"Sitting on the Porch Just Hearing the Crickets": Rural Living and Mental Well-Being Among Veterans in the U.S. South.

BACKGROUND: In the rural U.S. South, limited healthcare access and social isolation coexist with protective factors like natural tranquility and community connection. Black or African American women Veterans in this region, whose well-being is shaped by both the lasting effects of military service and the conditions of living rurally, represent a population rarely addressed in rural health studies. This study explores participants' lived experiences of rural residence and its implications for mental well-being. METHODS: This cross-sectional qualitative study included 41 semi-structured interviews with Black or African American women Veterans in RUCA-classified rural or highly rural areas across nine Southeastern states. Reflexive thematic analysis was applied using a socioecological framework covering individual, interpersonal, organizational, and community levels. RESULTS: Rural residence was frequently a deliberate choice for Veterans, sought for quiet, privacy, and relief from sensory and social stressors. Many participants experienced both the restorative aspects of the natural environment and the challenges of increased isolation and limited access to healthcare and social support. Community reintegration was made more difficult without pre-existing local ties, and the absence of peers was a consistent theme. CONCLUSIONS: Rural residence may serve as both a sanctuary and source of isolation, a duality we refer to as the "rurality paradox." This experience is influenced by community tenure, life stage, familial and caregiving roles, available resources, and social connections. Our findings deepen understanding of how rural living affects the well-being and daily lives of Black women Veterans and highlight the potential value of context-sensitive support tailored to their needs.