Report examines health indicators on county basis

There is something like a chicken-or-the-egg dilemma coming out of a new county-level analysis of U.S. licensed psychologists done by the American Psychological Association’s Center for Workforce Studies.

It’s not clear which came first – healthier populations or more psychologists – but the March 2016 report found that counties with a larger concentration of licensed psychologists had comparably higher health indicators.

“The pattern of results is very consistent. Areas with more psychologists had healthier populations,” said Karen Stamm, Ph.D., senior research officer for the center and a lead author of the report.

It is possible that having more psychologists in a county leads to a healthier population, but it could also be that areas with healthier populations attract more psychologists, Stamm said. Or, there are many other possible factors, she said. “We didn’t do a causal analysis. This is purely correlational.”

Generally, counties with more licensed psychologists had better health indicators like lower rates of smoking, lower rates of obesity and fewer physical and mental health issues, according to the study, which examined the distribution of licensed psychologists in the United States and the relationship between the distribution and population health outcomes.

The Northeast was a shining example of that pattern in the 2015 County-Level Analysis of U.S. Licensed Psychologists and Health Indicators report.

“New England in particular is in one of the hot spot areas where there are more licensed psychologists relative to the national average,” Stamm said. “If you look at the average overall, there are 33.5 per county. In the New England area, there are 130 licensed psychologists per county.”

New England also had several health indicators that fared better than the national average – a lower percentage of the population reporting poor or fair health, fewer poor physical health days, a smaller population of people with obesity, a lower percentage of physically inactive people, lower smoking rates, lower teen birth rates, and a lower percentage of diabetes, Stamm said.

The only other health indicator, the number of poor mental health days, was at the national average for the New England area, she said.

Lower concentrations of licensed psychologists were found in the South along with poorer health outcomes. “The South Region, where both the number and the concentration of licensed psychologists were significantly lower compared to other areas in the nation, also had significantly worse outcomes on most health indicators,” according to the report.

Health indicator data came from the Robert Wood Johnson Foundation’s 2015 County Health Rankings, which combined county-level health indicators from a number of federal data sources, such as the Behavioral Risk Factor Surveillance System and Center for Disease Control and Prevention, according to the report.

The report also found fewer numbers of psychologists in rural areas compared to urban areas.

That pattern may indicate access or availability issues, although causation was not analyzed in this report, Stamm said. “We didn’t look at why this was occurring,” she said. “We were looking at a pretty high-level analysis….There may be other barriers in those areas that we didn’t look at.”

The analysis counted approximately 106,000 licensed psychologists in the United States, using figures from 2012-2015 State Licensing Board lists. Psychologists in the report were defined as
active, doctoral-level licensed psychologists.

About 34.5 percent of counties had no records of licensed psychologists, 66.4 percent of counties had no more than five psychologists and 74.6 percent of counties had no more than10 psychologists, according to the report.

Three states – Utah, Oklahoma, and Hawaii were excluded from overall results as exact data was not available from those states, Stamm said.

The report is the first time the center has analyzed county-level numbers and geographic distribution of psychologists and its relationship to national health indicators also measured at a county level.

While this report shows general patterns in counties across the U.S., individual psychologists or practices may have experiences that differ from what the overall numbers show, said Stamm.

She has fielded questions stemming from this report from psychologists wondering why, for example, their practice may be in a cold spot, yet they have a long waiting list.

“We’re just trying to show the very general pattern,” she said.

The full report can be read here: http://www.apa.org/workforce/publications/15-county-analysis/index.aspx