The Rural Mental Health Gap: Depression Among Filipino Emerging Adults During COVID-19

Article information

Cleofas, J. V. (2022). The urban-rural divide and depression during COVID-19 pandemic among Filipino emerging adults. Journal of Loss & Trauma, 27(8), 790–791. https://doi.org/10.1080/15325024.2022.2028086 

What this article is about

This short research letter asks an important public health question: Did where young Filipinos lived during the pandemic—urban or rural areas—matter for depression risk?

The article focuses on Filipino emerging adults, or young people aged 18–29. This life stage is already filled with transitions: finishing school, entering work, exploring identity, building independence, and planning the future. COVID-19 disrupted many of these milestones, creating what the article describes as interruptions to psycho-emotional development. 

The study was conducted during the third quarter of 2021, when the Philippines was still deeply affected by the pandemic. At that point, many parts of life—school, work, healthcare, social connection—had shifted online, but not everyone had equal access to digital resources, health services, or economic support. 

Why the urban-rural divide matters

Mental health is not only shaped by individual feelings or personal coping. It is also shaped by place.

Urban and rural areas often differ in:

• availability of mental health professionals,
• access to hospitals and clinics,
• internet connectivity,
• economic opportunities,
• transport and service infrastructure,
• and the speed or quality of pandemic response.

In the Philippines, mental health services are already limited, and the article notes that these services are often concentrated in urban areas. This means rural young adults may experience distress with fewer pathways for screening, support, or treatment. 

What the researcher did

The article draws from a larger online survey project on social media and health. For this analysis, the researcher looked at 1,087 Filipino emerging adults aged 18–29. 

The key variables were simple but meaningful:

• Area of residence: urban or rural
• Depression: screened using the 14-item Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)
• Covariates: age and sex

Participants were categorized into two groups:

• with probable depression: WEMWBS score of 14–44
• no depression: WEMWBS score of 45–70 

The researcher then used logistic regression to examine whether rural or urban residence was associated with probable depression, while keeping age and sex constant. 

What the study found

The findings were striking.

More than half of the respondents—51.334%—reported scores within the range of probable depression. In raw numbers, that was 558 out of 1,087 emerging adults. 

The second major finding was the urban-rural gap: emerging adults living in rural areas had 1.421 times greater odds of probable depression compared with those living in urban areas, after adjusting for age and sex. 

In plain language: rural residence was associated with a higher depression risk among Filipino emerging adults during the pandemic.

How should we interpret this?

The article does not say that rural living automatically “causes” depression. Because this was a cross-sectional study, it can show association, not causation. But the pattern makes sociological and public health sense.

Rural emerging adults may have faced multiple disadvantages at once:

1. Limited mental health services
   Psychological care and specialist services are often harder to access outside major urban centers.
2. Fewer healthcare resources
   During COVID-19, areas with fewer healthcare facilities and personnel may have struggled more to respond to both infection risks and mental health needs.
3. Digital inequality
   As education, work, and social support moved online, poorer internet access in many rural areas may have deepened isolation and limited access to remote services.
4. Economic strain
   Rural communities often face lower income opportunities and fewer buffers during crisis, which can intensify mental distress.

So the finding is not just about geography. It is about how geography intersects with health systems, digital access, income, and developmental disruption.

Why this matters for emerging adults

Emerging adulthood is supposed to be a time of movement: studying, working, meeting people, exploring identity, and building a future. The pandemic paused or derailed many of these processes.

For rural young adults, the disruption may have been even more difficult because support systems were less accessible. This means the pandemic may have widened existing mental health inequalities—not only between rich and poor, but also between urban and rural youth. 

Bottom line

This article shows that pandemic mental health inequalities in the Philippines may have a clear geographic pattern. Rural Filipino emerging adults were more likely to screen within the range of probable depression than urban peers. Any serious youth mental health response must therefore include rural mental health access, rural development, digital inclusion, and community-based support. 

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Policy/practice recommendations

1. Bring mental health services closer to rural youth
   Mental health practitioners, local governments, and schools should expand screening, referral, counseling, and crisis support in underserved rural localities. 
2. Strengthen tele-mental health—but fix access first
   Online counseling can help, but only if rural youth have reliable internet, devices, privacy, and digital literacy.
3. Integrate mental health into rural development
   Rural development should not only focus on roads, income, or agriculture. It should also include psychosocial support, youth wellbeing, and access to care.
4. Monitor young adults beyond the acute pandemic period
   The mental health impact of COVID-19 may persist after restrictions end, especially for young people whose educational and work transitions were interrupted.
5. Use schools and community organizations as access points
   Colleges, barangay programs, youth organizations, and rural health units can help identify young adults needing support and connect them to appropriate services.

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Glossary of key terms

• Emerging adulthood — A life stage usually spanning ages 18–29, marked by transitions in education, work, identity, relationships, and independence. 
• Urban-rural divide — Differences in opportunities, resources, services, and risks between urban and rural populations.
• Probable depression — A screening-based classification suggesting that a person’s wellbeing score falls within a range associated with depressive symptoms. It is not the same as a clinical diagnosis. 
• WEMWBS — Warwick-Edinburgh Mental Wellbeing Scale, a 14-item measure of mental wellbeing used here as a screening tool for depression. 
• Logistic regression — A statistical method used to estimate whether a factor, such as rural residence, is associated with higher or lower odds of an outcome, such as probable depression.
• Odds ratio — A statistic showing how much more or less likely an outcome is in one group compared with another. Here, rural respondents had 1.421 times greater odds of probable depression than urban respondents. 
• Cross-sectional study — A study that collects data at one point in time. It can show associations but cannot prove cause and effect.