Title: Literature Review Assessing Pediatric Mental Health Disparities in Rural Areas
Authors: Kayla Epperly, MAMS; Kayla Hagemann, MAMS
Introduction
Rural communities account for the vast majority of the area with roughly 20% of the rural population being under the age of 18. Pediatric mental health care in rural areas is scarce and difficult to access, despite the significant need. The purpose of this literature review is to ascertain the disparities behind the delivery of pediatric mental health care and how they can be addressed.
Methods
Pediatric individuals of any gender with any diagnosed mental health disorder living in Rural America were the target of our study. Our literature review used Google Scholar and PubMed and applied combinations of the following key terms: socioeconomic standing, lack of providers, rural vs urban geographic location, and stigma related to pediatric mental health. Sources that are specific to the impacts of the COVID-19 virus on rural pediatric mental health were excluded from our review.
Results
We found that children in a more urbanized setting are more likely to receive mental health treatment in comparison to those in rural settings. This was found to be correlated with differences in provider availability, socioeconomic standing of families, and rural sub-demographic factors including specific ages, race, and gender. However, it should be noted that we found that there is a significant barrier in rural pediatric research projects due to the difficulty of recruiting research participants. This barrier to the research can be attributed to, but not limited by, small population sizes, lack of resources for utilization, and negative perceptions on research.
Discussion
After our review of articles, it is evident that there are barriers to pediatric mental health in rural areas. Moreover, it can be concluded that further research on the delivery and overall treatment outcomes of rural pediatric mental healthcare and the barriers associated with them is warranted, specifically due to the difficulty of recruiting rural pediatric mental health research participants.
A question from a judge: You state that a lack of participation of research subjects in rural areas is an impediment to identifying potential solutions to the lack of access of rural pediatric patients to care. There is an emerging literature about the use of financial incentives to improve participation, retention and outcomes in clinical research. Please provide your comments about the ethics of paying rural research subjects to provide input regarding their pediatric mental health care.
Thank you for your comment and question. The ethics behind providing a financial incentive to increase rural research participants is an interesting topic. There are many concerns regarding this which include the potential of coercion and exploitation. As much of the pediatric mental health participants may be from a younger age range, parental judgement and information is used in the research. These ethical concerns come into play when discussing rural participants and parents as many are distrusting of the scientific community, are from a lower socioeconomic standing, and have lower levels of education.
The type of incentive and amount are two aspects that must be taken into consideration. Paying too little has the potential to cause exploitation of the rural community members. The type of incentive is also important to consider because providing direct cash can lead to the before-mentioned issue but considering that many rural families may have difficulty with transportation, covering the cost of bus fare(s) or the overall price of the trip(s) to the location of the research could be a potential option to consider. It is important to understand that parents may exploit their children for the financial incentives from the research as well, so it is important to take into considerations the risk of this when proposing an incentive. The idea of the incentive could distort the responses of the parent in order to receive the incentive. Providing a financial incentive has the potential to greatly increase participation rates in rural communities, but it is important to understand the risks this may have on the research itself and the perceived view this will have on future research in rural communities.
This is an interesting and important topic. As one of the judges for this project, I was hoping to learn more about the articles you found in your search such as how many articles were found and how many did you include in your results. Also, were these included articles research based with hypotheses and data or were some of them opinion papers. Finally, did some of these article compare mental health in your target age group in rural versus urban settings directly? Thanks!
Thank you for your comment and questions. I found 15 articles and included information from all of them into my results. The articles included ranged from research with a hypothesis or proposed questions to be answered with collected and assessed data to research that were reviews of previous literature and research. Most of the articles that I reviewed compared pediatric mental health disparities in rural communities versus urban communities directly, but some discussed disparities in rural communities without the direct comparison to an urban community.
Thank you for your presentation. Why do you believe that it is difficult to recruit and retain mental health providers in rural areas?
Thank you for your comment and question. I believe that it is difficult to retain and recruit mental health providers in rural areas due to many factors including (but not limited to) lack of familiarity and the lack of resources. The lack of familiarity of rural communities can deter providers away from being recruited. Instinctively, we gravitate towards things that we are familiar or comfortable with. If someone has a lack of experience in rural healthcare and/or the patient population within a rural community, they could be less likely to find themselves working within one. Many rural communities do not have adequate healthcare resources, which places more of a burden on these providers to provide an increased level of care in order to compensate for this lack of resources. This, along with the higher patient load due to the lack of providers, could lead to increased burnout and potentially resigning from their positions to find work elsewhere. The two ideas can also be discussed in conjunction. If a provider finds themselves working within a rural community and are unfamiliar with the setting, they may find themselves uncomfortable with the lack of resources or have difficulty connecting with their patient population due to their unfamiliarity. This can lead to decreased satisfaction and could potentially lead them to look for work in a more comforting setting. Retainment and recruitment of providers in rural communities continues to be a critical priority in addressing for the future of rural healthcare.