Conceptualising the Mental Health of Rural Women: A Social Work and Health Promotion Perspective
Harvey, Desley, Rural Society
The mental health and well-being of rural women and how to promote it is not well understood. This paper reviews contrasting discourses in relation to rural women, highlighting the way in which gender roles may be reinforced and women's health and well-being compromised. The structural analysis, practice frameworks and skills provided by the disciplines of social work and health promotion can assist in the development of a broader conceptualisation of rural women's mental health and suggest a way forward in promoting their mental health and well-being.
Mental health, Well-being, Rural women, Social work, Health promotion
Received 28 April 2009 Accepted 19 July 2009
The study of rural women's health could benefit from a broader conceptualisation of mental health. Current approaches to rural women's health focus on the prevention and treatment of illness (Alston et al., 2006) and do not take into account characteristics of the rural social context which are likely to influence mental health (Judd et al., 2002). Perspectives from the disciplines of social work and health promotion, which include a structural analysis of personal problems can contribute to a more holistic understanding of the mental health of rural women.
Regional and remote communities in Australia experience a confluence of health determinants that might be expected to heighten the risk of mental health problems (Commonwealth Department of Health and Aged Care, 2000). The negative impact on health of psychosocial determinants such as unemployment, discrimination, lack of control and social isolation (Eckert, Wilkinson, Taylor, Stewert, & Tucker, 2006) is amplified through exposure to additional stressors related to rural living, including geographical isolation, economic restructuring, drought, floods and bushfires (Commonwealth Department of Health and Aged Care, 2000). These conditions are compounded by a lack of appropriate, accessible mental health services and the stigma related to mental health service use (Commonwealth Department of Health and Aged Care, 2000). Yet women in regional and remote areas do not experience higher rates of mental illness than urban women (Australian Institute of Health and Welfare, 2008) and there is little inter-regional variation in personal well-being measured by life satisfaction for women (Cummins, Davern, Okerstrom, Lo, & Eckersley, 2005). Studies have also found no significant interregional differences in the prevalence of depression and psychological distress for women in Australia (Australian Institute of Health and Welfare, 2008) and the prevalence of anxiety is reported to be significantly less for women aged 45-64 outside major cities (Australian Institute of Health and Welfare, 2008). These studies appear to lend support to conclusions from previous studies that women in rural areas 'have rather better emotional health than city women' (Lee, 2003, p. 6) and that 'mid-age rural women cope remarkably well with the lack of health services in rural areas, and with the stress caused by their social, economic, family and community roles' (Brown, Young, & Byles, 1999, p. 152).
Yet rural women do not rate their health as highly as urban women. Self-assessed health can provide a broad, subjective indication of women's health including well-being (Bryson & Warner-Smith, 1998). A decade ago women in regional and remote areas were just as likely as those in major cities to rate their health positively (Australian Institute of Health and Welfare, 2008). However, findings recently published by the Australian Institute of Health and Welfare (2008) indicate that this is changing, with women in regional and remote areas now significantly less likely than women in major cities to report excellent/very good health and more likely to report fair/poor health. The reasons have not been explored in literature. …