Rural-Urban Differences in Excessive Alcohol Use and Select Mental Health Conditions

Previous research demonstrates that excessive alcohol use behaviors, alcohol-related harms, and the prevalence of mental health conditions disproportionately impact rural communities, with mixed findings on rural-urban differences in behavior uptake. This study aims to examine rural-urban differences in the prevalence of excessive alcohol use among individuals with selected self-reported mental health conditions.

The 2021 and 2022 National Survey on Drug Use and Health (NSDUH) data was used to obtain prevalence estimates for self-reported past-year any mental illness (AMI), lifetime depressive symptoms (DS), past-month excessive alcohol use alone, and past-month excessive alcohol use among individuals reporting either past year AMI or lifetime DS using survey-weighted descriptive statistics. Bivariate associations and survey-weighted multivariable logistic regression models were used to determine the odds of having the selected outcomes across levels of residence (large urban, small urban, and rural).

Around half of all individuals reported past month excessive alcohol use; rates were slightly higher among small urban residents compared to rural and large urban residents. Prevalence for past year AMI, lifetime DS, and past month excessive alcohol use alone were highest among small urban residents. After adjusting for sociodemographic characteristics, no significant differences were observed by residence for AMI and excessive alcohol use or for DS and excessive alcohol use.

These results add to a limited availability of updated and generalizable research examining differences in self-reported mental health conditions and excessive alcohol use behaviors across a comprehensive rural-urban continuum and can be used to inform targeted policy solutions and intervention strategies.