Unveiling the rural dichotomy: the dual impact of rurality on youth mental health

Introduction:The geographic, cultural, social and economicmilieu that impacts mental health in rural communities globallyhas been well documented. However, few studies have addressedhow rural ecosystems impact specifically upon the mental healthand wellbeing of young people. Furthermore, the limitedexplorations of factors contributing to poorer mental healthoutcomes in rural youth have primarily included adult voices. Thestudy aimed to give a youth voice to the vexed problem of highrates of youth mental illness and suicide in rural and remote areas,exploring young people's experiences in a deeply contextualmanner.Methods:This study followed a phenomenological qualitativedesign underpinned by the principles of participatory actionresearch. A youth-led reference group provided guidance on thestudy design and recruitment. A total of 29 young people aged12-19years were recruited from a small rural community insouthern Western Australia. Individual and focus group semi-structured interviews were conducted. The interviews weretranscribed and subjected to thematic analysis informed byecological systems theory. Results:The findings demonstrate the impact of a rural address onyouth mental health through the influence of three overarchingspheres of influence, as described by ecological systems theory:'everyone knows everyone', 'small school and beyond' and 'theplace'.Most themes included both positive and negativecomponents, as well as ambivalence, demonstrating a double-edged sword.Conclusion:The study findings support the view that mentalhealth in rural young people is best viewed through an ecosystemlens, acknowledging the complex and dynamic interplay betweeninterpersonal, community and environmental factors on youngpeople. The paradoxes and contradictions present in almost everyinterview are informative, instructive and of great value inconsidering the needs and desires of rural young people. Ruralcommunities should be supported to build upon their intrinsicstrengths to ameliorate the impact of rurality on mental health riskfactors for young people. Building on the assets inherent in ruralcommunities, could rural young people have better outcomes thanurban youth?