What factors influence the psychological wellbeing of children and adolescents in rural NSW?

Ingrid Peters and Tonelle Handley, Australia, August 2020

Resource Summary

This short article is adapted from the paper: Peters, I., Handley, T., Oakley, K., Lutkin, S. & Perkins, D. (2019). Social determinants of psychological wellness for children and adolescents in rural NSW. BMC Public Health 19, 1616. Available here.

In Australia, there is a difference in the rates of mental illness between people who live in urban versus rural areas (ABS, 2016; AIHW, 2008; Campbell, Manoff and Caffey, 2006). It is unknown why rural areas show higher rates of mental illness and higher rates of suicide. Living in a rural area alone cannot account for the differences in mental wellbeing, as all rural places are unique. However, people who live in rural places often have less access to services for mental health concerns, and strong attitudes of self-reliance. This means that when someone in a rural area does experience a problem with their mental health, they may not seek help until their condition is more severe, if at all.

To date, almost all research on rural mental health has focused on adults. Given that 50% of mental illness begins before age 14 (Mash and Barkley, 2006), it is important to understand what factors may contribute to psychological wellness in children and young people. The rates of psychological distress in children in rural Australian communities has not been well researched. This study aims to begin to fill that research gap.

What did the study investigate?

The study investigated three broad domains that are thought to impact children; their families, their community, and individual factors.
The study aimed to answer the following questions with regards to children’s psychological wellbeing:

  • Does living in an urban or rural setting have an impact? If so, if you live more rurally than someone else, does that make a difference to psychological wellbeing?
  • Do individual factors (e.g. age, sex) have an impact?
  • Do family factors (e.g. parental unemployment, family income) make a difference?
  • Does the financial status of the community or how well-connected parents feel to their community have an impact?

How did the study explore these questions?

Parents from 294 families with 539 children were asked to complete the following self-report measures:

  • The Strengths and Difficulties Questionnaire, which was used to rate the psychological wellbeing of their children.
  • The Sense of Community Index, which was used to rate parents’ level of connection to the community they live in.
  • A survey about parents’ own personal financial situation and employment levels, as well as demographics about their children.

The study also used data from the Australian Bureau of Statistics to rate the financial position of communities. Level of remoteness was measured using the Australian Standard Geographic Classification (ASGC) categories, which are based on the Accessibility/Remoteness Index of Australia Plus (ARIA+) (i.e. a measure of the level of remoteness in road distance from required services within Australia).

What did the study find?

Key findings included:

  • There was a difference in psychological wellbeing between children who lived in urban versus rural areas. Generally, the study found that psychological wellbeing was better for children in urban areas than those in rural areas. We also found a general trend that being more remote was connected to lower psychological wellbeing scores.
  • Lower levels of psychological wellness were found for children whose families had lower incomes or whose parents were unemployed. This was observed across geographical areas.
  • Lower levels of psychological wellness were observed for children whose parents had a lower sense of connection to their community. This was found across all geographical areas.
  • The level of community finances did not impact on children’s levels of psychological wellness.
  • Males generally had lower levels of psychological wellness than females.
  • Generally younger participants were perceived by their parents to have poorer psychological wellness than their older counterparts.

What are the implications of the study?

This study is the first to quantify poorer psychological wellness in Australian children and adolescents from rural and remote communities. The biggest influences on children’s psychological wellbeing were personal factors (e.g. male gender, younger age) and their family situation (e.g. parental employment and income). The children included in this study also experienced poorer wellbeing than an Australian normative sample, suggesting that broader social factors also have an impact on their psychological development of young people raised in these areas.

This study highlights the need for early intervention, particularly for rural communities, to boost the psychological wellbeing of children. Initiatives are needed that support children and families who have poor psychological wellbeing, and that provide affordable, universal, accessible, and timely services. The findings also suggest that government policies and programs which strengthen rural communities’ resilience to adversity more broadly may also offer benefits to children’s wellbeing. Policies that aim to reduce the impacts of household stress for low-income families should also be considered.


Australian Bureau of Statistics. (2015). Causes of death, Australia. Contract No:3303.0. Accessed 28/09/2016.

Australian Institute of Health and Welfare (AIHW). (2008). Rural, regional and remote health: Indicators of health status and determinants of health. In: Welfare AloHa (ed.). Rural health series. Canberra: AIHW.

Campbell, A., Manoff, J., & Caffey, J. (2006). Rurality and mental health: An Australian primary care study. Journal of Rural and Remote Health, 6(3), 595.

Mash, E.J, & Barkley, R.A. (2006). Treatment of childhood disorders (third edition). New York: Guilford Publications.

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