Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders.

Full Abstract

OBJECTIVE:
The authors studied whether rural and urban disparities in health-related quality of life, demonstrated previously among veterans, persist among veterans with common psychiatric disorders.

METHODS:
A cohort of 748,216 users or anticipated users of Veterans Affairs services completed the Veterans Short Form Health Survey in 1999. From the survey, the authors determined health-related quality-of-life scores (physical [PCS] and mental [MCS] health component summaries) and used ICD-9-CM codes to identify veterans with six mental health disorders-depression, anxiety, posttraumatic stress disorder, alcohol dependence, schizophrenia, and bipolar disorder. With Rural-Urban Commuting Area codes to determine urban residency, the prevalence of psychiatric illness and health-related quality of life were compared across rural and urban groups.

RESULTS:
All psychiatric disorders except anxiety disorders not related to posttraumatic stress disorder were more prevalent in urban settings. However, rural veterans within mental illness cohorts had worse PCS and MCS scores. Differences in PCS scores were substantial, ranging between 2.27 for schizophrenia and 3.39 for alcohol dependence (p<.001 for all diagnoses). Differences in MCS scores were statistically significant but modest. In regression models, rural-urban disparities within psychiatric disorder cohorts persisted after sociodemographic factors were controlled for.

CONCLUSIONS:
Although less likely than their urban counterparts to have mental disorders, rural veterans with mental illness experienced a greater disease burden and were likely to incur greater health care costs. Improving access to mental health care for veterans in rural settings may narrow quality-of-life disparities among rural and urban veterans.

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Author information

Author/s: Wallace, Amy E (AE); Weeks, William B (WB); Wang, Stanley (S); Lee, Austin F (AF); Kazis, Lewis E (LE);

Affiliation: Department of Psychiatry, Veterans Affairs Medical Center, White River Junction, Vermont 05009, USA. amy.e.wal lace(-atsign-)dartmouth.edu

Journal and publication information

Publication Type: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.

Journal: Psychiatric services (Washington, D.C.) (Psychiatr Serv), published in United States. (Language: eng)

Reference: 2006-Jun; vol 57 (issue 6) : pp 851-6

Dates: Created 2006/06/06; Completed 2006/10/31; Revised 2006/11/15;

PMID: 16754763, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Cohort Studies
Cost of Illness
Cross-Sectional Studies
Female
Health Status
Humans
International Classification of Diseases
Male

Male
Mental Disorders - epidemiology; psychology; therapy
Mental Health Services - standards
Quality of Life - psychology
Questionnaires
Rural Population - statistics & numerical data
Social Justice - standards
Urban Population - statistics & numerical data
Veterans - psychology; statistics & numerical data

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