Annotated Bibliography

Professor’s instructions:
Write an annotated bibliography in APA format for one reputable public health resources. Choose an international, national, or local public health-related journal or website that would be useful for the advanced practice nurse in determining the current healthcare needs of vulnerable populations. For each annotation, emphasize key terms commonly used within the context of public health.
– I just need an annotated bibliography in APA format for the article I attached. 300 words minimum. NEED it by tomorrow morning.
nursingAnnotated Bibliography
ATTACHED FILE(S)
Rural–Urban Mental Health Disparities in the United States During
COVID-19
Nicole M. Summers-Gabr
Southern Illinois University School of Medicine
The United States has more confirmed deaths from coronavirus 2019 (COVID-19) than any other country
in the world. State governors made decisions around social distancing in their jurisdictions, which caused
schools and businesses to close. Those with broadband access continued a sense or normalcy in their
lives. However, for the more than 20 million people who do not have broadband access, a different set
of barriers has been experienced. These challenges are especially prominent in rural communities
throughout various states. The present commentary addresses how health disparities for preexisting
conditions place rural residents at greater risk for morbidity during COVID-19. Reasons for physical and
mental health disparities, such as limited access to hospitals or specialty providers (e.g., psychiatrists),
are described. Whereas telehealth is promoted as a way to meet health access needs, especially during a
pandemic, this luxury is not readily available for all U.S. residents. Recent actions brought about by the
government (e.g., the CARES Act) have tried to address the rural–urban gap in telehealth, but more is
needed.
Keywords: COVID-19, rural, mental health, telehealth, broadband
By April 2020, the United States had more confirmed corona-
virus 2019 (COVID-19) cases and deaths than any other country in
the world (World Health Organization, 2020). The geographical
dispersion of the population made it challenging to address
COVID-19 systematically. Each state governor proposed its own
restrictions. Within each state, counties underwent unequal infec-
tion rates. More research is necessary to understand the magnitude
of threat this pandemic poses in rural counties. Around 85% of the
population resides in urban counties, yet 63% percent of U.S.
counties classify as rural (Rothwell, Madans, & Arispe, 2014).
However, in truth, rural–urban health disparities are a risk now
more ever.
Rural communities are disproportionately affected by several
health issues, such as heart disease (Kulshreshtha, Goyal, Dabhad-
kar, Veledar, & Vaccarino, 2014), cancer, and stroke (Moy et al.,
2017), which primes them for higher risk of morbidity during
COVID-19. Rural communities often have a higher percentage of
people who struggle with substance use and mental health prob-
lems (Eberhardt & Pamuk, 2004). Between 2001 and 2015, the
suicide rate was nearly 1.5 times higher in rural than in urban
counties (Ivey-Stephenson, Crosby, Jack, Haileyesus, & Kresnow-
Sedacca, 2017).
Two reasons behind mental health disparities are (a) poor access
to health care and (b) limited availability to skilled mental health
providers. Rural hospitals faced an increasing risk of closures.
Between 2010 and 2019, 98 rural hospitals closed (Seigel, 2019).
Rural counties also have fewer psychiatrists and psychologists
than urban counties (Centers for Disease Control and Prevention,
2020). Table 1 and Table 2 present a selection of states and
identifies the proportion of nonmetro counties based on standards
set through the Urban–Rural Continuum Code from the United
States Department of Agriculture (USDA). Data show that in some
states, more than 50% of their counties do not have a psychiatrist
(see Table 1) or psychologist (see Table 2). Also, a higher pro-
portion of nonmetro counties consistently lack a psychiatrist (see
Table 1) or psychologist (see Table 2) in comparison with metro
counties.
These preexisting reasons for health disparities, as well as other
challenges posed by living in a rural community, exacerbate men-
tal health issues during COVID-19. Around the world, anxiety has
driven people to respond by panic buying (Dholakia, 2020). Social
distancing practices introduced feelings of isolation, disconnection
from routines, and put residents at risk for depression. The state of
mental health in the United States is further complicated by the
fear felt by 22 million people unemployed (Long, 2020). Yet, for
rural communities, the situation was more odious because they
were experiencing all of these issues along with higher rates of
preexisting conditions and lower access to health care.
One approach to addressing mental health needs during
COVID-19 is telehealth (Leite, Hodgkinson, & Gruber, 2020;
Ohannessian, Duong, & Odone, 2020; Zhou et al., 2020). How-
ever, telehealth requires broadband access, the capacity to pay for
Editor’s Note. This commentary received rapid review due to the time-
sensitive nature of the content. It was reviewed by the Journal Editor.—
KKT
This article was published Online First June 1, 2020.
Thank you to Jessica Grim for her efforts in helping to prepare this
article.
Correspondence concerning this article should be addressed to X Nicole
M. Summers-Gabr, Department of Population Science and Policy, South-
ern Illinois University School of Medicine, 201 East Madison Street, P.O.
Box 19664, Springfield, IL 62794. E-mail: nsummers-gabr42@siumed.edu
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Psychological Trauma:
Theory, Research, Practice, and Policy
© 2020 American Psychological Association 2020, Vol. 12, No. S1, S222–S224
ISSN: 1942-9681 http://dx.doi.org/10.1037/tra0000871
S222
https://orcid.org/0000-0002-6944-6620
https://orcid.org/0000-0002-6944-6620
mailto:nsummers-gabr42@siumed.edu
http://dx.doi.org/10.1037/tra0000871
technological devices like a smartphone or laptop, and a certain
level of skills in operating this technology (Leite et al., 2020). That
means for rural, older, and other vulnerable U.S. populations,
telehealth is not currently a solution for the inequalities in mental
health access.
From a mental health perspective, lack of broadband access
during COVID-19 intensifies the vicious cycle of poverty and
mental health across generations. The Federal Communications
Commission (FCC) estimates that 21.3 million Americans do not
have access to broadband, but other figures suggest that it is 42
million individuals (Busby, Tanberk, & BroadbandNow Team,
2020). For youth, no broadband access means no engagement in
remote learning activities (Giorgi, 2020); therefore, students will
be disconnected from peers or mentors and be more behind in
learning milestones than urban or wealthier peers. For adults, no
broadband access results in a limited capacity to work remotely
(Giorgi, 2020). For all ages, especially the aging population, lack
of broadband access means that grocery delivery apps are not a
viable solution to the lack of resources. Therefore, the scarcity of
broadband isolates rural communities further, inhibits residents
from taking advantage of educational and economic opportunities,
and bars prospective patients from receiving telehealth treatment
to overcome the emotional challenges brought about by the pan-
demic.
From a national level, the government instituted the following
changes during the pandemic to bridge the broadband gap:
1. Keep Americans Connected Pledge (FCC, 2020b)
a. For 60 days starting in the middle of March, tele-
communications providers agreed not to terminate
service or change late fees for 60 days.
b. Waiving gift rules so that health care provides,
schools, and libraries can offer better telehealth and
remote learning activities (e.g., accepting Wi-Fi hot-
spots, networking gear).
2. CARES Act
a. $100 million provided to the USDA for its ReCon-
nect Program, a program which brings broadband to
rural areas (USDA, 2020).
b. $200 million for a telehealth program to connect
hospitals and clinics to their patients remotely
(e.g., purchasing communication devices; FCC,
2020a).
Despite these changes, several issues are still not addressed.
First, although $100 million was invested in increasing broadband
access, $80 billion is needed to bring broadband to all U.S.
residents (Giorgi, 2020). Second, the $200 million invested in the
telehealth program assumes that patients already have broadband
access. Last but not least, the sustainability of the changes brought
by this money is uncertain.
For now, as communities face new mental health challenges
each day, the initiation of locally driven approaches have filled the
gaps where governmental resources have not reached. For in-
stance, schools offered meal pick-ups (Barnett, 2020) or drop-offs
using the bus route (ABC12 News, 2020) so that youth did not go
hungry. In another endeavor, a hospital created an emotional
support hotline available to all people who experienced anxiety
and stress during COVID-19 (Forde, 2020). Finally, there are the
anecdotal stories not widely publicized in the media, such as
Table 1
The Proportion of U.S. Counties Without Access to a Psychiatrist
State
Total counties
(% nonmetro)
Percent of
counties without
a psychiatrist
Percent of metro
counties without
a psychiatrist
Percent of nonmetro
counties without
a psychiatrist
California 58 (36.20) 13.79 0 38.09
Colorado 64 (70.15) 56.25 11.76 72.34
Illinois 102 (60.78) 59.80 35.00 75.58
Louisiana 65 (44.61) 58.46 38.89 82.76
Michigan 83 (68.67) 42.17 7.69 57.89
Montana 56 (90.07) 67.85 20.00 72.55
New York 62 (38.71) 14.51 10.52 20.83
North Carolina 100 (54.00) 36.00 23.91 46.30
Table 2
The Proportion of U.S. Counties Without Access to a Psychologist
State
Total counties
(% nonmetro)
Percent of
counties without
a psychologist
Percent of metro
counties without
a psychologist
Percent of nonmetro
counties without
a psychologist
California 58 (36.20) 8.62 0 23.80
Colorado 64 (70.15) 36.92 11.76 46.80
Illinois 102 (60.78) 45.09 32.50 53.22
Louisiana 65 (44.61) 50.76 44.44 83.38
Michigan 83 (68.67) 10.84 0 12.28
Montana 56 (90.07) 55.35 40.00 56.86
New York 62 (38.71) 4.83 2.09 8.33
North Carolina 100 (54.00) 17.00 10.87 22.22
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S223RURAL-URBAN DISPARITIES
stories of residents buying meals to donate to hospital staff on the
front lines or teachers delivering printed school materials so that
students from disadvantaged backgrounds are not left behind.
Without a system-wide change to broadband access, economic,
physical health, and mental health disparities will persist. In the
meantime, grassroots movements will continue to thrive in times
of need.
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Received April 30, 2020
Accepted May 1, 2020 �
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S224 SUMMERS-GABR
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Covid-19 and Rural Broadband: Progress, Problems and a Long Way to Go

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Rural–Urban Mental Health Disparities in the United States During COVID-19
References

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