Stigma may be a particularly important barrier to mental health care in rural communities where lack of anonymity increases the probability that someone who seeks care will be labeled "crazy." This study examined rural-urban differences in the stigma associated with depressive symptoms and the stigma associated with seeking treatment for depressive disorders. In addition, the study compared how the stigma associated with seeking treatment predicted use of care in rural and urban residents with a history of depressive symptoms. Two hundred subjects from metropolitan and adjacent non-metropolitan counties rated one of four randomly selected vignettes using 14-point semantic differential scales. The findings indicated that rural residents with a history of depressive symptoms labeled people who sought professional help for the disorder somewhat more negatively than their urban counterparts. Logistic models controlling for sociodemographic characteristics demonstrated that the more negative the labeling, the less likely depressed rural residents were to have sought professional help. Labeling was not associated with use of care among urban people with depressive symptoms. We concluded that prospective studies are warranted to inform the development of interventions to decrease the stigma associated with seeking treatment for depressive disorders in rural communities.

This study examined the relation between religiousness and depressive symptoms in African American, Asian American, European American, Hispanic American, and Native American adolescents .N D 13,317/ in the United States with selfesteem and school attachment as potential mediators in this link. The data were taken from a nationally represented sample of adolescents in Grades 7 through 12, from the National Longitudinal Study of Adolescent Health (Add Health). Structural equation analyses with measurement and structural invariance across the five ethnic groups and gender supported the model that religiousness, as a composite of internal and external religiousness items, negatively predicted depressive symptoms 1 year later controlling for baseline depressive symptoms. Self-esteem and school attachment partially mediated this link but only for European American and African American adolescents.

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