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Community, Health, and Family

Mental Health Adversity and Service Use among Rural and Urban Youth in South-Central Pennsylvania Breanne Tremblay*, Breanne Tremblay, Alaina Kutsch, Zack Streit, Emil Turdukulov, Dara Babinski,

Background: Rural youth face mental health challenges similar to their urban peers but with greater structural disadvantages and fewer supports. Borderline Personality Disorder (BPD) carries a high suicide risk, with ~80% reporting suicidal ideation, yet little is known about BPD and other psychiatric concerns, suicidality, and related service use among rural youth. This study examines rural–urban differences in psychiatric diagnoses, BPD features, suicide‑related behaviors, and service use in South‑Central Pennsylvania youth. Methods: Youth from three studies were overrepresented for mental health concerns (rural (≤291/mi²): N= 62, M= 11.68, SD= 1.30; urban: N= 396, M= 11.76, SD= 1.24). Measures included youth self‑report of BPD features and suicide‑related behaviors, as well as parent‑reported psychiatric diagnoses and service utilization. Results: There were no group differences in the number of psychiatric diagnoses (rural M= 1.15; urban M= 1.03) or BPD features (t (451) = −1.02, p= .31). Rural youth, however, used school and community psychological services at roughly twice the rate of urban youth (RR= 2.03; RR= 2.42), respectively. Conclusion: Although psychiatric diagnoses, BPD features, and suicide‑related behaviors did not differ by location, rural youth reported greater school and community service use, highlighting the need to understand structural influences on access. Limitations: Service quality and future outcomes were not assessed, limiting conclusions about how service use affects later mental health and suicide risk. Future work should evaluate how structural factors and service quality influence outcomes, particularly among rural youth with BPD features.