In the Journals

Developmental, behavioral issues more common among rural children

Rural children from small communities exhibited a higher prevalence of mental, behavioral and developmental disorders than children living in cities and suburbs, according to data from the CDC’s Morbidity and Mortality Weekly Report.

“Indicators of poor mental health among adults — for example, serious mental illness among men, major depressive episodes among men and women, and recent serious psychological distress among women — have been found to be higher in large rural counties than in small, rural, suburban and urban counties,” Lara R. Robinson, PhD, from the National Center on Birth Defects and Developmental Disabilities at the CDC, and colleagues wrote. “Most studies examining children’s mental health in rural and urban areas indicate comparable rates of mental disorders in the two types of areas. However, mental disorders might be underreported in rural areas.”

Lara R. Robinson

­Owing to increased reporting of mental, behavioral and developmental disorders (MBDDs) in rural areas, researchers used data collected from the National Survey of Children’s Health to assess specific discrepancies in health care, family and community factors for those with and without an MBDD in rural and urban areas. Robinson and colleagues included children between the ages of 2 and 8 with valid parent-reported information on age, sex, each MBDD and zip code. Geographic locations were divided into subgroups: urban, large rural, small rural and isolated.

Parent-reported MBDDs were more prevalent in small rural areas (18.6%) than in urban areas (15.2%), and approximately one in six experienced parent–reported MBDDs across all rural subtypes. Those who reported their child as having an MBDD were more likely to have an absence of a medical home, had poor mental health, lived in families with financial concerns, and resided in areas that did not have adequate amenities and was in poor condition for both urban and most rural subgroups.

Children with MBDDs had a higher chance of not having health insurance than those without an MBDD in urban areas; this statistic was unique to this subsection.

Additionally, all children living in small and large rural areas had more financial concerns in the home, including difficulties providing food and housing, when compared with children living in urban areas. They also had less community resources such as parks, recreation centers, sidewalks and libraries, and poor community conditions (e.g., garbage, vandalism, poor housing conditions) were more likely reported. However, families who lived in small rural or isolated locations felt safer in their communities. Isolated communities had a higher level of social support from neighbors and community members, and were more likely to have a medical home and a parent without mental health concerns.

Robinson and colleagues call for more research to be conducted on neighborhood risk and protection for childhood mental health disorders within rural communities.

“These [National Survey of Children’s Health] data and previous research indicate that children with MBDDs were more negatively affected by certain health care, family and community factors than children without an MBDD,” Robinson and colleagues wrote. “In addition, the data in this report demonstrate similar patterns of these differences across the rural-urban continuum, suggesting MBDDrelated disparities exist regardless of residency type.” — by Katherine Bortz

Disclosure: The researchers report no relevant financial disclosures.