVE: To test the hypotheses that a) rural pediatricians will be more likely to agree that there are barriers to identifying, treating and referring patients, b) rural physicians will be less likely to identify mothers' MH problems and more likely to treat child MH problems relative to their urban counterparts, c) to identify the contextual variables that explain these differences.

 

DESIGN/METHODS: Data were collected via the 59^th AAP Periodic Survey. Survey data were linked to the 2003 Area Resource File and the 2000 Census via Geographic Information systems (GIS). Difference of means tests, logistic regression, and spatial statistics were used to test hypotheses.

 

RESULTS: With few exceptions, rural pediatricians are more likely to agree that barriers exist to identifying, treating and referring both child and maternal mental health problems. The largest differences in perceived barriers between rural and urban pediatricians are with respect to lack of MH providers (88% vs 60%), inadequate reimbursement for MH treatment (62% vs 42%), and long waiting periods to see MH providers (89% vs. 73%). With the exception of eating disorders, rural pediatricians are more likely to treat child MH problems (75% vs 40% for ADHD, 31% vs 15% for Depression, and 25% vs 10% for Anxiety disorder). Rural pediatricians are less likely to inquire about maternal MH problems (19% vs 35% for caregiving problems, 22% vs 36% for substance abuse) with the exception of smoking (73% vs 66%). However, rural pediatricians are slightly more likely to treat maternal MH problems than their urban counterparts. Physician characteristics, patient characteristics, and health system characteristics are all significant predictors of these differences.

 

CONCLUSIONS: Rural pediatricians are more likely to treat MH problems but face significantly greater barriers to providing MH services. It is critical to understand the interaction between physician, patient and health system characteristics in order to understand pediatricians' attitudes towards barriers and the likelihood of identifying, treating and referring child and maternal mental health problems.