Urban-rural differences in psychiatric rehabilitation outcomes

Objective: Employing rural and urban patient populations, the aim of the study was to examine the differences in rehabilitation intervention outcomes, particularly in regard to the social and clinical determinants. Design: The study employed a retrospective, cross-sectional analysis of patient outcome and characteristics. Setting: Community-based psychiatric rehabilitation service in regional and rural Australia. Participants: A total of 260 patients were included in the service evaluation phase of the study and 86 in the second part of the study. Participants were community-based and suffered from a chronic mental illness. Main outcome measure(s): Clinical and functional outcomes were measured using the Health of Nations Outcome Scale and the 16-item Life Skills Profile. The outcome score employed was the difference between scores at intake and at the last complete assessment. Clinical and sociodemographic characters were recorded using a proforma developed for the study. Results: Patients from rural Maitland had a significantly larger mean reduction in total scores and classified more often as 'Improved' on both the Health of Nations Outcome Scale and Life Skills Profile than patients from either of the urban areas (P < 0.01). Study of randomly selected patients showed that those from an urban area had a more complex illness with multiple needs and less often received family support than their rural counterparts. Conclusions: For rural communities the improvement in rehabilitation outcomes might be attributable to a more benign form of the illness and the availability of higher levels of social capital.