Do Mental Health Treatments Work No Matter Where You Live? What the Data Shows

The prevalence of mental illness is similar in rural and urban America, but access to care is not. A 2020 review published in the Journal of Clinical and Translational Science found that rural residents experience significant disparities in mental health outcomes despite comparable rates of illness: a gap driven less by biology than by access. Rural Americans face higher rates of depression and suicide than people in urban areas, yet they are less likely to seek or receive mental health services.

The scarcity is stark. According to a 2023 Bipartisan Policy Center Report, more than 60% of nonmetropolitan counties lack a psychiatrist, and almost half of nonmetropolitan counties do not have a psychologist, compared with 27% and 19% or urban counties, respectively. The consequences surface in the most serious outcomes: CDC data show suicide rates climbing steadily as counties grow more rural, reaching roughly 18 to 21 per 100,000 residents in the most rural areas, which is close to double the rate of about 11 per 100,000 in the largest metropolitan counties.

Anyone in crisis can reach the 988 Suicide & Crisis Lifeline for free, confidential support by calling or texting 988, any time.

That pattern points to a gap in access and engagement rather than a clear regional difference in outcomes within this dataset. It’s a distinction that LifeStance outcomes help illuminate.

Between September 2024 and December 2025, LifeStance reviewed results for 143,941 LifeStance patients screened for depression and 139,798 patients screened for anxiety, all of whom reported at least moderate symptom severity when they began care (a score of 10 or higher). Progress was tracked with two widely used clinical questionnaires: the PHQ-9 for depression and the GAD-7 for anxiety. Each turns a patient’s symptoms into a score, so a drop out of the moderate-or-higher range reflects real, measurable change. Throughout this analysis, “clinically significant improvement” refers to that kind of measured change in a patient’s score.

A note on how we grouped patients: We organized results by the four official U.S. Census regions: Midwest, Northeast, South, and West. These regions differ meaningfully in how urban or rural they are, based on U.S. Census Bureau population data. Comparing outcomes across regions with very different urban-rural makeups lets us ask a practical question: do results hold up in parts of the country that include large rural populations? Importantly, this is a region-level view that compares regions to one another, not individual rural patients against individual urban patients.

If living in a less-urban part of the country meant weaker results, we’d expect the regions with larger rural populations like the Midwest (74.3% urban) and South (75.8% urban) to trail the more heavily urban Northeast (84%) and West (88.9%). They didn’t.

Improvement stayed within about two percentage points across every region. Depression improvement ranged from 75.53% in the West to 77.82% in the South, and anxiety improvement from 80.99% in the West to 83.32% in the Northeast. Notably, the outcomes didn’t track with how urban a region is. For instance, the South, one of the less-urban regions, posted the single highest depression-improvement rate in the study, while the heavily urban West sat at the lower end. In other words, a region having a larger rural population didn’t translate into weaker results. Overall, 75% or more patients with at least moderate depression or anxiety improved significantly no matter their geographic region.

One honest caveat. Because this is a region-level analysis, each region blends rural and urban patients together, so it isn’t a direct, patient-by-patient comparison of rural care versus urban care. What it does show is meaningful: across four large regions with very different urban-rural profiles, outcomes were consistent, and geography wasn’t a dividing line. That consistency supports that LifeStance delivered strong, dependable care to patients in this analysis on a national scale, including in parts of the country where mental health resources are stretched thin.

Consistent national results are encouraging, but care is still personal. Finding the right mental health provider, someone whose approach and specialty fit your needs, often matters as much as whether care happens in-person or online. If you’re considering therapy or psychiatry, you can confirm which services are available in your area and check whether treatment would be covered by your insurance before a first visit.

For a fuller picture of how patients tend to fare, LifeStance’s broader outcomes data report found that 79% of patients showed clinically significant improvement in anxiety symptoms and 73% showed clinically significant improvement in depression symptoms. Figures like these reflect group averages and are not a promise of any individual outcome, but they offer a grounded, evidence-based reason to reach out for support no matter where you live.

The outcomes discussed in this article are based on aggregate data from LifeStance patients and are intended for informational purposes only. Individual experiences and treatment outcomes vary, and no specific result can be guaranteed. The findings described do not constitute medical advice and should not be relied upon as a substitute for consultation with a qualified healthcare professional. Mental health treatment recommendations are individualized and may include therapy, medication when clinically appropriate, or other interventions.