Americans in rural areas are less likely to receive stress management counseling from physicians: a national repeated cross-sectional study of the 2018 and 2019 National Ambulatory Medical Care Survey

Stress is a significant contributor to suicide ideation and attempts. This paper (1) describes the frequency of clinic visits in which physicians record stress management counseling; and (2) identifies visit-, physician-, and patient-related predictors of stress management counseling. We conducted a secondary analysis of the 2018 and 2019 National Ambulatory Medical Care Survey (NAMCS) clinic visit datasets. We identified clinic-, patient-, and physician-related predictors of stress management counseling. All analyses used weighted adjustment to account for the complex survey design. The weighted sample included 1,495,326,615 visits (unweighted (n=14,175) in 2018-2019. Combined, 1.32 per 100 visits (95% CI=0.72-1.92) included stress management counseling. Stress management counseling was less likely to occur when the visit occurred in a rural area (OR=0.22, 95% CI=0.09-0.53), among other characteristics. Stress management counseling rarely occurs during physician office visits in rural areas, despite rural areas suffering disproportionately worse health outcomes than urban areas.