Exploring the role of rurality and rural identity in mental health help-seeking behavior: A systematic qualitative review.

Abstract

People living in rural areas are more likely to experience attitudinal mental health help-seeking barriers than their urban equivalents, but the role rurality plays in this inequality is poorly understood. This systematic qualitative review aimed to explore the attitudinal barriers experienced by rural residents and better define rurality's role in them. Four attitudinal barrier themes are identified from this review as being experienced by rural residents-stoicism, stigma, distrust, and meaning, and the coexistence of multiple barriers were observed. Rurality is found to have an influence on the stoicism, stigma, and distrust barriers and is explicitly vocalized within barrier statements. With a relationship between rurality and mental health help-seeking barriers strongly implied, we endorse the need for targeted research to inform future policymaking and practice to address urban and rural mental health help-seeking inequalities.

A call to action to address rural mental health disparities

“…It is estimated that as many as 65% of nonmetropolitan counties do not have psychiatrists [6], and over 60% of rural Americans live in designated mental health provider shortage areas [13]. Specialty mental health services are scarce in rural areas, which is likely to contribute to these disparities in care [14]. Historically, the primary strategies used to address the lack of access to specialty mental health care in rural areas have been to provide economic incentives and training in rural settings [15].…”

“…There is variability across these factors, but their combined influence on mental health care remains significant. Research suggests that individuals living in rural areas are less likely than residents of urban areas to seek professional help for psychological distress for several reasons including stigma (both public and self-directed) and limited mental health literacy [14,[22][23][24]. Contextual, social, and socioeconomic factors such as lack of transportation, higher poverty rates, and varied insurance coverage [25] are also critical in limiting individual's access to treatment and utilization of professional services.…”

The Role of Rural and Urban Geography and Gender in Community Stigma Around Mental Illness

“…Within the United States, a point of interest would be the community and self-stigma experienced in rural areas. Rural communities have a culture of their own, and as a result of the community size, often lack anonymity (Cheesmond, et al, 2019;Rost et al, 1993). However, research on care seeking behavior and public stigma around mental illness in rural communities is limited and narrow in scope (Polaha et al, 2015;Stewart et al, 2015).…”

Attitudinal and demographic factors associated with seeking help and receiving antidepressant medication for symptoms of common mental disorder

“…For example, a recent qualitative systematic review of attitudinal barriers to help seeking identi ed the meaning that individuals ascribe to such symptoms as important, i.e. as being related to life problems, along with the value attached to stoicism and mistrust towards health services based on prior negative experiences [55].…”