title: 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 > or = 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.
authors.affiliation: South Central Mental Illness Education and Clinical Center (MIRECC) and Health Services Research and Development (HSR&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA. fortneyjohnc@uams.edu
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Harman
authors.forename: Stanley
authors.initials: S
authors.lastname: Xu
authors.forename: Fran
authors.initials: F
authors.lastname: Dong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001131:Arkansas; D016001:Confidence Intervals; D003863:Depression / Q000188:drug therapy* / Q000628:therapy; D037001:Directive Counseling; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010045:Outpatients; D011594:Psychometrics; D011613:Psychotherapy; D011787:Quality of Health Care; D012111:Residence Characteristics; D019035:Rural Health Services / Q000592:standards*; D012424:Rural Population; D012647:Self-Assessment; D014481:United States; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents