The mental health risk factors for primary healthcare workers (PHWs) following the Coronavirus Disease 2019 pandemic and the differences by urbanicity remain unclear. In this study, we aimed to identify key factors of anxiety and depression among PHWs in urban and rural settings in China.

This cross-sectional study was conducted in all 31 provinces in mainland China, between 1 May and 31 October 2022. A total of 3,769 PHWs, including family physicians, nurses, public health professionals, pharmacists, and other medical staff, were recruited from 44 urban community health service centers and 27 rural township hospitals. The Bayesian Additive Regression Tree model was employed to identify risk factors of anxiety and depression.

Among 3,769 PHWs, 1,006 (26.7%) worked in urban areas and 2,763 (73.3%) in rural areas. Occupational satisfaction significantly influenced anxiety in both urban and rural practitioners. For urban PHWs, living with family (odds ratio (OR): 0.42, 95% confidence interval (CI): 0.28–0.62) and self-rated health (fair: OR: 0.31, 95% CI: 0.23–0.42; good: OR: 0.13, 95% CI: 0.09–0.20) were key factors of anxiety. For rural PHWs, after-work exercise (rarely: OR: 0.28, 95% CI: 0.11–0.76; frequently: OR: 0.15, 95% CI: 0.05–0.44) played a critical role. Depression was associated with after-work exercise, self-rated health, and occupational satisfaction for all PHWs. Additionally, living with family (OR: 0.51, 95% CI: 0.34–0.75) and organizational support satisfaction (satisfied: OR: 0.28, 95% CI: 0.19–0.42) were significant for urban practitioners.

Risk factors such as occupational satisfaction, health, and family relations significantly influence PHW mental health in China, with notable differences by urbanicity. Tailored mental health interventions are recommended to address urban–rural disparities.