Conceptualising the Mental Health of Rural Women: A Social Work and Health Promotion Perspective
Harvey, Desley, Rural Society
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. However, qualitative studies have found that the social experiences of rural women play a part in how they perceive their health and well-being (Harvey, 2007) and this may influence how women rate their health.
Contrasting findings about the health and wellbeing of rural women may in part reflect varied definitions of health, mental health and well-being across disciplines and studies. Developing a way of understanding mental health, which takes into account the important contribution of the rural social context, can assist in gaining a more comprehensive understanding of rural women's health. The aim of this discussion is to highlight the contribution which the disciplines of social work and health promotion (both of which have a holistic view of health and a commitment to social justice through social change) can make to a broader conceptualisation of mental health and therefore rural women's health. …