Background:The majority of Veterans Affair(VA)hospitals are in urban areas.We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status.Methods:Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview.Mental health status,including posttraumatic stress disorder(PTSD),major depression,alcohol abuse and mental health global severity,were assessed using structured interviews.Psychiatric service use was based on self-reported utilization in the past 12 months.Results were compared between veterans residing in rural and non-rural areas.Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors.Results:A total of 1730 subjects(55％of the eligible veterans)responded to the survey and 1692 of them had complete geocode information.Those that did not have this information(n=38),were excluded from some analyses.Veterans residing in rural areas were older,more often of the white race,married,and experienced fewer stressful events.In comparison to those residing in non-rural areas,veterans residing in rural areas had lower global mental health severity scores;they also had fewer mental health visits.In multivariate logistic regression,rural residence was associated with lower service use,but not with PTSD,major depression,alcohol abuse,and global mental health severity score after adjusting confounding factors(e.g.,age,gender,marital status and education).Conclusions:Rural residence is associated with lower mental health service use,but not with poor mental health in veterans with former warzone deployment,suggesting rural residence is possibly protective.