Globally there is a difference in lifestyle in both the urban and the rural populations. The rural populations tend to suffer more from the adverse living conditions than the urban counterparts. The degraded quality of life results in the overall poor health of the rural people. Depression is a very common mental disease which is prevalent in both urban as well as the rural areas but research shows that the rate of depression is significantly higher in rural areas, although the rates are slightly different between men and women (Buttigieg, Rathert & Eiff, 2015). The population of the rural areas is vulnerable to many social issues such as lack of employment, overcrowding, poor health etc. Research shows that the rate of suicides and mental health issues increase with the increase in the remoteness of the place. Thus it can be concluded that the geographical, cultural and several environmental factors are directly affecting the mental health of the people. There are certain biological factors which contribute to depression as well such as certain heart diseases and cerebrovascular diseases, obesity, diabetes, mellitus, Parkinson disease and certain cognitive diseases. Social traumas, functional disability, lower income, lack of education all lead to depression.
The rural population of Australia is scanty and quite widespread so people living in those areas are quite socially isolated and they are deprived of human contacts such as with friends or family. This can lead to a very lonely lifestyle and finally, they become depressed. Living in the remote areas is not only lonely but also unsafe so they slowly start contributing themselves to suicidal behavior. Due to the geographical barriers, the rural people do not have access to proper healthcare services and support groups. Their mental health degrades even further when they face problems with the basic necessities of life such as education, job opportunities or health care services (Dyk, Radunovich & Sano, 2018). To access these services they have to travel a long way to the cities which can be very agonizing during urgent times. The rural population of Australia consists of a considerable number of indigenous tribes and communities who live in such remote areas from where it is quite impossible to travel to the cities to access such healthcare amenities. Thus due to lack of access to healthcare on time increases the level of stress of those people which eventually drives them to depression.
Environmental factor has an important impact on the rural populations because their main occupation is agriculture which is greatly dependent on the environmental changes. They are constantly threatened by the unpredictable weather and the natural calamities like flood, drought, forest fires etc. The sudden change in the climate or the occurrence of any catastrophe can damage their crops and their lands creating financial stresses. The inability to recover the losses from a natural catastrophe can bear significant contributions towards stress, anxiety, and depression so they often turn to substance abuse to deal with their frantic emotions (Haugen & Musser, 2012).
The environmental factor cannot be just limited to the natural disasters and the weather changes it also involves the atmosphere in which people live in. People in the rural area due to lack of proper health care services often turn to drug and alcohol abuse. According to studies 54% of men and 22% of women were reported to be regular alcohol abusers from the agricultural community. Alcohol and drug abuse bring about certain significant changes in the behavior of a person which in future contributes to the suicidal behavior of a person (Whittall, Lee & O’Connor, 2016).
A considerable amount of population consists of the aboriginal Australians who have remained as a secluded community. They have witnessed violence and the trauma to lose their loved ones since the time of colonization. Violence can have a very negative impact on a person’s mental health. These aboriginal Australians continue to be harassed and humiliated even today. These kinds of behavior have considerably increased their psychosocial distress thus the rates of depression and other kinds of mental diseases are prevalent in such tribes (Hunnicutt, 2010).
The traditional gender roles in the rural areas and the aftereffects of alcohol abuse leads to domestic violence against women. Women living in the rural areas face more domestic violence than the urban women. The women are unable to leave such abusive relationships as they find it hard to leave their own tribe and community. The women are mostly uneducated so they fear to lose their present life by losing their animals, their present job etc. This stress of living such an abusive life and being unable to leave adds up to the depression (Güdük, 2018).
The rate of social participation is also an important cause behind the contribution to depression. People of the rural areas find it difficult to engage themselves in communal work and conversations because firstly, the population is very scanty and secondly, the people hardly have anything in common to talk about. Accessibility to key resources is also a factor in social participation, people in the urban areas have a lot of means of entertainment, so they have to get out of their houses and interact with other people such as a public library, a cultural center or a movie theatre, on the other hand, the rural people do not have any means of entertainment (Miller, 2011). The people end up mostly spending their time in their homes which often gets boring and lonely which finally adds up to depression, anxiety, and stress.
The culture of a community also plays an important role in the mental health of a person because it affects the mental illness and the methods of using healthcare services. However, every patient is different and reacts differently to different situations so there is no point in stereotyping the reactions of the patients based on their tribe or appearance. There are several factors which contribute as well as prevent mental illness. Children living in a supportive family having good relations with other siblings can prevent the onset of any kind of mental illness at an early stage whereas children living in an abusive family, witnessing marital discord, abusive behavior, neglect , sexual abuse are prone to mental issues and often risk suicides. Culture also affects the coping habits of a person. It helps the person to deal with the upsetting feeling and how to deal with other grievances (Palfrey, Thomas & Phillips, 2004).
The main occupation in the rural areas is agriculture so the main culture in many tribes is that after the father retires, the son takes over the fields. However, due to limited education and means of entertainment in those areas, they are forced to leave for the metropolitan cities. The situation of wanting to leave but not unable to do it stresses the children and thus contributes to depression (Roufeil, Gullifer & Maybery, 2014).
A person sometimes might be victims of various stigmas in his culture which might affect his perception towards healthcare and treatment seeking for mental issues. Stigma regarding mental illness is quite common across various cultures so it is very difficult for such people to come out of those stigmas and seek help for their mental illness. Communities must try to remove such stigmas from their community and encourage them to seek help. Another cultural problem which the rural people face is migration issues. When a group of people migrates to a different land they find it quite difficult to adjust to the culture of that place so that creates a tension in them. They seem to have a constant fear of not fitting in that society which often leads to low self-esteem and depression (Parks, 2009).
The various sociological, environmental, geographic and cultural factors have a huge impact on the overall health of the rural population as it has been discussed earlier. The factors seem to impact both the rural people as well as the health practitioners who practice medicine in such rural areas. A doctor has to overcome these social barriers first and then help his patients.
Due to the geographical factors, the health practitioners working in the rural and the remote area find it very difficult to practice medicine as they feel isolated from their peers and family and friends. They even have to bear high transportation costs and living costs. Rural practitioners also feel professional isolation (Chilingerian et al., 2009). The newer recruitments have trouble following the supervision and the adjustments which they have to make in their new lives. The rural practitioners are often found to be a solo practitioner and they face certain problems as they are unable to discuss and consult certain cases with their colleagues. Sometimes in certain areas even though the healthcare services are being provided, the patients do not turn due to certain stigmas or cultures or taboo about health care.
While working in smaller villages the confidential relationship between doctor patients raises a lot of conflicts as the doctor is sometimes approached by the relative of the patient asking the reason for his visit to the doctor (Roberts, 2017).
When a non-indigenous doctor starts to practice in an indigenous community he might find it difficult to practice or be accepted in the community. The doctor has to win the trust of the members of the community as they will also be staying in the community (Merino, 2012). Due to these problems, the practitioner often feels lonely, left out, has lack of sleep etc.
Conclusion
Depression is a mental health issue which is prevalent in both the urban as well as the rural areas but with the increase in remoteness, the rate of depression and suicide goes up too. Healthcare should be accessible to everyone despite the challenges. The geographical, environmental, sociological and cultural factors are the main reasons behind the onset of depression, stress, and anxiety. The factors are challenging both the patient as well as the doctor so both of them have to overcome them. Mental disorders are highly prevalent across all races and ethnicities. The contribution of these factors varies according to the mental illness. Mental illness is considered to be a complex product of all these factors combined. Even the role of one of the factors can be threatening for the patient and the role of different factors differ according to different mental illness (Tham & Hardy, 2012). Mistrust of the healthcare services is also an important reason behind the deteriorating mental health of the rural population. These issues must be met up with sufficient evidence and removed forever. The clinician should not be biased or stereotyped in his judgment and treat his patients equally. The various stigmas and taboos present in the society should be discouraged and the rural masses must be enlightened about the truth properly.
References
Buttigieg, S., Rathert, C., & Eiff, W. (2015). International best practices in health care management. Bingley, U.K.: Emerald.
Chilingerian, J., Blair, J., Fottler, M., Powell, M., Savage, G., & Savage, G. (2009). International health care management. Bradford (England): Emerald Group Publishing Limited.
Dyk, P., Radunovich, H., & Sano, Y. (2018). Health Challenges Faced by Rural, Low-Income Families: Insights into Health Disparities. Retrieved from https://www.familyscienceassociation.org/sites/default/files/4%20-%20Dyk%2C%20%20Radunovich%20%26%20Sano.pdf
Güdük, Ö. (2018). Health care accreditation system in Australia. Health Care Academician Journal, 5(1), 54.
Haugen, D., & Musser, S. (2012). Health care. Farmington Hills, MI: Greenhaven Press.
Hunnicutt, S. (2010). Universal health care. Detroit: Greenhaven Press.
Merino, N. (2012). Health care. Detroit: Greenhaven Press.
Miller, D. (2011). Health care. Detroit, Mich.: Lucent Books.
Palfrey, C., Thomas, P., & Phillips, C. (2004). Effective health care management. Oxford, UK: Blackwell Pub.
Parks, P. (2009). Health care. San Diego, CA: ReferencePoint Press.
Roberts, R. (2017). A health commission for regional, rural and remote Australia. Australian Journal Of Rural Health, 25(2), 76-76.
Roufeil, L., Gullifer, J., & Maybery, D. (2014). The health challenges facing rural people and communities in Australia: What can psychology offer?. Australian Journal Of Rural Health, 22(6), 271-272. doi: 10.1111/ajr.12155
Tham, R., & Hardy, S. (2012). Oral healthcare issues in rural residential aged care services in Victoria, Australia. Gerodontology, 30(2), 126-132. doi: 10.1111/j.1741-2358.2012.00652.x
Whittall, D., Lee, S., & O’Connor, M. (2016). Factors affecting rural volunteering in palliative care – an integrated review. Australian Journal Of Rural Health, 24(6), 350-356. doi: 10.1111/ajr.12313
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