Rural-urban variations in psychological distress: findings from the Behavioral Risk Factor Surveillance System, 2007

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To describe rural and urban differences in the prevalence and correlates of psychological distress in the United States.


We analyzed 2007 Behavioral Risk Factor Surveillance System (BRFSS) data from 62,913 respondents residing in 94 counties in 24 states, and District of Columbia that administered the Kessler-6 (K6) psychological distress questionnaire and met the BRFSS weighting criterion. Using the Rural Urban Classification Codes (RUCC), 94 counties fell into four groups (two metropolitan and two non-metropolitan) out of the nine-part RUCC scheme; these levels were collapsed into two distinct categories of urban and rural.


Unadjusted estimates indicate that urban county residents have a 22 % higher likelihood of having either MPD or SPD than rural residence (odds ratio [OR]: 1.22, 95 % confidence interval [CI]: 1.09–1.36). This association was slightly attenuated after adjusting for sociodemographic characteristics 17 % higher (OR: 1.17, 95 % CI: 1.04–1.31).


This is the first study to our knowledge reporting rural and urban prevalence of psychological distress derived from population-based, county-level data for 94 counties in the United States.

Submitted: 19 September 2008; revised: 21 January 2009; accepted: 22 January 2009