DEPRESSION AND ANXIETY DURING COVID-19 AMONG ADULTS AT RURAL MENTAL HEALTH AGENCY

Abstract

This quantitative archival cross-sectional study examined depression and anxiety symptomatology among adults receiving outpatient behavioral health services in a rural region of the Midwestern United States during the COVID-19 pandemic. Archival data from the Patient Health Questionnaire-4 (PHQ-4) were analyzed for 322 adult clients who worked at a community mental health agency between June 2020 and June 2022. Descriptive and inferential analyses were conducted to assess symptom severity and explore gender-based differences. The average PHQ-4 score was 5.56 (SD = 3.79), reflecting mild to moderate psychological distress across the sample. Females reported significantly higher scores (M = 5.96, SD = 3.81) than males (M = 5.01, SD = 3.72), with small but consistent effects observed across t-test, ANOVA, and Mann-Whitney U analyses.  These findings align with broader evidence of heightened pandemic-related mental health burden, particularly among women, and suggest that rural adults, who often face geographic, socioeconomic, and technological barriers to care, may be at increased risk. By applying standardized screening tools within an underserved setting, this study contributes to the rural mental health literature by documenting clinically meaningful gender disparities in psychological distress. The results support the need for targeted, gender-responsive mental health interventions and underscore the importance of scalable screening practices in crisis response. Implications for service delivery, policy development, and future research are discussed in the context of improving rural behavioral health infrastructure and addressing disparities exacerbated by public health emergencies. This study uniquely contributes to the rural mental health literature by using standardized measures to document gender disparities in psychological distress during a public health crisis, emphasizing the practical value of scalable tools in underserved areas.