Determinants of mental health and well-being within rural and remote communities.
BACKGROUND
The individual and contextual factors influencing current mental health and well-being within rural communities are poorly understood.


METHODS
A stratified random sample of adults was drawn from non-metropolitan regions of NSW, Australia. One-quarter (27.7%) of the 2,639 respondents were from remote/very remote regions. An aggregate measure of current well-being was derived from levels of distress and related impairment (Kessler-10 LM), self-reported overall physical and mental health, functioning, satisfaction with relationships, and satisfaction with life. Multivariate methods investigated the contributions to current well-being of demographic/dispositional factors, recent events and social support, individual exposure to rural adversity, and district/neighbourhood level characteristics.


RESULTS
Respondents from very remote regions tended to be younger and have lower education. Univariate associations were detected between well being and exposure to rural adversity (greater drought-related worry, lower perceived service and support availability, greater number of years living in the current district). Multivariate analysis (n = 2,462) accounted for 41% of the variance in well-being scores. The major contributing variables were dispositional factors (trait neuroticism, marital status), recent adverse events and indices of social support. However, no additional effects were detected for district-level variables (drought severity, regional socioeconomic categorisation, population change). Similar associations were detected using the K-10 alone as the outcome measure.


CONCLUSIONS
The chief determinants of current well being were those reflecting individual level attributes and perceptions, rather than district-level rural characteristics. This has implications for strategies to promote well being within rural communities through enhancing community connectedness and combating social isolation in the face of major adversities such as drought.
Centre for Brain and Mental Health Research, University of Newcastle and Hunter New England Health, Room 5010, Level 5, McAuley Building, The Mater, Edith Street, Waratah, P.O. Box 833, Newcastle, NSW, Australia. brian.kelly@newcastle.edu.au
Brian J
BJ
Kelly
Terry J
TJ
Lewin
Helen J
HJ
Stain
Clare
C
Coleman
Michael
M
Fitzgerald
David
D
Perkins
Vaughan J
VJ
Carr
Lyn
L
Fragar
Jeffrey
J
Fuller
David
D
Lyle
John R
JR
Beard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005195:Family Relations; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales / Q000453:epidemiology; D010549:Personal Satisfaction; D012423:Rural Health / Q000706:statistics & numerical data*; D012944:Social Support; D055815:Young Adult