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Rural and Urban Disparities in Health-Related Quality of Life Among Veterans With Psychiatric Disorders

OBJECTIVE: The authors studied whether rural and urban disparities in health-related quality of life, demonstrated previously among veterans, persist among veterans with common psychiatric disorders. METHODS: A cohort of 748,216 users or anticipated users of Veterans Affairs services completed the Veterans Short Form Health Survey in 1999. From the survey, the authors determined health-related quality-of-life scores (physical [PCS] and mental [MCS] health component summaries) and used ICD-9-CM codes to identify veterans with six mental health disorders—depression, anxiety, posttraumatic stress disorder, alcohol dependence, schizophrenia, and bipolar disorder. With Rural-Urban Commuting Area codes to determine urban residency, the prevalence of psychiatric illness and health-related quality of life were compared across rural and urban groups. RESULTS: All psychiatric disorders except anxiety disorders not related to posttraumatic stress disorder were more prevalent in urban settings. However, rural veterans within mental illness cohorts had worse PCS and MCS scores. Differences in PCS scores were substantial, ranging between 2.27 for schizophrenia and 3.39 for alcohol dependence (p<.001 for all diagnoses). Differences in MCS scores were statistically significant but modest. In regression models, rural-urban disparities within psychiatric disorder cohorts persisted after sociodemographic factors were controlled for. CONCLUSIONS: Although less likely than their urban counterparts to have mental disorders, rural veterans with mental illness experienced a greater disease burden and were likely to incur greater health care costs. Improving access to mental health care for veterans in rural settings may narrow quality-of-life disparities among rural and urban veterans.

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