Rural older adults' mental health: status and challenges in care delivery

Introduction: Health disparities remain a challenge in rural populations, with mental health care especially challenging as the proportion of older adults continues to increase worldwide. This study examined the mental health service needs of, and use by, independently living rural older adults, with a focus on depression. Methods: Older adults (>= 50 years) were asked to complete a survey. Results: There were 150 respondents: 29% were between the ages of 50 and 64 years and 71% were 65 years and older. On a composite variable, 23.3% were at-risk for depression. One-half to two-thirds reported awareness of local mental health services, but nearly three-quarters never used these. Barriers to effective treatment of depression included stress, healthcare costs, and denial/fear of depression. There was an 'avoidance' factor in depression diagnosis and management. Conclusion: Older adults in rural communities experiencing depression pose a problem. Strategies are needed to overcome multiple barriers to effective diagnosis and treatment. There is a need to better understand the role of stress in older adults' lives. It is especially important for primary care providers and the local community to organize resources to allow for more time to be spent with older adults with mental health problems.