Butterworth, Peter JohnHandley, Tonelle E.Lewin, Terry J.Reddy, PrasunaKelly, Brian J.2015-03-022015-03-020943-1853http://hdl.handle.net/1885/12754AIM Regional variation in the prevalence of mental disorders and particularly variation in the role of risk and protective factors has received limited research attention. This study investigates variation in the prevalence of significant psychological distress across regions, and quantifies the relative impact of family functioning and social support. SUBJECT AND METHOD Multilevel analysis of data from the longitudinal Australian Rural Mental Health Study, comprising a stratified random sample from non-metropolitan New South Wales. Distress was assessed using the Kessler-10. The analysis considered clustering within households and across geographic regions based on Local Government Areas and collapsed to represent residence in inner regional, outer regional, remote and very remote locations. RESULTS There was limited clustering of psychological distress within areas (0.4 %). However, the household accounted for almost 45 % of the variance in psychological distress, and the salience of the household was greater in more remote regions (33.1 % in inner regional to 60.5 % in very remote areas). Family functioning and perceived social support were associated with increased risk of psychological distress, but explained only a modest amount of variance in mental health at household level. After controlling for individual and family/social covariates, 34.5 % of the remaining variance in psychological distress was observed at the household level. CONCLUSION The findings suggest that individuals in remote locations are more reliant on their family/confidants for their mental health than those in more populated areas. Future research will consider whether this simply reflects differences in the accessibility of formal health services or broader social and cultural differences.The study was funded by the National Health and Medical Research Council (Project Grants No. 401241; No. 631061), the Australian Research Council grant arcID:ft130101444 and also supported by a Research Capacity Building Grant to the Australian Rural Health Research Collaboration.8 pages© Springer-Verlag Berlin Heidelberg 2014rural healthpsychological distressepidemiologyregional variationhousehold factorsmultilevel analysis2014-1210.1007/s10389-014-0640-92016-06-14