Date of Conferral

7-10-2025

Degree

Ph.D.

School

Public Health

Advisor

Jennifer Oliphant

Abstract

Arizona’s rural communities face shortages in mental health care services. In 2020, the nearly simultaneous onset of the COVID-19 pandemic and the legalization of recreational cannabis introduced overlapping public health stressors that may have disproportionately affected these vulnerable populations. However, their combined impact on rural mental health remains understudied. This three-manuscript dissertation employed interrupted time series analyses to assess how these events influenced monthly hospital visits for schizophrenia, psychosis, cannabis-induced psychosis, and suicidal behaviors among rural Arizona adults aged 21 and older. A total of 16,468 records from the Arizona State Inpatient and Emergency Department Databases (SID and SEDD) met the inclusion criteria and were analyzed using negative binomial regression models. Age and primary insurance payer served as independent variables, with gender and race/ethnicity included as covariates and hospital visits as the dependent variable. Manuscript 1 showed significant increases in psychosis-related hospital visits during the pandemic-only period (March–October 2020) and the post-legalization period (November 2020–May 2023), particularly among adults aged 30–39 and those over 50. Medicaid was the most common payer. Manuscript 2 identified 12 cannabis-induced psychosis cases, precluding statistical analysis and suggesting potential underdiagnosis or lack of treatment access. Manuscript 3 observed significant increases in suicidal ideation and attempt-related visits during the pandemic, with private insurance and Medicare as the predominant payers. Overall, this dissertation underscores the need for targeted rural mental health policies and increased access to care in Arizona’s underserved communities.

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