This review synthesizes empirical research in rural mental health services to identify current research priorities to improve the mental health of rural Americans. Using a conceptual framework of the multiple determinants of use, quality, and outcomes, the authors address (1) how key constructs are operationalized, (2) their theoretical influence on the care process, (3) reported differences for nonmetropolitan and metropolitan individuals or within nonmetropolitan individuals, (4) salient issues rural advocates have raised, and (5) key research questions. While the authors recognize that rurality is a useful political umbrella to organize advocacy efforts, they propose that investigators no longer employ any of the multiple definitions of the term in the literature as even intrarural comparisons have not provided compelling evidence about the underlying causes of observed outcomes differences. Until these underlying causes have been identified, it is difficult to determine which components of the nonmetropolitan service system need to be improved.
Get full access to this article
View all access options for this article.
References
1.
Abraham, I. L. , K. C. Buckwalter, J. B. Neese, and J. C. Fox. 1994. Mental health of rural elderly: A research agenda for nursing. Mental Health Nursing15:203-213.
2.
Aday, L. A. , and R. Andersen. 1974. A framework for the study of access to medical care. Health Services Research9 (3): 208-220.
3.
Alegria, M. , R. V. Bijl, E. Lin, E. E. Walters, and R. C. Kessler. 2000. Income differences in persons seeking outpatient treatment for mental disorders: A comparison of the United States with Ontario and the Netherlands. Archives of General Psychiatry57:383-391.
4.
Armstrong, P. S. , and M. D. Schulman. 1990. Financial strain and depression among farm operators: The role of perceived economic hardship and personal control. Rural Sociology55 (4): 475-493.
5.
Baer, L. , P. Cukor, M. A. Jenike, L. Leahy, J. O’Laughlen, and J. T. Coyle. 1995. Pilot studies of telemedicine for patients with obsessive-compulsive disorder. American Journal of Psychiatry152 (9): 1383-1385.
6.
Baer, L. , D. R. Elford, and P. Cukor. 1997. Telepsychiatry at forty: What have we learned?Harvard Review of Psychiatry5 (1): 7-17.
7.
Baer, R. D.1996. Health and mental health among Mexican American migrants: Implications for survey research. Human Organization55 (1): 58-66.
8.
Baigent, M. F. , C. J. Lloyd, S. J. Kavanagh, D. I. Ben-Tovim, P. M. Yellowlees, R. S. Kalucy, and M. J. Bond. 1997. Telepsychiatry: “Tele” yes, but what about the “psychiatry”?Journal of Telemedicine and Telecare3 (suppl. 1): 3-5.
9.
Baugher, E. , and L. Lamison-White. 1996. Poverty in the United States: 1995. Washington, DC: U.S. Department of Commerce, Bureau of the Census.
10.
Berk, M. L. , C. L. Schur, and J. C. Cantor. 1995. Ability to obtain health care: Recent estimates from the Robert Wood Johnson Foundation National Access to Care Survey. Health Affairs14 (3): 139-146.
11.
Bierman, K. L. , and The Conduct Problems Prevention Research Group. 1997. Implementing a comprehensive program for the prevention of conduct problems in rural communities: The fast track experience. American Journal of Community Psychology25 (4): 493-514.
12.
Bird, D.1998. Best practices in rural medicaid managed behavioral health: Credentialing. Available from http://www.muskie.usm.maine.edu/bestpractice.
13.
Bird, D. , D. Lambert, D. Hartley, P. G. Beeson, and A. F. Coburn. 1998. Rural models for integrating primary care and mental health services. Administration and Policy in Mental Health25 (3): 287-308.
14.
Blackmon, L. A. , H. O. Kaak, and J. Ranseen. 1997. Consumer satisfaction with telemedicine child psychiatry consultation in rural Kentucky. Psychiatric Services48 (11): 1464-1466.
15.
Braden, J. , and K. Beauregard. 1994. Health status and access to care of rural and urban populations. National Medical Expenditure Survey Research Findings, no. 18, edited by Agency for Health Care Policy and Research. Rockville, MD: Public Health Service.
16.
Bronstein, J. M. , V. A. Johnson, and C. A. Fargason Jr.1997. How rural physicians compare on costs and quality measures for Medicaid ambulatory care episodes. Journal of Rural Health13 (2): 126-135.
17.
Buck, J. A. , J. L. Teich, B. Umland, and M. Stein. 1999. Behavioral health benefits in employer-sponsored health plans, 1997. Health Affairs18 (2): 67-78.
18.
Burns, B. J. , E. J. Costello, A. Angold, D. Tweed, D. Stangl, E.M.Z. Farmer, and A. Erkanli. 1995. Children’s mental health service use across service sectors. Health Affairs14 (3): 147-159.
19.
Burns, B. J. , E. J. Costello, A. Erkanli, D. L. Tweed, E.M.Z. Farmer, and A. Angold. 1997. Insurance coverage and mental health service use by adolescents with serious emotional disturbance. Journal of Child and Family Studies6 (1): 89-111.
20.
Bussing, R. , B. T. Zima, and T. R. Belin. 1998. Differential access to care for children with ADHD in special education programs. Psychiatric Services49 (9): 1226-1229.
21.
Calloway, M. , B. Fried, M. Johnsen, and J. Morrissey. 1999. Characterization of rural mental health service systems. Journal of Rural Health15 (3): 296-307.
22.
Casey, M. M.1999. Rural managed care. In Rural health in the United States, edited by Thomas C. Ricketts III, 113-118. New York: Oxford University Press.
23.
Casey, M. M. , A. Wellever, and I. Moscovice. 1997. Rural health network development: Public policy issues and state initiatives. Journal of Health Politics, Policy and Law22 (1): 23-47.
24.
Chang, C. F. , L. J. Kiser, J. E. Bailey, M. Martins, W. C. Gibson, K. A. Schaberg, D. M. Mirvis, and W. B. Applegate. 1998. Tennessee’s failed managed care program for mental health and substance abuse services. Journal of the American Medical Association279 (11): 864-869.
25.
Christianson, J.1998. Potential effects of managed care organizations in rural communities: A framework. Journal of Rural Health14 (3): 169-179.
26.
Christianson, J. B. , R. Hamer, and D. Knutson. 1997. HMO financial arrangements with rural physicians. Journal of Rural Health13 (3): 240-252.
27.
Christianson, J. B. , W. Manning, N. Lurie, T. J. Stoner, D. Z. Gray, M. Popkin, and S. Marriott. 1995. Utah’s prepaid mental health plan: The first year. Health Affairs14 (3): 160-172.
28.
Coburn, A. F. , E. H. Kilbreth, S. H. Long, and M. S. Marquis. 1998. Urban-rural differences in employer-based health insurance coverage of workers. Medical Care Research and Review55:484-495.
29.
Cornelius, L. , K. Beauregard, and J. Cohen. 1991. Usual sources of medical care and their characteristics. In National Medical Expenditure Survey research findings 11. Rockville, MD: Public Health Services.
30.
Coward, R. T. , L. L. Clarke, and K. Seccombe. 1993. Predicting the receipt of employer-sponsored health insurance: The role of residence and other personal and workplace characteristics. Journal of Rural Health9 (4): 281-292.
31.
Day, J. , and A. Curry. 1996. Educational attainment in the United States: 1995. Current Population Reports, series P20-489. Washington, DC: U.S. Department of Commerce, Bureau of the Census.
32.
Donabedian, A.1972. Models for organizing the delivery of personal health services and criteria for evaluating them. Milbank Memorial Fund Quarterly50 (4, part 2): 103-154.
33.
Donabedian, A. . 1990. The seven pillars of quality. Archives of Pathology and Laboratory Medicine114:1115-1118.
34.
Donabedian, A. . 1992. The role of outcomes in quality assessment and assurance. QRB: Quality Review Bulletin18 (1): 356-360.
35.
Doniger, M. , R. Tempier, M. Lalinec-Michaud, and D. Meunier. 1986. Telepsychiatry: Psychiatric consultation through two-way television. A controlled study. Canadian Journal of Psychiatry31 (1): 32-34.
36.
Duncan, R. P. , K. Seccombe, and C. Amey. 1995. Changes in health insurance coverage within rural and urban environments—1977 to 1987. Journal of Rural Health11 (3): 169-176.
37.
Economic Research Service, U.S. Department of Agriculture . 1997. Employment growth rates converge for metro and non-metro areas. Rural Conditions and Trends8 (2): 9-13.
38.
Farrell, S. P. , J. R. Koch, and M. Blank. 1996. Rural and urban differences in continuity of care after state hospital discharge. Psychiatric Services47 (7): 652-654.
39.
Federal Office of Rural Health Policy . 1997. Facts about rural physicians. Rockville, MD: U.S. Department of Health and Human Services.
40.
Fischer, E. P. , and R. R. Owen. 1999. Quality of public sector care for schizophrenia in Arkansas. Mental Health Services Research1 (4): 213-221.
41.
Fischer, E. P. , R. R. Owen, and B. J. Cuffel. 1996. Substance abuse, community service use, and symptom severity of urban and rural residents with schizophrenia. Psychiatric Services47 (9): 980-984.
42.
Fortney, J. , N. Chumbler, M. Cody, and C. Beck. 2002. Geographic access and service use in a community-based sample of cognitively impaired elders. Journal of Applied Gerontology.
43.
Fortney, J. , K. Rost, and J. Warren. 2000. Comparing alternative methods of measuring geographic access to health services. Health Services and Outcomes Research Methodology1 (2): 173-184.
44.
Fortney, J. , K. Rost, and M. Zhang. 1998. A joint choice model of the decision to seek depression treatment and choice of provider sector. Medical Care36 (3): 307-320.
45.
Fortney, J. , K. Rost, M. Zhang, and J. Warren. 1999. The impact of geographic accessibility on the intensity and quality of depression treatment. Medical Care37 (9): 884-893.
46.
Fortney, J. , J. C. Thill, M. Zhang, N. Duan, and K. Rost. 2001. Provider choice and utility loss due to selective contracting in rural and urban areas. Medical Care Research and Review58:60-75.
47.
Fortney, J. C. , and B. M. Booth. 2001. Access to substance abuse services in rural areas. In Recent developments in alcoholism, services research in an era of managed care, vol. 15, edited by Marc Galanter, 177-209. New York: Kluwer/Plenum.
48.
Fox, J. , E. Merwin, and M. Blank. 1995. De facto mental health services in the rural south. Journal of Healthcare for the Poor and Underserved6 (4): 434-468.
49.
Fox, J. C. , M. Blank, J. Berman, and V. G. Rovnyak. 1999. Mental disorders and help seeking in a rural impoverished population. International Journal of Psychiatry in Medicine29 (2): 181-195.
50.
Frank, R. G. , and T. G. McGuire. 1986. A review of studies of the impact of insurance on the demand and utilization of specialty mental health services. Health Services Research21 (2, part 2): 241-265.
51.
Frenzen, P. D.1993. Health insurance coverage in U.S. urban and rural areas. Journal of Rural Health9 (3): 204-214.
52.
Gallo, J. J. , S. Marino, D. Ford, and J. C. Anthony. 1995. Filters on the pathway to mental health care, II. Sociodemographic factors. Psychological Medicine25 (6): 1149-1160.
53.
Geller, J. M.1999. Rural primary care providers’ perceptions of their roles in the provision of mental health services: Voices from the plains. Journal of Rural Health15 (3): 326-334.
54.
Geller, J. M. , and K. J. Muus. 1997. The role of rural primary care physicians in the provision of mental health services: Letter to the field no. 5. Available from http://www.wiche.edu/MentalHealth/Frontier/index.htm.
55.
Gold, M. R. , R. Hurley, T. Lake, T. Ensor, and R. Berenson. 1995. A national survey of the arrangements managed-care plans make with physicians. New England Journal of Medicine333 (25): 1678-1683.
56.
Golding, J. M. , and K. B. Wells. 1990. Social support and use of mental health services by Mexican Americans and non-Hispanic whites. Basic and Applied Social Psychology11 (4): 443-458.
57.
Goldsmith, H. F. , M. O. Wagenfeld, R. W. Manderscheid, and D. Stiles. 1997. Specialty mental health services in metropolitan and nonmetropolitan areas: 1983 and 1990. Administration and Policy in Mental Health24 (6): 475-488.
58.
Gonzales, J. J. , K. M. Magruder, and S. J. Keith. 1994. Mental disorders in primary care services: An update. Public Health Reports109 (2): 251-258.
59.
Granovetter, M. S.1973. The strength of weak ties. American Journal of Sociology78 (6): 1360-1380.
60.
Grazier, K. L. , and L. L. Eselius. 1999. Mental health carve-outs: Effects and implications. Medical Care Research and Review56 (suppl. 2): 37-59.
61.
Hartley, D.2001. Effects of managed mental health care on service use in urban and rural Maine. Journal of Rural Health17 (2): 95-104.
62.
Hartley, D. , D. C. Bird, and P. Dempsey. 1999. Rural mental health and substance abuse. In Rural health in the United States, edited by Thomas C. Ricketts III, 159-178. New York: Oxford University Press.
63.
Hartley, D. , L. Quam, and N. Lurie. 1994. Urban and rural differences in health insurance and access to care. Journal of Rural Health10 (2): 98-108.
64.
Hauenstein, E. J.1996. Testing innovative nursing care: Home intervention with depressed rural women. Issues in Mental Health Nursing17:33-50.
65.
Hauenstein, E. J. . 1997. A nursing practice paradigm for depressed rural women: The Women’s Affective Illness Treatment Program. Archives of Psychiatric Nursing11 (1): 37-45.
66.
Heller, T. A. , E. B. Larson, and J. P. LoGerfo. 1984. Quality of ambulatory care of the elderly: An analysis of five conditions. Journal of the American Geriatrics Society32 (11): 782-788.
67.
Holzer, C. E., III and J. A. Ciarlo. 1999. Mental health service utilization in rural and nonrural areas, letter to the field no. 20. Available from http://www.wiche.edu/MentalHealth/Frontier/index.htm.
68.
Holzer, C. E., III , H. F. Goldsmith, and J. A. Ciarlo. 1998. The availability of health and mental health providers by population density, letter to the field no. 11. Available from http://www.wiche.edu/MentalHealth/Frontier/index.htm.
69.
Horgan, C. , and D. Salkever. 1987. The demand for outpatient mental health care from nonspecialty providers. Advances in Health Economics and Health Services Research8:211-233.
70.
Horgan, C. M.1986. The demand for ambulatory mental health services from specialty providers. Health Services Research21 (2): 291-319.
71.
Howard, K. I. , T. A. Cornille, J. S. Lyons, J. T. Vessey, R. J. Lueger, and S. M. Saunders. 1996. Patterns of mental health service utilization. Archives of General Psychiatry53:696-703.
72.
Hoyt, D. R. , R. D. Conger, J. G. Valde, and K. Weihs. 1997. Psychological distress and help seeking in rural America. American Journal of Community Psychology25 (4): 449-470.
73.
Ivey, S. L. , R. Scheffler, and J. L. Zazzali. 1998. Supply dynamics of the mental health workforce: Implications for health policy. Milbank Quarterly76 (1): 25-58.
74.
Katon, W. , and J. Gonzales. 1994. A review of randomized trials of psychiatric consultation-liaison studies in primary care. Psychosomatics35 (3): 268-278.
75.
Katon, W. , P. Robinson, M. Von Korff, E. Lin, T. Bush, E. Ludman, G. Simon, and E. Walker. 1996. A multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry53:924-932.
76.
Katon, W. , M. Von Korff, E. Lin, G. Simon, E. Walker, T. Bush, and E. Ludman. 1997. Collaborative management to achieve depression treatment guidelines. Journal of Clinical Psychiatry58 (suppl. 1): 20-23.
77.
Katon, W. , M. Von Korff, E. Lin, G. Simon, E. Walker, J. Unutzer, T. Bush, J. Russo, and E. Ludman. 1999. Stepped collaborative care for primary care patients with persistent symptoms of depression: A randomized trial. Archives of General Psychiatry56:1109-1115.
78.
Keller, A.1998. Managed behavioral health care in the frontier: Letter to the field no. 9. Available from http://www.wiche.edu/MentalHealth/Frontier/index.htm.
79.
Keller, P. A. , J. D. Murray, and D. S. Hargrove. 1999. A rural mental health research agenda: Defining context and setting priorities. Journal of Rural Health15 (3): 316-325.
80.
Kessler, R. C. , K. A. McGonagle, S. Zhao, C. B. Nelson, M. Hughes, S. Eshleman, H. U. Wittchen, and K. S. Kendler. 1994. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry51 (1): 8-19.
81.
Krout, J. A.1998. Services and service delivery in rural environments. In Aging in rural settings: Life circumstances & distinctive features, edited by Raymond T. Coward and John A. Krout, 247-266. New York: Springer.
82.
Lambert, D. , M. Agger, and D. Hartley. 1999. Service use of rural and urban Medicaid beneficiaries suffering from depression: The role of supply. Journal of Rural Health15 (3): 344-355.
83.
Lambert, D. , and M. S. Agger. 1995. Access of rural AFDC Medicaid beneficiaries to mental health services. Health Care Financing Review17 (1): 133-145.
84.
Lambert, D. , and D. Hartley. 1998. Linking primary care and rural psychiatry: Where have we been and where are we going?Psychiatric Services49 (7): 965-967.
85.
Lambert, D. , D. Hartley, D. Bird, R. Ralph, and P. Saucier. 1998. Medicaid mental health carve-outs: Impact and issues in rural areas. Unpublished report, Maine Rural Health Research Center.
86.
Leaf, P. J. , M. L. Bruce, G. L. Tischler, D. H. Freeman Jr., M. M. Weissman, and J. K. Myers. 1988. Factors affecting the utilization of specialty and general medical mental health services. Medical Care26 (1): 9-26.
87.
Leaf, P. J. , M. M. Livingston, G. L. Tischler, M. M. Weissman, C. E. Holzer III, and J. K. Myers. 1985. Contact with health professionals for the treatment of psychiatric and emotional problems. Medical Care23 (12): 1322-1337.
88.
Lipton, J. A. , and J. J. Marbach. 1984. Ethnicity and the pain experience. Social Science and Medicine19 (12): 1279-1298.
89.
Lomicka, E. W.1997. Building managed care networks for rural communities. Managed Care Quarterly5 (2): 51-65.
90.
Manning, W. G. , C. F. Liu, T. J. Stoner, D. Z. Gray, N. Lurie, M. Popkin, and J. B. Christianson. 1999. Outcomes for Medicaid beneficiaries with schizophrenia under a prepaid mental health carve-out. Journal of Behavioral Health Services & Research26 (4): 442-450.
91.
Manning, W. G. , J. P. Newhouse, N. Duan, E. B. Keeler, A. Leibowitz, and M. S. Marquis. 1987. Health insurance and the demand for medical care: Evidence from a randomized experiment. American Economic Review77 (3): 251-277.
92.
Manning, W. G. , K. B. Wells, N. Duan, J. P. Newhouse, and J. E. Ware Jr.1984. Cost sharing and the use of ambulatory mental health services. American Psychologist39 (10): 1077-1089.
93.
Manning, W. G. , K. B. Wells, N. Duan, J. P. Newhouse, and J. E. Ware Jr.. 1986. How cost sharing affects the use of ambulatory mental health services. Journal of the American Medical Association256 (14): 1930-1934.
94.
McDonel, E. C. , G. R. Bond, M. Salyers, D. Fekete, A. Chen, J. H. McGrew, and L. Miller. 1997. Implementing assertive community treatment programs in rural settings. Administration and Policy in Mental Health25 (2): 153-173.
95.
Mechanic, D. , M. Schlesinger, and D. D. McAlpine. 1995. Management of mental health and substance abuse services: State of the art and early results. Milbank Quarterly73 (1): 19-54.
96.
Merwin, E. I. , H. F. Goldsmith, and R. W. Manderscheid. 1995. Human resource issues in rural mental health services. Community Mental Health Journal31 (6): 525-537.
97.
Miranda, J. , F. Azocar, M. Komaromy, and J. M. Golding. 1998. Unmet mental health needs of women in public-sector gynecologic clinics. American Journal of Obstetrics and Gynecology178 (2): 212-217.
98.
Mohatt, D. F.1997. Access to mental health services in frontier America: Letter to the field no. 4. Available from http://www.wiche.edu/MentalHealth/Frontier/index.htm.
99.
Morrissey, J. P. , M. C. Johnsen, and M. O. Calloway. 1997. Evaluating performance and change in mental health systems serving children and youth: An interorganizational network approach. Journal of Mental Health Administration24 (1): 4-22.
100.
Moscovice, I. , M. Casey, and S. Krein. 1998. Expanding rural managed care: Enrollment patterns and prospects. Health Affairs17 (1): 172-179.
101.
Moscovice, I. , and R. Rosenblatt. 2000. Quality of care challenges for rural health. Journal of Rural Health16 (2): 168-176.
102.
Mueller, K. J. , K. Patil, and E. Boilesen. 1998. The role of uninsurance and race in healthcare utilization by rural minorities. Health Services Research33 (3): 597-610.
103.
Murray, J. D. , and P. A. Keller. 1991. Psychology and rural America: Current status and future directions. American Psychologist46 (3): 220-231.
104.
National Rural Health Association . 1999. Mental health in rural America. Available from http://www.nrharural.org/dc/issuepapers/ipaper14.html.
105.
Neese, J. B. , I. L. Abraham, and K. C. Buckwalter. 1999. Utilization of mental health services among rural elderly. Archives of Psychiatric Nursing13 (1): 30-40.
106.
Norton, C. H. , and M. A. McManus. 1989. Background tables on demographic characteristics, health status, and health services utilization. Health Services Research23 (6): 725-756.
107.
Office of Applied Studies, Substance Abuse and Mental Health Services Administration . 1997. National Household Survey on Drug Abuse: Main findings 1995. DHHS publication no. (SMA) 97-3127. Hyattsville, MD: Government Printing Office.
108.
Office of Applied Studies, Substance Abuse and Mental Health Services Administration . 1999. National Household Survey on Drug Abuse: Main findings 1997. DHHS publication no. (SMA) 99-3295. Hyattsville, MD: Government Printing Office.
109.
Office of Rural Health Policy . 1997. Exploratory evaluation of rural applications of telemedicine. Rockville, MD: U.S. Department of Health and Human Services.
110.
Olfson, M. , and H. A. Pincus. 1994. Outpatient psychotherapy in the United States, I: Volume, costs, and user characteristics. American Journal of Psychiatry151 (9): 1281-1288.
111.
Ortega, S. T. , D. R. Johnson, P. G. Beeson, and B. J. Craft. 1994. The farm crisis and mental health: A longitudinal study of the 1980s. Rural Sociology59 (4): 598-619.
112.
Oss, M. , J. J. Mackie, S. Birch, and D. Hartley. 1998. Best practices in rural Medicaid managed behavioral health: Measuring & monitoring access. Available from http://www.muskie.usm.maine.edu/bestpractice.
113.
Patton, L.1989. Setting the rural health services research agenda: The congressional perspective. Health Services Research23 (6): 1005-1051.
114.
Pauly, M. V.1998. Managed care, market power, and monopsony. Health Services Research33 (5, part 2): 1139-1460.
115.
Penchansky, R. , and J. W. Thomas. 1981. The concept of access: Definition and relationship to consumer satisfaction. Medical Care19 (2): 127-140.
116.
Penrod, J. D. , T. D. McBride, and K. J. Mueller. 2001. Geographic variation in determinants of Medicare managed care enrollment. Health Services Research36 (4): 733-750.
117.
Price, N. , W. Glazer, and H. Morgenstern. 1985. Demographic predictors of the use of injectable versus oral antipsychotic medications in outpatients. American Journal of Psychiatry142:1491-1492.
118.
Ralph, R. O.1998. Best practices in rural Medicaid managed behavioral health: Consumer issues. Available from http://www.muskie.usm.maine.edu/bestpractice.
119.
Ricketts, T. C. , R. T. Slifkin, and K. D. Johnson-Webb. 1995. Patterns of health maintenance organization service areas in rural counties. Health Care Financing Review17 (1): 99-113.
120.
Ricketts, T. C., III , K. D. Johnson-Webb, and R. K. Randolph. 1999. Populations and places in rural America. In Rural health in the United States, edited by Thomas C. Ricketts III, 7-24. New York: Oxford University Press.
121.
Rosenblatt, R. A. , C. Roberts, and M. Wakefield. 2000. Quality of care in the rural context: A proposed research agenda. Paper presented at the National Rural Health Association Setting the Rural Health Agenda Conference, 25-27 January, Washington, DC.
122.
Rosenstock, I. M.1966. Why people use health services. Milbank Memorial Fund Quarterly44 (2): 94-127.
123.
Rosenthal, T. C. , P. James, C. Fox, J. Wysong, and P. G. FitzPatrick. 1997. Rural physicians, rural networks, and free market health care in the 1990s. Archives of Family Medicine6 (4): 319-323.
124.
Rost, K. , J. Fortney, M. Zhang, J. Smith, and G. R. Smith. 1999. Treatment of depression in rural Arkansas: Policy implications for improving care. Journal of Rural Health15 (3): 308-315.
125.
Rost, K. , J. Humphrey, and K. Kelleher. 1994. Physician management preferences and barriers to care for rural patients with depression. Archives of Family Medicine3:409-414.
126.
Rost, K. , J. Kirchner, J. C. Fortney, and B. M. Booth. 2000. Rural-urban differences in service use by at-risk drinkers. Journal of Rural Community PsychologyE3 (1). Retrieved from http://www.marshall.edu/jrcp/Vole31/rost.html.
127.
Rost, K. , P. Nutting, J. Smith, J. C. Coyne, L. Cooper-Patrick, and L. Rubenstein. 2000. The role of competing demands in the treatment provided primary care patients with major depression. Archives of Family Medicine9 (2): 150-154.
128.
Rost, K. , G. R. Smith, B. Guise, and D. B. Matthews. 1994. The deliberate misdiagnosis of major depression in primary care. Archives of Family Medicine3:333-337.
129.
Rost, K. M. , R. R. Owen, J. Smith, and G. R. Smith Jr.1998. Rural-urban differences in service use and course of illness in bipolar disorder. Journal of Rural Health14 (1): 36-43.
130.
Rost, K. M. , M. Zhang, J. Fortney, J. Smith, J. Coyne, and G. R. Smith Jr.1998. Persistently poor outcomes of undetected major depression in primary care. General Hospital Psychiatry20 (1): 12-20.
131.
Rost, K. M. , M. Zhang, J. Fortney, J. Smith, and G. R. Smith Jr.1998a. Rural-urban differences in depression treatment and suicidality. Medical Care36 (7): 1098-1107.
132.
Rost, K. M. , M. Zhang, J. Fortney, J. Smith, and G. R. Smith Jr.1998b. Expenditures for the treatment of major depression. American Journal of Psychiatry155 (7): 883-888.
133.
Rural Health Research Center . 1997. Rural managed care: Patterns & prospects. Minneapolis: University of Minnesota Press.
134.
St. Clair, P. A. , V. L. Smeriglio, C. S. Alexander, and D. D. Celentano. 1989. Social network structure and prenatal care utilization. Medical Care27 (8): 823-832.
135.
St. Lawrence, J. S.1999. Emerging behavioral strategies for the prevention of HIV in rural areas. Journal of Rural Health15 (3): 335-343.
136.
Scheffler, R. M. , and A. B. Miller. 1989. Demand analysis of mental health service use among ethnic subpopulations. Inquiry26:202-215.
137.
Scheidt, R. J.1998. The mental health of the elderly in rural environments. In Aging in rural settings: Life circumstances & distinctive features, edited by Raymond T. Coward and John A. Krout, 85-103. New York: Springer.
138.
Segal, S. P. , J. R. Bola, and M. A. Watson. 1996. Race, quality of care, and antipsychotic prescribing practices in psychiatric emergency services. Psychiatric Services47 (3): 282-286.
139.
Serrato, C. , R. S. Brown, and J. Bergeron. 1995. Why do so few HMOs offer Medicare risk plans in rural areas?Health Care Financing Review17 (1): 85-97.
140.
Shapiro, S. , E. A. Skinner, M. Kramer, D. M. Steinwachs, and D. A. Regier. 1985. Measuring need for mental health services in a general population. Medical Care23:1033-1043.
141.
Shelton, D. A. , and R. Frank. 1995. Rural mental health coverage under health care reform. Community Mental Health Journal31 (6): 539-552.
142.
Sherbourne, C. D.1988. The role of social support and life stress events in use of mental health services. Social Science and Medicine27 (12): 1393-1400.
143.
Slifkin, R. T. In press. Developing policies responsive to barriers to health care among rural residents: What do we need to know?Journal of Rural Health.
144.
Slifkin, R. T. , and M. M. Casey. 1999. Medicaid managed care in rural areas. In Rural health in the United States, edited by Thomas C. Ricketts III, 95-112. New York: Oxford University Press.
145.
Smith, J. L. , K. M. Rost, P. A. Nutting, C. E. Elliott, and N. Duan. 2000. A primary care intervention for depression. Journal of Rural Health16 (4): 313-323.
146.
Strakowski, S. M. , H. S. Lonczak, K. W. Sax, S. A. West, A. Crist, R. Mehta, and O. J. Thienhaus. 1995. The effects of race on diagnosis and disposition from a psychiatric emergency service. Journal of Clinical Psychiatry56 (3): 101-107.
147.
Sturm, R. , C. A. Jackson, L. S. Meredith, W. Yip, W. G. Manning, W. H. Rogers, and K. B. Wells. 1995. Mental health care utilization in prepaid and fee-for-service plans among depressed patients in the medical outcomes study. Health Services Research30 (2): 319-340.
148.
Sullivan, G. , C. A. Jackson, and K. L. Spritzer. 1996. Characteristics and service use of seriously mentally ill persons living in rural areas. Psychiatric Services47 (1): 57-61.
149.
Susman, J. L. , B. F. Crabtree, and G. Essink. 1995. Depression in rural family practice: Easy to recognize, difficult to diagnose. Archives of Family Medicine4:427-431.
150.
Trout, D. L.1995. Should any willing provider laws become a mandate for behavioral healthcare? Consumer payors require customization and choice of network products. Behavioral Healthcare Tomorrow4 (4): 40, 43-45.
151.
Van Hook, M. P. , and M. E. Ford. 1998. The linkage model for delivering mental health services in rural communities: Benefits and challenges. Health & Social Work23 (1): 53-60.
152.
Vega, W. A. , B. Kolody, S. Aguilar-Gaxiola, and R. Catalano. 1999. Gaps in service utilization by Mexican Americans with mental health problems. American Journal of Psychiatry156 (6): 928-934.
153.
Wagenfeld, M. O.1988. Rural mental health and community psychology in the post community mental health era: An overview and introduction to the special issue. Journal of Rural Community Psychology9 (2): 5-13.
154.
Wagenfeld, M. O. , J. D. Murray, D. F. Mohatt, and J. C. DeBruyn. 1994. Mental health and rural America: 1980-1993. NIH publication no. 94-3500. Washington, DC: U.S. Department of Health and Human Services.
155.
Warner, L. A. , R. C. Kessler, M. Hughes, J. C. Anthony, and C. B. Nelson. 1995. Prevalence and correlates of drug use and dependence in the United States: Results from the National Comorbidity Survey. Archives of General Psychiatry52:219-229.
156.
Watts, C. A. , R. M. Scheffler, and N. P. Jewell. 1986. Demand for outpatient mental health services in a heavily insured population: The case of the Blue Cross and Blue Shield Association’s federal employees health benefits program. Health Services Research21 (2): 267-289.
157.
Wellever, A.1998a. Future rural managed care issues. Journal of Rural Health14 (3): 274-277.
158.
Wellever, A. . 1998b. Implications of HMOs for rural providers and consumers. Journal of Rural Health14 (3): 268-273.
159.
Wells, C. A., Jr.1996. Managed care strategies for rural providers. Healthcare Financial Management50 (7): 37-39.
160.
Wells, K. B. , A. Burnam, W. Rogers, R. Hays, and P. Camp. 1992. The course of depression in adult outpatients: Results from the Medical Outcomes Study. Archives of General Psychiatry49:788-794.
161.
Wells, K. B. , R. D. Hays, M. A. Burnam, W. Rogers, S. Greenfield, and J. E. Ware Jr.1989. Detection of depressive disorder for patients receiving prepaid or fee-for-service care: Results from the medical outcomes study. Journal of the American Medical Association262 (23): 3298-3302.
162.
Wells, K. B. , S. D. Hosek, and M. S. Marquis. 1992. The effects of preferred provider options in fee-for-service plans on use of outpatient mental health services by three employee groups. Medical Care30 (5): 412-427.
163.
Wells, K. B. , W. G. Manning Jr., and B. Benjamin. 1986. Use of outpatient mental health services in HMO and fee-for-service plans: Results from a randomized controlled trial. Health Services Research21 (3): 453-472.
164.
Wells, K. B. , W. G. Manning Jr., N. Duan, J. P. Newhouse, and J. E. Ware Jr.1987. Cost-sharing and the use of general medical physicians for outpatient mental health care. Health Services Research22 (1): 1-17.
165.
Wells, K. B. , W. G. Manning Jr., and R. B. Valdez. 1989. The effects of insurance generosity on the psychological distress and psychological well-being of a general population. Archives of General Psychiatry46:315-320.
166.
Wells, K. B. , W. G. Manning Jr., and R. B. Valdez. 1990. The effects of a prepaid group practice on mental health outcomes. Health Services Research25 (4): 615-625.
167.
Wysong, J. A. , M. K. Bliss, J. W. Osborne, R. P. Graham, and D. A. Pikuzinski. 1999. Managed care in rural markets: Availability and enrollment. Journal of Health Care for the Poor and Underserved10 (1): 72-84.
168.
Yuen, E. J. , J. L. Gerdes, and J. J. Gonzales. 1996. Patterns of rural mental health care: An exploratory study. General Hospital Psychiatry18 (1): 14-21.
169.
Zarate, C. A., Jr. , L. Weinstock, P. Cukor, C. Morabito, L. Leahy, C. Burns, and L. Baer. 1997. Applicability of telemedicine for assessing patients with schizophrenia: Acceptance and reliability. Journal of Clinical Psychiatry58 (1): 22-25.
170.
Zhang, M. , K. M. Rost, and J. C. Fortney. 1999a. Depression treatment and cost offset for rural community residents with depression. Journal of Social Service Research25 (3): 99-110.
171.
Zhang, M. , K. M. Rost, and J. C. Fortney. 1999b. Earnings changes for depressed individuals treated by mental health specialists. American Journal of Psychiatry156:108-114.
