There is growing concern about the availability of healthcare services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health conditions in North America. Using PRISMA guidelines, we used four electronic databases (Pubmed, Cochrane, PsychInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus non-rural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle Ottawa Scale was used. Our initial search returned 491 studies and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), PTSD (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities while eleven (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in person outreach to these rural communities may be alternatives to impact these outcomes.

The present study was designed to ascertain the extent to which dimensions of acculturation would differ across personal identity statuses in a sample of 2,411 first- and second-generation, immigrant, college-attending emerging adults. Participants from 30 colleges and universities around the United States completed measures of personal identity processes, as well as of heritage and American cultural practices, values, and identifications. Cluster-analytic procedures were used to classify participants into personal identity statuses based on the personal identity processes. Results indicated that, across ethnic groups, individuals in the achieved and searching moratorium statuses reported the greatest endorsement of heritage and American cultural practices, values, and identifications; and individuals in the carefree diffusion status reported the lowest endorsement of all the cultural variables under study. These results are discussed in terms of the convergence between personal identity and cultural identity processes.