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

Abstract

Empirical evidence describes the negative outcomes people with mental health disorders experience due to societal stigma. The aim of this study was to examine the role of gender and rural-urban living in perceptions about mental illness. Participants completed the Day’s Mental Illness Stigma Scale, a nationally validated instrument for measuring stigma. Directors of Chambers of Commerce in North Dakota distributed the electronic survey to their members. Additionally, distribution occurred through use of social media and other snowball sampling approaches. Analysis of data gathered from 749 participants occurred through examination of the difference in perceptions based on geography and gender. The zip codes of residence were sorted to distinguish between rural and urban participants. Application of weighting measures ensured closer alignment with the general population characteristics. Findings indicate that for the majority of the seven stigma measures the Day’s Mental Illness Stigma Scale examines, the coefficient of rural–gender interactions was positive and highly significant with higher levels of stigma in rural areas. Females exhibited lower stigma perceptions than males. However, women living in rural areas held higher degrees of stigma compared to urban residing females. Implications of the study include the need to advance mental health literacy campaigns for males and people residing in rural communities. Additional empirical studies that examine the role of geography and gender in understanding stigma toward people with mental health disorders will result in improved treatment outcomes due to increased and focused educational efforts.

Mental Health Literacy in Zurich: A First Measurement Attempt Using the General HLS-EU-Q47

“…While many studies examined the relationship of HL and sociodemographic factors (16,17), health behavior (16)(17)(18)(19), and health outcome (16,17,20), so far only few studies examined these aspects in relation to MHL. These studies related MHLaspects to sociodemographic characteristics such as age (21)(22)(23), gender (21)(22)(23)(24), education (21)(22)(23), financial situation (23,25), and rural residence (24,26). Studies investigating MHL-aspects in the context of health behavior showed that stigma could be associated with more frequent alcohol and drug abuse (27), and low rates of help-seeking could be associated with higher rates of substance use disorders (28).…”

Resisting stigma and evaluating realism in a direct-to-consumer advertisement for psychiatric drugs

“…Traditional and modified labeling theory and stigma resistance One theoretical lens through which to view mental illness and associated stigma is labeling theory, in both its traditional and modified versions. Traditional labeling theory, proposed by Scheff (1984), argues that the most damaging element of mental illness is the process of being labeled mentally ill because this process is a way of ascribing deviance to people. In the case of mental illness, stereotypes are activated in the minds of the people around the diagnosed person and behavior that conforms to the role of the stereotypical mental patient is subsequently rewarded, reinforcing the power of the label (Thoits, 2011).…”

“…"mentally ill"), they tend to take on those attributes more fully. Scheff (1984) argues that this can cause people to stabilize a group of symptoms into a "career" of mental illness because the label becomes firmly linked with the individual's identity (p. 158). Indeed, research supports the theory that formal labeling in the form of a mental health diagnosis is associated with decreased well-being (Thoits, 2020).…”

“…Snowball sampling and convenience sampling techniques were also used for recruitment. Snowball sampling has frequently been used in studies where specific population characteristics are difficult to find (Naderifar et al, 2017) and for studies examining mental illness and stigma (Hayat et al, 2021;Livingston et al, 2018;Schroeder et al, 2021). Snowball sampling can be an effective way to recruit participants for research where participants might be wary of sharing potentially stigmatizing personal information (Naderifar et al, 2017).…”

Self-Reliance, Social Norms, and Self-Stigma as Barriers to Psychosocial Help Seeking Among Rural Cancer Survivors with Cancer-Related Distress

“…Specifically, higher rates of perceived public stigma (i.e. the perception that others view those who seek help for mental health concerns as "weak" or "crazy"; Vogel et al, 2009) and selfstigma (i.e., the perception of oneself as being inferior or a failure if seeking help with a mental health concern; Vogel et al, 2006) have been shown to exist in rural populations (Schroeder et al, 2021;Stewart et al, 2015). However, despite these important findings, this past research is largely limited to individuals not currently experiencing distress or who are asked to respond to a hypothetical situation.…”