Introduction The influence of social support on mental health outcomes may vary with remoteness in Australian communities. However, the potential variation of determinants of mental health with remoteness has rarely been directly examined. The current research aims to examine the association of social support and distress with remoteness.

Methods Community cohorts from rural and urban New South Wales were combined (N=5924; mean age=61.1 yrs; 44.2% Male). Standardised scores were used to facilitate assessment of participant satisfaction with social support networks as measured by the Duke Social Support Index and Interview Schedule for Social Interaction. Remoteness was assessed using a continuous measure, the Accessibility and Remote Index of Australia. The association between demographic characteristics, social support, remoteness, the interaction of social support and remoteness, and psychological distress (cut-off >24 on the Kessler 10) was studied using logistic regression.

Results Younger age (OR 0.99; 95% CI 0.98 to 0.99), not being in a married or defacto relationship (OR 1.50; 95% CI 1.19 to 1.93) and decreased social support (OR 0.48; 95% CI 0.45 to 0.53), but not gender or remoteness, significantly predicted psychological distress. There was a significant interaction of social support by remoteness (OR 1.12; 95% CI 1.03 to 1.22).

Conclusion Social support displayed a differential effect on distress outcomes across urban and rural environs. These results suggest that remoteness and associated community characteristics may moderate the protective influence of social support and that urban environments may be particularly influenced by very low levels of social support.