A Comparison of a Rural and Urban Children's Mental Health Clinic Population

This thesis dealt with one aspect of the proposition that rural mental health care is different than urban mental health care. This aspect is the assumption that the population of children seen at a rural mental health clinic is different from the population of children seen at an urban mental health clinic. Eight hypotheses were formulated to serve as guides in studying this assumption. All of the hypotheses involved rural-urban comparisons. The present study was an extension of previous research by Herjanic (1972). Testing the hypotheses of the study entailed recording data from the case files of rural and urban clinic children. The rural group of children consisted of children seen at a mental health center that served a county population just under 30,000; the urban group consisted of children seen at a guidance center that served a population of over 335,000. Both clinics were located in the same Midwestern state. The rural and urban clinic groups were formed by randomly selecting from each clinic 25% of the children whose cases were opened during the two year period of 1978-1979. The total sample size of the rural group was 73 cases, while the total sample size of the urban group was 229 cases. Results included the finding that proportionately more rural children than urban children were hospitalized for psychiatric reasons (p<.01). These results seemed best interpreted in terms of particular service delivery features of the rural-urban clinics and communities involved in the study, rather than in terms of any contention that a rural environment causes more severe psychopathology. There was a trend in the findings suggesting that proportionately more urban clinic children than rural clinic children have passive kinds of presenting problems (p<.08). Following previous researchers, it was suggested that rural living may present fewer of the tests (of adequacy and self-sufficiency) presumed to cause such symptoms, and also, that these kinds of symptoms may be better tolerated in rural settings. Contrary to Herjanic’s previous findings, rural and urban clinic groups did not differ with respect to whether or not they were school referrals, and whether or not they came from traditional or nontraditional families. The present results were not generally supportive of Herjanic’s findings. A theme running through the interpretation of the present results was that many features seemed best attributed to service delivery characteristics of clinics or communities, rather than to characteristics of rural and urban children per se. It was cautioned that because of apparent limits on the generality of the present findings the present results need to be regarded as only tentative indications of rural-urban differences (or nondifferences). The reliability and generality of the findings could be enhanced if the present study could be replicated across different rural-urban settings. Such replication work would not seem unduly difficult to carry out. Hence, a researcher associated with a rural clinic might as a matter of routine compare annual admissions data with equivalent data from a selected urban clinic.