Associations Between Community Resilience, Healthcare Resources, and Cognitive Disability, Distress, and Depression in the U.S.

Abstract

Resilience is the capacity to adapt, maintain, or regain well-being in the face of adversity. Community resilience reflects the collective ability of populations to withstand, adapt to, and recover from acute stressors (e.g., disasters) and chronic challenges (e.g., under-resourced systems). It encompasses modifiable social determinants, including access to health care, housing, transportation, and social cohesion. This study examined the association between community resilience and 5 health outcomes across U.S. counties: cognitive disability, frequent mental distress, depression, frequent physical distress, and mobility disability. Data from the 2023 Federal Emergency Management Agency National Risk Index, Centers for Disease Control and Prevention PLACES, and the Area Health Resources File were integrated for 3,135 U.S. counties. A cross-sectional study design was applied. Multivariate regression models with state-fixed effects estimated variation in health outcomes by community resilience level. Analyses were conducted in November 2024 and revised in September 2025. Substantial differences in resilience were observed across healthcare infrastructure and rurality. Over 84% of very low-resilience counties were rural, compared with 42% of very high-resilience counties. Inadequate access to primary care was reported in 94% of very low-resilience counties compared with 69% of very high-resilience counties, whereas inadequate access to mental health care was reported in 96% versus 83%. Limited health information technology infrastructure was also more common in very low-resilience counties (76% vs 32%). Regression analyses showed that very low-resilience counties had significantly higher prevalence of cognitive disability (coefficient=3.73; 95% CI=3.50, 3.97), mental distress (coefficient=1.97; 95% CI=1.81, 2.14), physical distress (coefficient=2.84; 95% CI=2.66, 3.02), mobility disability (coefficient=3.96; 95% CI=3.69, 4.23), and depression (coefficient=0.71; 95% CI=0.47, 0.95; all p<0.001). Counties designated as care shortage areas also exhibited elevated prevalence. Community resilience is a critical and modifiable determinant of population health. Strengthening resilience should be prioritized to improve mental, physical, and cognitive health outcomes across U.S. communities.