What Is Rural Adversity, How Does It Affect Wellbeing and What Are the Implications for Action?

Abstract

A growing body of literature recognises the profound impact of adversity on mental health outcomes for people living in rural and remote areas. With the cumulative effects of persistent drought, record-breaking bushfires, limited access to quality health services, the COVID-19 pandemic and ongoing economic and social challenges, there is much to understand about the impact of adversity on mental health and wellbeing in rural populations. In this conceptual paper, we aim to review and adapt our existing understanding of rural adversity. We undertook a wide-ranging review of the literature, sought insights from multiple disciplines and critically developed our findings with an expert disciplinary group from across Australia. We propose that rural adversity be understood using a rural ecosystem lens to develop greater clarity around the dimensions and experiences of adversity, and to help identify the opportunities for interventions. We put forward a dynamic conceptual model of the impact of rural adversity on mental health and wellbeing, and close with a discussion of the implications for policy and practice. Whilst this paper has been written from an Australian perspective, it has implications for rural communities internationally.

Keywords: community wellbeing; intersectionality; rural adversity; rural communities; rural mental health; rural theory; rurality; social determinants.

Figure 1

Schematic showing the staged development of the rural adversity conceptual paper.

Figure 2

Depiction of how adverse events vary with onset and duration over time. (A) Schematic of phases associated with adverse events, with the pre-adverse event phase associated with baseline vulnerabilities and resilience potential. (B) Community-level rapid onset adverse events, examples include bushfire, flood and pestilence. (C) long term adverse events such as drought, where the phase edges are less clear—when drought initiates, when it ceases, with a long recovery and adaptation phase. (D) Individual adverse life events, examples include bereavement, serious illness, financial hardship, relationship breakdown etc. The intensity of impact is mapped for adverse events against time, with a comparison example of rapid and slow onset (E).

Figure 3

An ecological view of the impacts of adverse events at the individual (micro), community (meso) and wider system (macro) levels, and the adaptive strategies that influence preparedness, response and recovery. Ecological model adapted from [52] and tailored for rural adversity.

Figure 4

A dynamic conceptual model of rural adversity shows the impact of adverse events on the environment, community wellbeing and individual mental health (a) revised and adapted from [16]. Potential interventions to support mental health and mitigate against adverse events and their mapped impacts (b) (see main text for detailed description).