Many Utah residents experience poor mental health, with 1 in 5 Utah adults experiencing some form of mental illness and 1 in 20 experiencing serious mental illness (e.g., bipolar disorder or schizophrenia). Using data from the Utah Wellbeing Survey, this fact sheet explores wellbeing and mental health in Utah by rural-urban location, specifically highlighting differences between rural, growing, and urban places in the state

Flint, Courtney G.

Koci, Kristen

Ulrich-Schad, Jessica

English

DigitalCommons@USU

UTAHNS' WELLBEING ANDMENTAL HEALTH BY RURAL-URBAN LOCATIONKristen Koci, Ph.D. CandidateCourtney Flint, Ph.D.Jessica Ulrich-Schad, Ph.D.Those living in the rural U.S. face some uniquemental health challenges. Approximately one-fifth ofthe U.S. population live in rural areas, and aboutone-fifth of those living in rural areas have someform of mental illness (Morales et al., 2020). Theprevalence of mental health issues are relativelycomparable in rural and urban places, though someresearch shows rural residents experience higherrates of depression and suicide (Health Resourcesand Services Administration [HRSA], 2005;Carpenter-Song & Snell-Rood, 2017). Ruralresidents in the U.S. also experience significantmental health disparities (Gamm et al., 2010;Morales et al., 2020). For example, accessibility,availability, and acceptability of services to addressmental health are limited in rural places in the U.S.(HRSA, 2005). The United States is currently facing a mental healthcrisis (United States Department of Health andHuman Services, 2023). More than 1 in 5 U.S.adults live with a mental illness, and about 1 in 25live with a serious mental illness (e.g.,schizophrenia, bipolar disorder, or majordepression), making mental illnesses among themost common health conditions in the U.S. (Centersfor Disease Control and Prevention [CDC], 2023). INTRODUCTIONBy some measures, Utah has the poorest mentalhealth of all states for adults (Summers et al.,2019). In 2021, 23.4% of Utah adults experienceddepression compared to 20.1% in the broader U.S.and, as of 2020, suicide is the leading cause ofdeath in Utah for those ages 10 to 24 (PublicHealth Indicator Based Information System [IBIS-PH], 2022 and 2023). Additionally, 1 in 20 Utahadults experience serious mental illness, and overhalf of Utah adults with a mental illness did notreceive mental health treatment as of 2019(Summers et al., 2019; National Alliance on MentalIllness [NAMI], 2021). Relatedly, there is ashortage of mental health providers, particularly inrural parts of the state (Summers et al., 2019). “Rural Americans face seriousmental health disparities,   including higher rates of suicideand depression compared withresidents of urban areas.”(Carpenter-Song & Snell-Rood, 2017, p. 503)Related to mental health, wellbeing is amultifaceted concept that “includes the presenceof positive emotions and moods (e.g.,contentment, happiness), the absence ofnegative emotions (e.g., depression, anxiety),satisfaction with life, fulfillment and positivefunctioning” (CDC, 2018). In short, it maygenerally be described as “judging life positivelyand feeling good” (CDC, 2018). There arevarious domains or categories of wellbeing thatmay be measured, including mental health,physical health, living standards, and safety andsecurity, among others. The relationship betweenmental health and wellbeing is important toconsider, as mental health is vital to anindividual’s self-reported wellbeing. This factsheet explores wellbeing and mental health inUtah by rural-urban location.DATA OVERVIEWRURAL-URBAN CATEGORIZATIONFor more information on the Utah WellbeingSurvey, please visit the Utah Wellbeing Projectwebsite. To learn more about wellbeing and mentalhealth in Utah, please see the complementary factsheet Utahns' Wellbeing and Mental Health. participating cities age 18+ were encouraged totake the survey. In 2022, 33 Utah cities/townsparticipated in the survey, with responses from9,948 residents. The data used here were collected through theUtah Wellbeing Survey. This survey helps keep “afinger on the pulse of residents' wellbeing andattitudes about community issues” and “helps topromote sound planning and decision-making tosupport the overall quality of life in Utah's cities andtowns” (Utah Wellbeing Project, 2023). The UtahWellbeing Survey has been conducted in over 40Utah cities and towns annually since 2019, andover 25,000 responses have been collected todate. Data from 2022, the most recent full year fromwhich data were collected, are used here. In 2022,the survey was administered online via Qualtrics,and each participating city advertised the survey viasocial media, newsletters, utility bills, websites,flyers, or other local mechanisms. Residents in The surveyed cities fall into three combined cityclusters based on the caucus groups delineated bythe Utah League of Cities and Towns (ULCT) (seeFigure 1). These clusters represent different levels ofrurality, moving from rural (rural hub/resort andtraditional rural communities) to growing (rapidgrowth cities) to urban (large and mid-sized cities).Large cities are also known as cities of the first andsecond class. Cities of the first class have apopulation greater than 100,000 and cities of thesecond class have a population greater than 65,000but less than 100,000. Mid-sized cities are those thathave reached a more mature life cycle stage buthave populations less than 65,000. Rapid growthcities are those which were primarily agricultural 5-10 years ago and are now issuing hundreds ofbuilding permits per year (most are in Utah, westernDavis, Weber, and Cache counties). Ruralhub/resort communities are those with substantialtourism resources and impacts (such as Park Cityand Moab). Traditional rural communities are thosewith a population less than 1,000, but this cluster isalso open to small cities that identify as rural.Figure 1. 2022 Surveyed Cities by Utah League of Cities and Towns (ULCT) ClusterFINDINGS: OVERALL PERSONALWELLBEING AND MENTALHEALTHThe survey asked respondents to rate their overallpersonal wellbeing. The average overall personalwellbeing score for all surveyed respondents was4.08 on a scale from 1 (very poor) to 5 (excellent).Figure 2 shows the average city scores for overallpersonal wellbeing within their city cluster. Scoreswere significantly lower for respondents from ruralhub/resort and traditional rural communities (average3.94) than for those from rapid growth cities (average Respondents also rated their level of personalwellbeing in several categories, including mentalhealth. The average overall mental health rating scorefor all surveyed respondents was 3.83 on a scalefrom 1 (poor) to 5 (excellent). Figure 3 shows theaverage city scores for overall mental health ratingwithin their city cluster. Similar to overall personalwellbeing, scores for overall mental health weresignificantly lower for those from rural hub/resort andtraditional rural communities (average 3.69) than forthose from rapid growth cities (average 3.96) andlarge and mid-sized cities (average 3.83).4.03) and large and mid-sized cities (average 4.06).[1][1] A one-way analysis of variance (ANOVA) was used to determine if means (averages) were statistically significantly different between cityclusters. A Scheffe’s test for multiple comparisons was used to specify the statistically significant differences between mean (average) scoresfor each city cluster. These tests were used for all means comparisons. Any time the words “significant” or “significantly” are used, they arereferring to statistical significance.Figure 2. Overall Personal Wellbeing Rating Scores From Participating Utah Cities (2022)Figure 3. Overall Mental Health Rating Scores From Participating Utah Cities (2022)FINDINGS: MENTAL HEALTHIMPORTANCERespondents rated how important variousdomains were to their overall personal wellbeing,including mental health. The average overallmental health importance score for all surveyedrespondents was 4.72 on a scale from 1 (not at allimportant) to 5 (very important). Figure 4 showsthe average city scores for overall mental healthimportance within their city cluster. The score forthose from rural hub/resort and traditional ruralcommunities (average 4.66) was significantlylower than for those from rapid growth cities(average 4.72) and large and mid-sized cities(average 4.74); (see Figure 4). However, theoverall mean score (4.72) tells us that mental Respondents rated the importance of variousother categories to their overall personalwellbeing, including safety and security, livingstandards, physical health, local environmentalquality, cultural opportunities, socialconnections, leisure time, education, andconnection with nature. Mental health was themost important domain overall for those fromrural hub/resort and traditional rural communitiesand large and mid-sized cities, while it was ratedthe second most important domain behindsafety and security for those from rapid growthcities. health was exceedingly important torespondents from all three city clusters, thoughthere is variation within each cluster. Figure 4. Overall Mental Health Importance Scores From Participating Utah Cities (2022)Figure 5 illustrates the relationship between theaverage rating and average importance of mentalhealth across participating cities. As shown in thefigure, average mental health rating andimportance scores are high across all of the study cities. Upon further examination, we can seethat Helper, Ephraim, Moab, Lehi, SaratogaSprings, Bountiful, and South Jordan have lowermental health rating scores accompanyinghigher importance scores as compared to theother study cities. Understanding mental healthrating and importance may help us betterapproach mental health in these communities.Figure 5. Mental Health Importance vs Mental Health Rating - Average Response inParticipating Utah Cities (2022)FINDINGS: MENTAL HEALTHIMPORTANCE AND RATINGFINDINGS: MENTAL HEALTHCONCERNSRespondents were asked about a series ofconcerns for the future of their city, includingsuicide and access to mental healthcare. Figure6 compares city clusters on opinions regardingthese concerns. The percentage of respondentsindicating a moderate or major concern aboutaccess to mental healthcare is 51.9% for those inlarge and mid-sized cities, 41.1% for those in rapid growth cities, and 55.2% for those in ruralhub/resort and traditional rural communities. Thepercentage of respondents indicating a moderate ormajor concern about suicide is 57.2% for those inlarge and mid-sized cities, 53.6% for those in rapidgrowth cities, and 62.5% for those in ruralhub/resort and traditional rural communities. Thereis a significant association between city clusters andrespondents’ concerns about suicide and access tomental healthcare, with significant differencesbetween all city clusters.[2][2] Multiple tests (e.g., Kruskal-Wallis One-Way ANOVA, Mann-Whitney U, and Chi-Square Correlation) were used to determine statisticallysignificant differences between city clusters. Access to Mental Healthcare (2022)Figure 6. Respondents’ Concerns About Suicide and FINDINGS: COMMUNITYCONNECTION AND MENTALHEALTHA striking finding from the 2022 Utah WellbeingSurvey is the strong positive relationship betweencommunity connection and the rating of mentalhealth. As shown in Figure 7, for each of the three cityclusters, mental health ratings were higher for thosewho felt more connected to their city as a community. CONCLUSIONSThis fact sheet explores mental health and wellbeingin Utah by rural-urban location. Findings revealed thatrespondents from rural communities had lower overallpersonal wellbeing and poorer mental health thanthose from rapid growth cities and large andOverall, increased mental health can enhanceoverall personal wellbeing, and we need a uniqueapproach to address mental health issues in ruralparts of the state. However, it should be noted thatthere is variation between rural places in Utah andelsewhere in the U.S., and as such, a targetedapproach to addressing mental health based oncommunities’ particular circumstances would bemore effective than a one-size-fits-all approach(Ulrich-Schad et al., 2022). For individual resourcesand more information on addressing mental healthand strengthening communities, please see the linksprovided in the Mental Health Resources section.mid-sized cities. Additionally, those from ruralcommunities indicated a greater concern aboutsuicide and access to mental healthcare than thosefrom rapid growth cities and large and mid-sizedcities. These findings are consistent with previousresearch on rural mental health, which shows thatrural residents experience higher rates ofdepression and suicide and “disproportionatelysuffer the negative effects of living with unmet orunder-met mental health needs” (Morales et al.,2020, p. 466; NAMI, 2022). Fewer mental healthresources and greater mental health stigma in ruralplaces could contribute to lower wellbeing andpoorer mental health in these areas (Carpenter-Song & Snell-Rood, 2017). Additionally, rapidgrowth cities may not have the local capacities tomanage the needs of their expanding populations.As such, along with addressing mental health issuesmore broadly, it is critical to address the uniquemental health issues faced by those living in ruraland rapid growth areas. Findings also show thatmental health is vital to overall personal wellbeingregardless of rural-urban status, and it is the mostimportant wellbeing domain overall. Thus,addressing mental health should be a top priority forthe state of Utah. Figure 7. Comparing Mental Health Rating andCommunity Connection by ULCT Cluster (2022)Community Connection ResourcesCreating Equitable Communities GuideSocially Connected Communities: Solutionsfor Social IsolationImproving Social Connectedness: A World ofDifferent InitiativesGuidelines for Parks, Recreation, and GreenSpaceMental Health Resources in UtahSuicide Crisis Lifeline at 988Utah Crisis Line at 801-587-3000Safe UT AppLive on UtahNational Alliance on Mental Illness - UtahUtah Poison Control Center at      1-800-222-1222Other Mental Health ResourcesPrevention Institute – Mental Health &WellbeingPrevention and Community Education ToolkitMental Health in Rural Communities Toolkit How to Talk about Mental Health National Mental Health ResourcesSubstance Abuse and Mental Health ServicesAdministration (SAMHSA) Helpline at      1-800-662-4357American Foundation for Suicide Prevention The Trevor ProjectTrans Lifeline at 877-565-8860Other Mental Health HotlinesMENTAL HEALTH RESOURCESPublic Health Indicator-Based Information System (IBIS-PH). (2022, November 16). Health indicatorreport of depression: Adult prevalence. https://ibis.health.utah.gov/ibisph-view/indicator/view/HlthStatMent.html Carpenter-Song, E. & Snell-Rood, C. (2017). The changing context of rural America: A call to examine theimpact of social change on mental health and mental health care. Psychiatric Services, 68(5), 425-434.Centers for Disease Control and Prevention (CDC). (2018, October 31). Well-Being concepts. U.S.Department of Health and Human Services.https://www.naspa.org/images/uploads/kcs/WHPL_Canon_WB_Well-Being_Concepts___HRQOL___CDC_2017.pdf. Centers for Disease Control and Prevention (CDC). (2023, April 25). About mental health.  U.S.Department of Health and Human Services. https://www.cdc.gov/mentalhealth/learn/index.htmGamm, L., Stone, S., & Pittman, S. (2010). Mental health and mental disorders – a rural challenge: Aliterature review. In Rural healthy people 2010: A companion document to healthy people 2010 (Volume2). College Station, Texas: The Texas A&M University System Health Science Center, School of RuralPublic Health, Southwest Rural Health Research Center. https://www.researchgate.net/profile/Larry-Gamm/publication/255683562_Mental_health_and_mental_disorders-a_rural_challenge_A_literature_review/links/55c39e6b08aeb9756740192b/Mental-health-and-mental-disorders-a-rural-challenge-A-literature-review.pdf Health Resources and Services Administration (HRSA). (2005). Mental health and rural America: 1994-2005. U.S. Department of Health and Human Services. https://files.eric.ed.gov/fulltext/ED591902.pdf Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mentalhealth disparities. Journal of Clinical and Translational Science, 4(5), 463-467.National Alliance on Mental Illness (NAMI). (2021, February). Mental health in Utah [Fact sheet].https://www.nami.org/NAMI/media/NAMI-Media/StateFactSheets/UtahStateFactSheet.pdfNational Alliance on Mental Illness (NAMI). (2022, November 17). Confronting mental health challenges inrural America. https://www.nami.org/Blogs/NAMI-Blog/November-2022/Confronting-Mental-Health-Challenges-in-Rural-America#:~:text=Rural%20Americans%20experience%20higher%20rates,access%20mental%20health%20care%20servicesREFERENCESPublic Health Indicator-Based Information System (IBIS-PH). (2023, January 24). Complete healthindicator report for suicide. https://ibis.health.utah.gov/ibisph-view/indicator/complete_profile/SuicDth.html Summers, L., Meppen, D., & Ball, S. (2019). Utah’s mental health system. Kem C. Gardner PolicyInstitute, University of Utah. https://gardner.utah.edu/wp-content/uploads/MentalHealthReportAug2019.pdfUlrich-Schad, J. D., Duncan, C. M., & Koci, K. (2022). Poverty, health and healthcare in rural communitiesin the U.S. In M. Halliwell and S. A. Jones (Eds.), The Edinburgh Companion to the Politics of AmericanHealth (pp. 33-50). Edinburgh University Press.United States Department of Health and Human Services. (2023, May 3). Fact sheet: Celebrating mentalhealth awareness month 2023. https://www.hhs.gov/about/news/2023/05/03/fact-sheet-celebrating-mental-health-awareness-month-2023.html Utah Wellbeing Project. (n.d.). Overview. Utah State University. Retrieved May 22, 2023, fromhttps://www.usu.edu/utah-wellbeing-project/index.  In its programs and activities, including in admissions and employment, Utah State University does not discriminate or tolerate discrimination, including harassment, based on race, color, religion, sex, national origin, age, genetic information, sexual orientation, gender identity or expression, disability, status as a protected veteran, or any other status protected by University policy, Title IX, or any other federal, state, or local law. Utah State University is an equal opportunity employer and does not discriminate or tolerate discrimination including harassment in employment including in hiring, promotion, transfer, or termination based on race, color, religion, sex, national origin, age, genetic information, sexual orientation, gender identity or expression, disability, status as a protected veteran, or any other status protected by University policy or any other federal, state, or local law. Utah State University does not discriminate in its housing offerings and will treat all persons fairly and equally without regard to race, color, religion, sex, familial status, disability, national origin, source of income, sexual orientation, or gender identity.  Additionally, the University endeavors to provide reasonable accommodations when necessary and to ensure equal access to qualified persons with disabilities. The following office has been designated to handle inquiries regarding the application of Title IX and its implementing regulations and/or USU’s non-discrimination policies: The Office of Equity in Distance Education, Room 400, Logan, Utah, titleix@usu.edu, 435-797-1266. For further information regarding non-discrimination, please visit equity.usu.edu, or contact: U.S. Department of Education, Office of Assistant Secretary for Civil Rights, 800-421-3481, ocr@ed.gov or U.S. Department of Education, Denver Regional Office, 303-844-5695 ocr.denver@ed.gov. Issued in furtherance of Cooperative Extension work, acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, Kenneth L. White, Vice President for Extension and Agriculture, Utah State University.November 2023Utah State University ExtensionPeer-Reviewed Fact Sheet

Utahns\u27 Wellbeing and Mental Health by Rural-Urban Location

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Utahns\u27 Wellbeing and Mental Health by Rural-Urban Location

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