The landscape of non-psychotic psychiatric illness in rural Canada: a narrative review

Introduction: Canada’s rural population has diverse demographic features and accounts for 18.9% of Canada’s population. Indigenous people, who are highly represented in rural communities, have additional risk factors related to colonialism and systemic racism. Psychiatric illness is elevated in rural communities, yet few have access to psychiatric services, including psychiatrists and addiction and mental health therapists.
Objective: To summarize articles reporting on prevalence, as well as the risk and protective factors influencing rates and experience of mental illness in rural communities. This information could inform improved prevention and recovery from non-psychotic illness in rural and remote areas of Canada. Methods: The authors conducted a narrative review on studies related to rural psychiatric illness in Canada published over a 20-year period (2001-2023). A review of CINAHL, Medline and Academic search complete was completed from October 2021 to February 2023 for literature on mental health in rural Canada, non-psychotic illness, (depression, anxiety, substance use) and suicide and treatment strategies for rural populations supplemented by federal documents, position papers and clinical practice guidelines.
Results: 33 articles were identified. Depression, substance use, and suicide rates are elevated in rural communities. Community factors varied, including the available industries, access to larger metropolitan centers and cohesiveness, which impacts mental health risk and highlights the need for further telepsychiatry, family physician capacity, and community-based interventions.
Discussion and Conclusion: Further focus on representative community-based research is critical to expand our knowledge. It is also critical to consider strategies to increase psychiatric care access, including postgraduate medical training and telehealth training.