Both Rurality and Race Factor into Depression among Older Americans

May is Mental Health Awareness Month. If you are thinking about harming yourself, or if you feel someone you know may be in danger of harming themselves or others, call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255. The Lifeline provides free and confidential support and crisis resources. Both numbers are available 24/7, 365 days a year. For more resources on mental health, see AARP’s Mental Health Resource Center.

One in five Americans ages 50 and older live in rural areas. While there can be many benefits to living in rural communities, rural residents face unique and longstanding challenges in accessing health care and experience health disparities compared with their urban counterparts. A recent AARP Public Policy Institute report, for example, showed that the prevalence of several chronic diseases—including obesity, diabetes, and stroke—was higher among older adults living in rural versus urban areas.

These trends show up in mental health as well. More recent data from 2020 reveal that rural residents ages 50 and older also experienced higher rates of depression. And in another wrinkle within this rural-urban disparity, estimates varied by race.

We analyzed 2020 data from the Behavioral Risk Factor Surveillance System (BRFSS) and found that among adults under the age of 65 the prevalence of depression was higher in those living in rural versus urban areas (figure 1). Adults ages 65 and older, however, had the lowest prevalence of depression overall and there was no statistically significant difference between rural and urban residents of this age group.

Source: AARP Public Policy Institute analysis of Behavioral Risk Factor Surveillance System (BRFSS) 2020 data 
* = difference in prevalence is statistically significant at p<0.05

Rural-urban differences among adults ages 50 and older persisted across racial and ethnic groups (figure 2). [i] White and Black adults ages 50 and older living in rural areas were more likely than those living in urban areas to report having diagnosed depression, with the difference especially pronounced among Black older adults. For older Hispanic adults, depression prevalence among rural residents was slightly higher than urban residents, but the difference was not statistically significant. White older adults reported higher rates of depression than their Black and Hispanic counterparts overall.

Source: AARP Public Policy Institute analysis of Behavioral Risk Factor Surveillance System (BRFSS) 2020 data 
* = difference in prevalence is statistically significant at p<0.05

Rural-urban disparities in health conditions—including depression—are deeply rooted in a range of social, economic, geographic, and other factors. Rural areas also face barriers to accessing health care, from lower health insurance coverage to inadequate number of mental health providers. Further, despite the increased availability of telehealth during the COVID-19 pandemic, telehealth use remained lower in rural areas due to what is known as the “digital divide,” or when rural communities lack adequate internet access and technology. Thus, responding to the rural-urban gap in depression rates will likely require solutions for many longstanding challenges in rural areas, including the digital divide, provider shortages, limited public transportation, and reduced access to health coverage.

[i] One limitation of this analysis was our inability to produce reliable estimates of depression for racial and ethnic groups other than Black, Hispanic, and White due to small sample sizes among certain groups living in rural areas, including American Indian/Alaska Natives, Native Hawaiian and Pacific Islanders, Asian Americans, and individuals who identify as belonging to more than one racial category.