Document Type

Working Paper

Publication Date



children, rural, MRHRC, mental health



Research indicates that privately insured, rural adults have lower use of office-based mental health services, but higher use of prescription medicines than their urban counterparts. Similar studies for rural children have been limited to specific populations, diagnoses, or to single states. Patterns for rural children may be different than those of urban children and adults generally because of their high enrollment in Medicaid and the State Children's Health Insurance Program, which tend to have more generous behavioral health benefits than private coverage and may equalize rural-urban treatment patterns. On the other hand, the more limited supply of specialty mental health providers in rural areas, particularly for children, could lead to lack of access and lower utilization of some types of mental health services in rural areas versus urban.


Using data on children ages 5-17 from the 2002-2008 Medical Expenditure Panel Survey, this study examines two research questions: 1) do patterns of children's mental health diagnosis and service use (e.g., office visits and psychotropic medications) differ by rural-urban residence? and 2) what is the effect of income and insurance type on use of mental health services?


Controlling for demographic and risk factors, rural children are as likely as urban children to have an attention deficit or hyperactivity disorder (ADHD) diagnosis and less likely to have any other type of psychiatric diagnosis. Initially observed higher prevalence of mental health diagnoses among rural children is explained by underlying differences in demographic characteristics and risk factors, such as higher rates of poverty, public coverage, mental health impairment, and lower prevalence of minorities. Rural children with the highest mental health need are no more or less likely to be diagnosed or treated for mental health conditions. However, among those with a possible impairment, rural children are less likely to be diagnosed with a psychiatric illness other than ADHD and are less likely to receive counseling.


Working Paper 49

Funding Organization

This study was funded under a Cooperative Agreement with the federal Office of Rural Health Policy, Health Resources and Services Administration, DHHS.

Grant Number




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