Urban areas, such as cities, are the largest type of community (1). Rural and remote areas have smaller populations, however remote areas additionally have a larger distance from bigger settlements and reduced transportation access. Urban and rural areas have economic and social differences in terms of employment rates, crime rates (2), living conditions (3), and access to education (4).
Risk and/or Protective Factor
The economic and social differences that people may experience between living in urban, rural, and remote areas can have effects on mental health.
People living in urban areas may be confronted with more adverse living conditions, decreased social support and more life stress, which can be risk factors for mental health difficulties (3). Living in urban areas has been associated with higher rates of mental health conditions and substance abuse in comparison to people living in rural areas.
Rural areas have been associated with lower unemployment rates and less crime (2); which are both protective factors for mental health. However, living in rural areas can also be a risk factor due to less access to mental health specialists, influencing mental health treatment (5); this impaired access is exacerbated in remote areas.
Due to the further distance from larger settlements, people from remote areas can also have reduced access to employment opportunities and education found in comparison to rural areas closer to urban areas (4); which can be a risk factor for mental health difficulties.
1. Bibby P, Shepherd J. Developing a New Classification of Urban and Rural Areas for Policy Purposes – the Methodology [Internet]. 2011. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/137655/rural-urban-definition-methodology-technical.pdf
2. Pateman T. Rural and urban areas: comparing lives using rural/urban classifications. Reg Trends [Internet]. 2011;43(1):11–86. Available from: https://doi.org/10.1057/rt.2011.2
3. Paykel ES, Abbott R, Jenkins R, Brugha TS, Meltzer H. Urban-rural mental health differences in Great Britain: Findings from the National Morbidity Survey. Psychol Med [Internet]. 2000 [cited 2021 Jan 22];30(2):269–80. Available from: https://doi.org/10.1017/S003329179900183X
4. Dijkstra L, Poelman H. Remote Rural Regions How proximity to a city influences the performance of rural regions [Internet]. 2008. Available from: https://ec.europa.eu/regional_policy/sources/docgener/focus/2008_01_rural.pdf
5. Hoeft TJ, Fortney JC, Patel V, Unützer J. Task-Sharing Approaches to Improve Mental Health Care in Rural and Other Low-Resource Settings: A Systematic Review. J Rural Heal [Internet]. 2018 Jan 1 [cited 2021 Jan 22];34(1):48–62. Available from: http://doi.wiley.com/10.1111/jrh.12229