Maxwell Levis, Monica Dimambro, Joshua Levy, Natalie Riblet, Bradley V Watts, Brian Shiner
{"title":"Using Natural Language Processing to Inform Targeted Rural and Urban Hispanic VA Suicide Prediction Models.","authors":"Maxwell Levis, Monica Dimambro, Joshua Levy, Natalie Riblet, Bradley V Watts, Brian Shiner","doi":"10.1037/rmh0000320","DOIUrl":"10.1037/rmh0000320","url":null,"abstract":"<p><strong>Objective: </strong>Rural Hispanic Veterans experience elevated suicide rates when compared to urban counterparts. Group differences remain poorly understood. This study evaluates a rurality-stratified sample of Hispanic Veterans Affairs (VA)-patients, leveraging unstructured electronic health record (EHR) data to refine population-specific suicide risk prediction metrics.</p><p><strong>Method: </strong>The study utilized a rural and urban Hispanic VA-patient dataset, including all suicide decedents from 2015-2018 (cases). Each case was matched with four patients who shared demographics and treatment year and remained alive (controls). After extracting and preprocessing all unstructured EHR text data, the corpus was analyzed using 500+ variable semantic analysis package. Least Absolute Shrinkage and Selection Operator and Logistic Regression were used to develop prediction models and area under receiver operating characteristic curve (AUC) was used to examine models' predictive accuracy.</p><p><strong>Results: </strong>The final datasets included 39 rural cases and 148 controls, alongside 273 urban cases and 1090 controls. The predictive models offered considerable accuracy (rural AUC = 0.86; urban AUC = 0.67). While rural models emphasized dislocation from community and communal resources, urban models emphasized alienation and identity challenges.</p><p><strong>Conclusions: </strong>This study enhances understanding about rural and urban Hispanic suicide decedents and could inform suicide prediction and preventive services.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"2025 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stephanie Nettleton, Sara Diesel, Bruce Alexander, Michael W O'Hara, Mark Vander Weg, Emily B K Thomas
{"title":"Postpartum depressive symptom severity among child-bearing Veterans: Examining contributions of environmental indices.","authors":"Stephanie Nettleton, Sara Diesel, Bruce Alexander, Michael W O'Hara, Mark Vander Weg, Emily B K Thomas","doi":"10.1037/rmh0000312","DOIUrl":"10.1037/rmh0000312","url":null,"abstract":"<p><p>Veterans are at increased risk of experiencing postpartum depression yet are understudied. Environmental factors like rurality and resource richness are associated with various health outcomes, although environmental relations to mental health outcomes, such as postpartum depression (PPD), have not been explored thoroughly. The current study aimed to examine the relation between living environment utilizing two indices (Area Deprivation Index and Rural Urban Commuting Area) and postpartum depressive symptom severity in postpartum Veterans. The study sample included postpartum Veterans that were recruited for an online CBT intervention. We utilized screening data from this recruitment effort. Depressive symptom severity was measured via the Patient Health Questionnaire-9. Individual Veteran-level administrative data included age, race, ethnicity, and residential address. Linear regression was used to determine whether resource richness and rurality were associated with depressive symptom severity when adjusting for race. Black Veterans had greater depressive symptom severity than White Veterans (β = 0.12, <i>t</i> = 3.39<i>, p</i> < .001). Rural-dwelling Veterans had lower depressive symptom severity than non-rural dwelling Veterans. Resource richness was not significantly associated with depressive symptom severity. There was not a significant interaction between race and rurality. The results of this study indicate that Black postpartum Veterans enrolled in VA care experienced greater depressive symptom severity. Additionally, rural-dwelling postpartum Veterans reported lower depressive symptom severity. Many postpartum Veterans in this sample were experiencing high symptom burden. Screenings for depressive symptom severity in the postpartum period should be provided to all childbearing individuals, but among Veterans, this may be particularly important.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"1 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12311851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rural mental healthPub Date : 2025-01-01Epub Date: 2024-10-17DOI: 10.1037/rmh0000279
Kelly Knight, Callan Gravel-Pucillo, Miles Lamberson, Roz King, Christian Pulcini
{"title":"Patient Perspectives of Emergency Mental Health Care in a Rural State.","authors":"Kelly Knight, Callan Gravel-Pucillo, Miles Lamberson, Roz King, Christian Pulcini","doi":"10.1037/rmh0000279","DOIUrl":"10.1037/rmh0000279","url":null,"abstract":"<p><p>Increases in emergency department (ED) presentations for mental health conditions continue to challenge the national mental healthcare infrastructure, often resulting in ED boarding. However, limited prior studies capture the perspectives on mental healthcare of those experiencing prolonged boarding in the ED (≥ 24 hours stay) for mental health conditions. We aimed to assess patient perspectives on acute mental healthcare among individuals boarding in a general ED in a rural state. We performed semi-structured interviews of adults (≥18 years old) presenting with a primary mental health condition boarding in a general ED for at least 24 hours. An interview guide was developed a priori, and a trained study team performed the interviews. A thematic analysis was conducted by two independent coders. A coding tree was developed through an iterative process that included double-coding transcripts and monitoring of inter-rater reliability. Fifteen patients were interviewed to reach saturation. Ages ranged from 22 to 65. Analysis revealed several key themes including the environment of the ED, interactions with family members and staff, communication regarding the plan of care, patient perceptions of autonomy and respect, and mental healthcare services provided outside the ED. Our study revealed that adults encounter significant challenges to access timely acute mental healthcare in the ED in a rural state. Participant recommendations for improvement included increasing the availability of therapy while in the ED and providing a physical environment that is more welcoming. Community, hospital-based, and statewide quality improvement and public policy strategies should be considered to address the identified challenges.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"49 1","pages":"33-42"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12002421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Veteran Perspectives on Priority Areas for Rural Community-Level Suicide Prevention.","authors":"Lauren M Denneson, Kelly M Kemp, Kyla J Tompkins","doi":"10.1037/rmh0000298","DOIUrl":"10.1037/rmh0000298","url":null,"abstract":"<p><p>Suicide rates are higher in rural areas of the United States, especially among veterans, and rural areas face many challenges that can affect the health of residents. This is the first known effort to identify priority areas for rural community suicide prevention among veterans from the perspective of those living in high-risk areas. Qualitative interviews (<i>n</i> = 28) were conducted with veterans residing in rural communities in Oregon, which were previously identified as areas with higher-than-expected suicide rates (i.e., hotspots). Veteran participants were asked questions about their experiences living in their communities, levels of community awareness of veteran suicide, and their perspectives on how to address suicide in their communities. Data were analyzed using inductive, open coding. Initial findings were discussed with two stakeholder groups, and findings were then distilled into a set of priority recommendations. Findings indicated three main recommendations for future research and programing for rural veteran suicide prevention: (a) increase capacity, accessibility, and awareness of socioeconomic resources, (b) strengthen access to person-centered health care, and (c) build a stronger sense of community cohesion. Identifying ways to enhance socioeconomic resources by supporting and expanding the currently available resources and organizations within rural communities should be further explored. Methods to increase access to care while retaining a person-centered approach may help ensure rural veterans seek care when needed. Finally, striving to support a stronger psychological sense of community among residents in rural areas should be considered important for rural community suicide prevention.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"49 3","pages":"234-243"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12716355/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145806640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cynthia Ewell Foster, Christina S Magness, Sarah Derwin, Eskira Kahsay, Tayla Smith, Frederick P Rivara, Lynn Massey, Cheryl A King
{"title":"Store Safely: A firearm injury prevention strategy for rural families.","authors":"Cynthia Ewell Foster, Christina S Magness, Sarah Derwin, Eskira Kahsay, Tayla Smith, Frederick P Rivara, Lynn Massey, Cheryl A King","doi":"10.1037/rmh0000276","DOIUrl":"10.1037/rmh0000276","url":null,"abstract":"<p><p>Firearms are the leading cause of death for youth in the US. Safe firearm storage is an evidence-based risk reduction technique, yet many families with children maintain unsecured firearms. In rural areas where gun ownership is common and rates of firearm-related suicides are increasing, developing culturally acceptable and feasible safe storage prevention strategies may have promise for reducing morbidity and mortality. This pilot study used a community-based participatory approach to develop a culturally tailored multi-component online safe storage preventive intervention called <i>Store Safely</i>. Participants were 45 rural firearm owning parents representing 45 unique families (35% male, 65% female, <i>M</i> age = 37.88, SD = 6.14) who had at least one child living at home. Acceptability, feasibility, and preliminary impact on firearm storage behaviors were measured via pre-test and post-test self-report surveys. Of the 43 parents (43 families) retained at follow-up, 97.7% completed the intervention and 86% utilized a home safety checklist. 40% of participants reported improving their storage, offering examples such as purchasing gun locks, safes, or lockboxes; separating ammunition from weapons; reviewing or discussing the safety of current storage; and relocating firearms to reduce child access. 84% found the website culturally sensitive and would recommend the materials to other parents. This firearm safe storage preventive intervention, developed in partnership with a rural community and tailored to reflect community norms and values, was associated with high levels of parental acceptability, engagement, and behaviors in support of safe firearm storage, suggesting its promise as a firearm injury prevention strategy.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"48 4","pages":"247-258"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11580489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142712130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rural mental healthPub Date : 2024-07-01Epub Date: 2024-05-30DOI: 10.1037/rmh0000265
Bingyu Xu, Sydni A J Basha, Zhigang Xie, Rebecca K Blais
{"title":"Suicide Risk in U.S. Adults: Alcohol Misuse, Veteran Status, and Urbanization Comparison.","authors":"Bingyu Xu, Sydni A J Basha, Zhigang Xie, Rebecca K Blais","doi":"10.1037/rmh0000265","DOIUrl":"10.1037/rmh0000265","url":null,"abstract":"<p><p>Suicide is a pressing public health concern. Identifying risk factors and understanding their interplay is vital for effective prevention and intervention. This study examined the association of alcohol misuse, veteran status, and urbanization on suicide risk among U.S. adults. Using data from the 2015-2020 National Survey on Drug Use and Health (NSDUH), a cross-sectional analysis was conducted on a representative sample of U.S. adults. To determine overall risk for suicide, adjusted odds ratios were calculated through multivariable adjusted multinomial logistic regression. The study utilized self-report survey data collected from noninstitutionalized U.S. population. The NSDUH utilized a stratified multistage probability sampling method to ensure representative data collection. Suicide risk did not differ significantly between urban and rural areas. Heavy drinking increased risk for suicide ideation and attempts among urban veterans and nonveterans. Binge drinking had a positive association with suicide ideation in urban nonveterans. In rural areas, alcohol misuse did not significantly influence suicide risk among veterans. Alcohol misuse is a significant risk factor for suicide among both veterans and nonveterans in urban settings. Tailored suicide prevention strategies that account for urbanization and veteran status are critically needed.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"48 3","pages":"156-167"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rural mental healthPub Date : 2023-07-01Epub Date: 2023-05-11DOI: 10.1037/rmh0000228
Alyssa Edwards, Rina Hung, Jennifer B Levin, Larry Forthun, Martha Sajatovic, Molly McVoy
{"title":"Health Disparities among Rural Individuals with Mental Health Conditions: A Systematic Literature Review.","authors":"Alyssa Edwards, Rina Hung, Jennifer B Levin, Larry Forthun, Martha Sajatovic, Molly McVoy","doi":"10.1037/rmh0000228","DOIUrl":"10.1037/rmh0000228","url":null,"abstract":"<p><p>There is growing concern about the availability of healthcare services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health conditions in North America. Using PRISMA guidelines, we used four electronic databases (Pubmed, Cochrane, PsychInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus non-rural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle Ottawa Scale was used. Our initial search returned 491 studies and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), PTSD (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities while eleven (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in person outreach to these rural communities may be alternatives to impact these outcomes.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"47 3","pages":"163-178"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10449379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul E Norrod, Wayne T Sanderson, Erin L Abner, Jacqueline Seals, Steve Browning
{"title":"Farmer Suicides Among States Reporting Violent Deaths, 2003 - 2017.","authors":"Paul E Norrod, Wayne T Sanderson, Erin L Abner, Jacqueline Seals, Steve Browning","doi":"10.1037/rmh0000232","DOIUrl":"10.1037/rmh0000232","url":null,"abstract":"<p><p>Research suggests that farmer suicide rates are at least two-fold higher than the general population. In estimating rates, prior research considered suicide events among farmers together with farmworkers, fishing, and forestry occupations and included non-farming populations in the defined at-risk populations (i.e., denominators). In this study, we sought to define and differentiate farmer suicide decedents from other agricultural occupations, estimate U.S. farmer suicide rates, and evaluate rate time trends. Farmer suicide decedents were ascertained from the 36 states in the National Violent Death Reporting System (NVDRS) from 2003-2017 using NVDRS occupation data. Farmers were defined as persons responsible for day-to-day farm decisions and operations. An expert panel was convened to classify farmer occupations. Rates were calculated using Census of Agriculture-identified farmers as the rate denominator, and time trends were evaluated using regression. Due to a low number of female decedents, female farmer suicide rates were not estimated. We identified1,575 male farmer suicide decedents and 77 female farmer decedents from the NVDRS during the study period. Aggregated age-specific male farmer suicide rates were highest among farmers ages 65 years and older (22.0/100,000). Estimated suicide rates for male farmers were highest during 2003 (31.8/100,000) and lowest during 2005 (19.2/100,000). Trend analysis revealed a statistically significant 2.4% annual percent change (APC) in rates over the 15-year study period. Suicide rates among male farmers showed evidence of an increase from 2003-2017. Farmer suicide rates parallel the rates of the U.S. population; thus, farmer suicide remains a public health concern.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"47 3","pages":"139-151"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9826362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rural mental healthPub Date : 2023-04-01Epub Date: 2022-10-24DOI: 10.1037/rmh0000220
Sara J Landes, Megan G Smith, Jason C Lam, Taylor C Watt, Geoffrey M Curran
{"title":"Rural Community Pharmacists' Perceptions of Implementing Mental Health Interventions to Reach Underserved Populations.","authors":"Sara J Landes, Megan G Smith, Jason C Lam, Taylor C Watt, Geoffrey M Curran","doi":"10.1037/rmh0000220","DOIUrl":"10.1037/rmh0000220","url":null,"abstract":"<p><p>Mental illness and suicide are significant public health problems. Limited resources put individuals at greater risk, particularly in rural areas with fewer health providers. Community pharmacists are the most accessible health professionals in rural communities and are interested in addressing mental health concerns. Research is limited on how to implement mental health interventions in community pharmacy settings. The objectives of this study were to assess community pharmacists' perceptions of mental health interventions and barriers and facilitators to implementation and prioritize interventions to be pilot tested. Qualitative interviews were conducted with community pharmacists (N=17). Interviews focused on perceptions of mental health interventions in pharmacy settings. Data were analyzed using template analysis. A stakeholder meeting reviewed data and prioritized interventions to be pilot tested. Pharmacists viewed implementing mental health interventions positively. Barriers included lack of mental health knowledge, time, diagnosis, and concerns about workflow. Facilitators included accessible settings, knowing the community, and seeing patients frequently. The most common needs for implementation were education and payment. Pharmacists preferred progress monitoring in collaboration with a prescriber and mental health first aid training. Further research is needed to gather feedback from prescribers to inform implementation.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"47 2","pages":"90-99"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10120869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9755643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Eating Disorder Treatment Dropout: What Factors Influence Access to Specialty Care in an Underresourced Appalachian Region?","authors":"Angeline R Bottera, Jessica L Luzier","doi":"10.1037/rmh0000230","DOIUrl":"10.1037/rmh0000230","url":null,"abstract":"<p><p>Appalachia is uniquely impacted by healthcare disparities. Outpatient dropout rates remain a significant barrier for individuals necessitating specialty eating disorder (ED) treatment. We explored factors impacting patient continuation in specialty outpatient care for EDs. Participants (<i>N</i>=138; 89.9% female) were patients with EDs attending specialty outpatient treatment in a geographically isolated, under-resourced Appalachian community. Patient dropout rate was 26.8%. Dropout rates did not significantly differ across any sociocultural factors except patient age and BMI; patients who discontinued were older and had higher BMIs at intake, perhaps due to longer duration of illness or treatment-related misconceptions. Implications and future directions are discussed.</p>","PeriodicalId":74746,"journal":{"name":"Rural mental health","volume":"47 2","pages":"123-128"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10552972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}