# Factors Associated with Mental and Behavioral Health Programming in U.S. Rural, Urban and Suburban Congregations

## TL;DR

This study explores how rural, urban, and suburban U.S. congregations differ in offering mental health programs and identifies factors that influence these differences.

## Contribution

The study reveals sociodemographic and sociopolitical factors linked to mental health programming in congregations across different U.S. regions.

## Key findings

- Urban and suburban congregations with over 500 attendees are more likely to provide mental health programming.
- Congregations that engage in voter registration and discuss science and religion are more likely to offer mental health support.
- Rural congregations following the prosperity gospel are more likely to provide mental health programming.

## Abstract

In the United States (U.S.), rural residents experience poorer mental health outcomes and more barriers to accessing mental health care than urban residents. Faith-based institutions provide mental and behavioral health programming that can fill gaps in accessibility to mental health care. This study’s primary objective was to examine specific factors associated with mental and behavioral health programming in rural, urban and suburban congregations. Data come from 1,262 U.S. congregations in the 2018–2019 National Congregations Study. We conducted logistic regression models to analyze the relationship between mental health programming and support and county classification, while controlling for sociodemographic and sociopolitical factors. We found that urban and suburban congregations with more than 500 attendees were more likely than smaller congregations to provide mental and behavioral health programming and support (OR = 3.43, p < 0.001). Urban and suburban congregations that made an effort to get people registered to vote (OR = 5.36, p < 0.01) and discussed science and religion (OR = 3.16, p < 0.05) were more likely to provide programming and support. Rural congregations (OR = 4.37, p < 0.05) and urban and suburban congregations (OR = 2.61, p < 0.05) that followed the prosperity gospel were also more likely to provide programming and support. While urban and suburban congregations are more likely to provide mental health programming and support than rural congregations, several complex sociodemographic, sociopolitical, and health-related characteristics impact the likelihood of providing mental health programs. Further research is needed to examine the quality and utilization of congregational mental health programming and/or support by rural, suburban and urban residents.

The online version contains supplementary material available at 10.1007/s10943-025-02403-6.