Implications of Rurality and Psychiatric Status for Diabetic Preventive Care Use among Adults with Diabetes

Background Diabetes and mental health conditions co-occur frequently in the United States1,2 and each is a risk factor for the other.3,4 Moreover, individuals with comorbid diabetes and psychiatric disorders are at greater risk for poor health outcomes than the general population or than their peers with diabetes.5,6 One step toward understanding and potentially reducing the health disparities faced by people with comorbid diabetes and mental health conditions is to monitor their receipt of diabetic preventive services, to ensure that these services conform to established standards.7 Previous investigations on this topic have indicated that after controlling for covariates of diabetes and psychiatric status, the presence of any mental health condition was associated with decreased quality of diabetic care, as measured by patients’ appropriate use of preventive services.8,9 Existing research does not clarify how rural residence and related factors might be connected to preventive care use among diabetic people with mental health needs. This question warrants attention, given that rural populations generally have poorer health,10 and higher rates of diabetes,11 while at the same time confronting multiple access barriers such as poverty, inadequate insurance coverage, provider supply shortages, and limited area resources.12 As a result of these barriers, people with diabetes may access recommended preventive care at lower rates in rural than in urban settings. Moreover, rural residents with co-occurring diabetes and psychiatric diagnoses might be less likely than either their urban counterparts or rural peers without mental health needs to obtain diabetic preventive care in accordance with standards.