Literature Collection

PURPOSE: The present study examined differences in the mental health outcomes and psychotherapy use of rural Veterans with military sexual trauma (MST), as compared to their urban peers, given rural Veterans' increased risk for delayed or missed care. METHODS: We analyzed Veterans Health Administration (VHA) administrative data for 311,917 Veterans with a history of MST. Veterans were classified as rural/highly rural (30.25%) or urban (69.75%) based on VHA Rural-Urban Commuting Area codes. Rural-urban differences were assessed for mental health disorders and service use across 4 VHA clinic types (i.e., integrated Primary Care-Mental Health Clinic, General Mental Health Clinic, Posttraumatic Stress Disorder Clinical Team, Substance Use Disorder Clinic) using logistic regression models adjusted for age. Analysis of covariance models compared differences in utilization intensity among Veterans with at least 1 encounter in the designated clinic. FINDINGS: Compared to urban Veterans with MST, rural Veterans with MST were more likely to be diagnosed with an anxiety disorder but less likely to be diagnosed with posttraumatic stress disorder, depression, bipolar disorder, alcohol use disorder, and other substance use disorder. As expected, rural Veterans with MST were less likely to receive individual and group psychotherapy services, regardless of the VHA clinic type, than their urban counterparts. Notably, rural Veterans remained in individual and group treatment longer than urban Veterans across nearly all clinics. CONCLUSION: Further investigation into challenges and opportunities to improve mental health care initiation among rural Veterans with MST is a critical next step in optimizing their well-being and quality of life.

OBJECTIVE: Effective treatments for opioid use disorder exist, but rural areas of the United States have a shortage of services offering such treatments. Physician bias toward patients with opioid use disorder can also limit care access, but no studies have assessed whether physician bias is a more acute barrier in rural compared with urban communities. METHODS: In total, 408 board-certified physicians in Ohio, a state with a high rate of opioid overdoses, completed an online survey examining perspectives on clinical care for patients who misuse opioids. Respondents with missing county-level data were excluded, leaving a total sample of 274. The authors used t tests to determine rural-urban differences in bias, key predictors of bias, and availability of opioid services. Multivariable regression modeling was used to estimate rural-urban differences in bias independent of key bias predictors. RESULTS: Physicians in rural areas (N=37) reported higher levels of bias toward patients with opioid use disorder than did their urban counterparts (N=237). This difference remained statistically significant even after accounting for known bias predictors and physician specialty. Physicians specializing in addiction medicine reported lower bias than did physicians not working in this specialty. CONCLUSIONS: Given existing disparities in harm reduction and addiction treatment services in rural areas, increased physician bias in counties lacking these services suggests that rural patients with opioid use disorder face numerous challenges to finding effective treatment. Bias reduction interventions should target health care professionals in rural communities where such efforts may have the most pronounced impact on improving health care access.