ORCID
https://orcid.org/0009-0005-1898- 0304
Date of Award
Fall 2025
Language
English
Embargo Period
11-2-2025
Document Type
Master's Thesis
Degree Name
Master of Science (MS)
College/School/Department
Department of Epidemiology and Biostatistics
Program
Epidemiology
First Advisor
Emily Leckman-Westin
Second Advisor
Allison Appleton
Keywords
Rural health, Mental health, Rural mental health, poverty, Patient Characteristics Survey
Subject Categories
Epidemiology
Abstract
Objective
This study aimed to determine whether rural New York State residents receive mental health care at the same rate as urban residents, how poverty rates in New York State relate to rurality and mental health care use, and how pre-pandemic mental health care use rates compare to 2022 use rates. The goal was not to estimate the burden of disease, nor to estimate the number of patients engaged in care in each zip code, but to highlight the potential differences in service use between urban and rural New York State Office of Mental Health clients.
Methods
A secondary analysis was performed by merging existing data sources. The 2017, 2019, and 2022 Patient Characteristic Surveys were used to create the outcome variable. The frequency of New York State Office of Mental Health clients from each three-digit zip code was collected from the Patient Characteristics Survey, to calculate a measure of service use within each zip code. Poverty data was collected from American Community Survey estimates for 2017, 2019, and 2021. Serious Mental Illness data was collected from a 2014 Substance Abuse and Mental Health Services Administration report. Geographic mapping was used to display service use rates and poverty rates. Three-digit zip codes were categorized as city or non-city. Differences in rates between groups were determined by Student T-tests (α=0.05). Relationships between poverty variables, rurality variables, and service use rates were estimated by linear regression models (α=0.05).
Results
50 three-digit zip codes were examined. Service use rates ranged from 0 to 235 per 10,000 population. City zip codes had higher service use rates than non-city zip codes. Service use rates slightly decreased from 2019 to 2022. Poverty rates showed a significant association with service use rates (r=0.5451, p=< 0.0001). This association was stronger among city zip codes (r=0.912, p=< 0.0001) than non-city zip codes (r=0.4410, p=< 0.0001).
Conclusions
Non-city zip codes had lower rates of service use than city zip codes. Poverty correlates positively with service use rates in New York State. Non-city zip codes may have more unmet need than city zip codes.
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Papa, Anna J., "Differences in Mental Health Care Use between Urban and Rural Populations in New York State, 2017-2022" (2025). Electronic Theses & Dissertations (2024 - present). 307.
https://scholarsarchive.library.albany.edu/etd/307
Methodological Appendices