Place-based Strengths and Vulnerabilities for Mental Wellness among Rural Minority Seniors

Project Summary Severe inequities in depression and its diagnosis and treatment among rural-dwelling, racial/ethnic minority seniors compared to their urban White counterparts result in increased mortality, cognitive impairment, and multiple co-morbidities, thus presenting a growing public health concern as the United States population ages. These health inequities are often attributable to social and environmental factors, including economic insecurity, histories of trauma, chronic gaps in transportation and safety-net services (e.g., food assistance, health care), and disparities in access to policymaking processes rooted in colonialism that make these groups “structurally vulnerable” to mental ill health. Fewer data exist on protective factors associated with social and environmental contexts, such as proximity of social support, community attachment, and a meaningful sense of place. While the importance of such place-based factors is widely recognized in scholarship on the social determinants of health, there is to date little research specifically examining how such factors shape disparities in depression and treatment, as well as limited practical approaches to target these factors and their effects on mental wellbeing for rural and minority populations. This K99/R00 application proposes to integrate my expertise as a cultural anthropologist in participatory qualitative research and implementation science with new knowledge in rural mental health research, quantitative and mixed-method designs, and intervention development, in order to conceptualize and intervene on the social and environmental causes of mental health disparities. Coursework, workshops, and the expertise of an interdisciplinary team of mentors at the Pacific Institute for Research and Evaluation and the University of New Mexico during the K99 period will provide me with the skills to undertake the proposed R00 research, which will utilize quantitative surveys, qualitative interviews, ecological network research, and spatial data analysis to elucidate how place-based vulnerabilities and protective factors shape experiences of depression among rural American Indian and Latinx elders in New Mexico. Guided by Intervention Mapping, a participatory approach for planning health interventions, data will contribute to a community-driven plan for a multisystem intervention targeting the place-based causes of disparities in depression, which will form the basis of a subsequent R01 implementation and evaluation study. This participatory and interdisciplinary study will elucidate how axes of difference pertaining to place, rurality, and minority status drive mental health disparities. The resulting place-focused intervention plan will improve mental health equity for aging populations that data show are severely and persistently underserved and advance the science of intervention and implementation beyond its predominant focus on individuals and healthcare settings. Data and training will contribute to my independence as an investigator focused on the social causes of health disparities and translate directly into future NIH-funded research targeting the upstream causes of mental health disparities in this and other underserved populations.