Rural-Urban Disparities in Children’s Mental and Behavioral Health: a Scoping Review
- 1Dartmouth Health Children’s, Lebanon, NH, USA
- 2The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
- 3Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
Abstract
Background and Objectives: One-in-five children and adolescents in the United States are diagnosed with a mental or behavioral health condition. Rural-residing children may be at heightened risk given higher rates of poverty, isolation, mental health stigma, and decreased access to mental health services. This scoping review summarizes studies reporting rural-urban differences in child and adolescent mental and behavioral health symptoms, diagnoses, assessment and treatment inn the United States and identifies evidence gaps. Methods: We performed a comprehensive literature search in multiple databases and ClinicalTrials.gov, including eligible studies published 01/01/1987-2/16/2024. Following screening of titles, abstracts and eligible full text articles, we extracted outcomes including i) symptoms, diagnoses, and behaviors and ii) assessment and treatment, in rural compared to urban areas. Results were synthesized narratively. Results: After screening 6,624 citations and 232 full-text articles, 44 articles met inclusion criteria. Five federally supported definitions of rurality were used in included studies, though many used alternative definitions. The largest number of studies focused on suicide, while several mental health conditions were entirely unstudied. Included studies reflected consistent evidence of an increased risk for suicide in rural-residing children, along with relatively increased acute care utilization and, among children with mental or behavioral health diagnoses, higher likelihood of co-occurring mental health diagnoses. Conclusions: During this study period spanning >30 years, only 44 studies have characterized rural-urban differences in pediatric mental health in the US. Future research is needed to understand and address rural-urban differences in mental and behavioral health and to direct public health efforts.
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BibTeX
@article{arakelyan2026ruralurban,
title = {{Rural-Urban Disparities in Children’s Mental and Behavioral Health: a Scoping Review}},
author = {Mary Arakelyan and Amanda C. Coyle and Ashley M. Boardman and Ian J. Lichtenstein and Sophie Kodak and Ellie Acquilano and JoAnna K. Leyenaar},
journal = {Pediatrics open science},
year = {2026},
month = nov,
doi = {10.1542/pedsos.2026-001475},
url = {https://doi.org/10.1542/pedsos.2026-001475},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Rural-Urban Disparities in Children’s Mental and Behavioral Health: a Scoping Review
AU - Mary Arakelyan
AU - Amanda C. Coyle
AU - Ashley M. Boardman
AU - Ian J. Lichtenstein
AU - Sophie Kodak
AU - Ellie Acquilano
AU - JoAnna K. Leyenaar
PY - 2026
DA - 2026/11/06
JO - Pediatrics open science
DO - 10.1542/pedsos.2026-001475
UR - https://doi.org/10.1542/pedsos.2026-001475
AB - Background and Objectives: One-in-five children and adolescents in the United States are diagnosed with a mental or behavioral health condition. Rural-residing children may be at heightened risk given higher rates of poverty, isolation, mental health stigma, and decreased access to mental health services. This scoping review summarizes studies reporting rural-urban differences in child and adolescent mental and behavioral health symptoms, diagnoses, assessment and treatment inn the United States and identifies evidence gaps. Methods: We performed a comprehensive literature search in multiple databases and ClinicalTrials.gov, including eligible studies published 01/01/1987-2/16/2024. Following screening of titles, abstracts and eligible full text articles, we extracted outcomes including i) symptoms, diagnoses, and behaviors and ii) assessment and treatment, in rural compared to urban areas. Results were synthesized narratively. Results: After screening 6,624 citations and 232 full-text articles, 44 articles met inclusion criteria. Five federally supported definitions of rurality were used in included studies, though many used alternative definitions. The largest number of studies focused on suicide, while several mental health conditions were entirely unstudied. Included studies reflected consistent evidence of an increased risk for suicide in rural-residing children, along with relatively increased acute care utilization and, among children with mental or behavioral health diagnoses, higher likelihood of co-occurring mental health diagnoses. Conclusions: During this study period spanning >30 years, only 44 studies have characterized rural-urban differences in pediatric mental health in the US. Future research is needed to understand and address rural-urban differences in mental and behavioral health and to direct public health efforts.
SN - 3066-2761
ER -